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APC Based Fee Schedule 412008 Excel ACS Wyoming EqualityCare

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APC Based Fee Schedule 412008 Excel ACS Wyoming EqualityCare Powered By Docstoc
					Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only N N N N N N N N N N N N N N N N N N N C N C N N C C N N N N N N N N N N N N N N N N C N N N C N N N C N N N N N N N C N C C N N C C C N N C N C N C N N N C N N N C N N N N N N N N N N C C C N N C N N N N N N N N C C C N N N C C C C N N N N C N C N C N N N N N N N N N N N N C C C N N N C N N N N N N C C N N N N N N N N C C N N N N N N N N N N N N N N N N N N N N C N C N N C C N N N N N N N N N N N N N N N N C N N N C N N N C N N N N N N N C N C C N N C C C N N C N C N C N N N C N N N C N N N N N N N N N N C C C N N C N N N N N N N N C C C N N N C C C C N N N N C N C N C N N N N N N N N N N N N C C C N N N C N N N N N N C C N N N N N N N N C C N

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Children's Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Critical PDD Access Update to Hospital ACS Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

00100 00102 00103 00104 00120 00124 00126 00140 00142 00144 00145 00147 00148 00160 00162 00164 00170 00172 00174 00176 00190 00192 00210 00212 00214 00215 00216 00218 00220 00222 00300 00320 00322 00326 00350 00352 00400 00402 00404 00406 00410 00450 00452 00454 00470 00472 00474 00500 00520 00522 00524 00528 00529 00530 00532 00534 00537 00539 00540 00541 00542 00546 00548 00550 00560 00561 00562 00563 00566 00580 00600 00604 00620 00622 00625 00626 00630 00632 00634 00635 00640 00670 00700 00702 00730 00740 00750 00752 00754 00756 00770 00790 00792 00794 00796 00797 00800 00802 00810 00820 00830 00832 00834 00836 00840 00842 00844 00846 00848 00851 00860 00862 00864 00865 00866 00868 00870 00872 00873 00880 00882 00902 00904 00906 00908 00910 00912 00914 00916 00918 00920 00921 00922 00924 00926 00928 00930 00932 00934 00936 00938 00940 00942 00944 00948 00950 00952 01112 01120 01130 01140 01150 01160 01170 01173 01180 01190 01200 01202 01210 01212 01214 01215

Anesth, salivary gland Anesth, repair of cleft lip Anesth, blepharoplasty Anesth, electroshock Anesth, ear surgery Anesth, ear exam Anesth, tympanotomy Anesth, procedures on eye Anesth, lens surgery Anesth, corneal transplant Anesth, vitreoretinal surg Anesth, iridectomy Anesth, eye exam Anesth, nose/sinus surgery Anesth, nose/sinus surgery Anesth, biopsy of nose Anesth, procedure on mouth Anesth, cleft palate repair Anesth, pharyngeal surgery Anesth, pharyngeal surgery Anesth, face/skull bone surg Anesth, facial bone surgery Anesth, open head surgery Anesth, skull drainage Anesth, skull drainage Anesth, skull repair/fract Anesth, head vessel surgery Anesth, special head surgery Anesth, intrcrn nerve Anesth, head nerve surgery Anesth, head/neck/ptrunk Anesth, neck organ, 1 & over Anesth, biopsy of thyroid Anesth, larynx/trach, < 1 yr Anesth, neck vessel surgery Anesth, neck vessel surgery Anesth, skin, ext/per/atrunk Anesth, surgery of breast Anesth, surgery of breast Anesth, surgery of breast Anesth, correct heart rhythm Anesth, surgery of shoulder Anesth, surgery of shoulder Anesth, collar bone biopsy Anesth, removal of rib Anesth, chest wall repair Anesth, surgery of rib(s) Anesth, esophageal surgery Anesth, chest procedure Anesth, chest lining biopsy Anesth, chest drainage Anesth, chest partition view Anesth, chest partition view Anesth, pacemaker insertion Anesth, vascular access Anesth, cardioverter/defib Anesth, cardiac electrophys Anesth, trach-bronch reconst Anesth, chest surgery Anesth, one lung ventilation Anesth, release of lung Anesth, lung,chest wall surg Anesth, trachea,bronchi surg Anesth, sternal debridement Anesth, heart surg w/o pump Anesth, heart surg < age 1 Anesth, heart surg w/pump Anesth, heart surg w/arrest Anesth, cabg w/o pump Anesth, heart/lung transplnt Anesth, spine, cord surgery Anesth, sitting procedure Anesth, spine, cord surgery Anesth, removal of nerves Anes spine tranthor w/o vent Anes, spine transthor w/vent Anesth, spine, cord surgery Anesth, removal of nerves Anesth for chemonucleolysis Anesth, lumbar puncture Anesth, spine manipulation Anesth, spine, cord surgery Anesth, abdominal wall surg Anesth, for liver biopsy Anesth, abdominal wall surg Anesth, upper gi visualize Anesth, repair of hernia Anesth, repair of hernia Anesth, repair of hernia Anesth, repair of hernia Anesth, blood vessel repair Anesth, surg upper abdomen Anesth, hemorr/excise liver Anesth, pancreas removal Anesth, for liver transplant Anesth, surgery for obesity Anesth, abdominal wall surg Anesth, fat layer removal Anesth, low intestine scope Anesth, abdominal wall surg Anesth, repair of hernia Anesth, repair of hernia Anesth, hernia repair< 1 yr Anesth hernia repair preemie Anesth, surg lower abdomen Anesth, amniocentesis Anesth, pelvis surgery Anesth, hysterectomy Anesth, pelvic organ surg Anesth, tubal ligation Anesth, surgery of abdomen Anesth, kidney/ureter surg Anesth, removal of bladder Anesth, removal of prostate Anesth, removal of adrenal Anesth, kidney transplant Anesth, bladder stone surg Anesth kidney stone destruct Anesth kidney stone destruct Anesth, abdomen vessel surg Anesth, major vein ligation Anesth, anorectal surgery Anesth, perineal surgery Anesth, removal of vulva Anesth, removal of prostate Anesth, bladder surgery Anesth, bladder tumor surg Anesth, removal of prostate Anesth, bleeding control Anesth, stone removal Anesth, genitalia surgery Anesth, vasectomy Anesth, sperm duct surgery Anesth, testis exploration Anesth, removal of testis Anesth, removal of testis Anesth, testis suspension Anesth, amputation of penis Anesth, penis, nodes removal Anesth, penis, nodes removal Anesth, insert penis device Anesth, vaginal procedures Anesth, surg on vag/urethral Anesth, vaginal hysterectomy Anesth, repair of cervix Anesth, vaginal endoscopy Anesth, hysteroscope/graph Anesth, bone aspirate/bx Anesth, pelvis surgery Anesth, body cast procedure Anesth, amputation at pelvis Anesth, pelvic tumor surgery Anesth, pelvis procedure Anesth, pelvis surgery Anesth, fx repair, pelvis Anesth, pelvis nerve removal Anesth, pelvis nerve removal Anesth, hip joint procedure Anesth, arthroscopy of hip Anesth, hip joint surgery Anesth, hip disarticulation Anesth, hip arthroplasty Anesth, revise hip repair

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155)

Added 1/1/07 to book Added 1/1/07 to book

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

1 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only N N C C N N N C C N N N N N N N N C C N N N N C C N N N N N N N N C N N C N N N N N N C C C C N C C C N N N N N N N N N N N N C N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N C N N N N T T T T T T T T T T T T T T C C C C T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T N N C C N N N C C N N N N N N N N C C N N N N C C N N N N N N N N C N N C N N N N N N C C C C N C C C N N N N N N N N N N N N C N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N C N N N 1 T T T T T T T T T T T T T T C C C C T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 53.01 206.70 37.88 67.19 67.19 67.19 552.19 67.19 769.10 552.19 67.19 875.13 37.88 37.88 0.00 0.00 0.00 0.00 205.60 205.60 205.60 69.72 69.72 127.09 127.09 328.73 37.88 37.88 69.72 37.88 37.88 37.88 69.72 37.88 37.88 37.88 69.72 37.88 37.88 37.88 37.88 37.88 37.88 37.88 37.88 205.60 205.60 205.60 414.88 769.10 769.10

Children's Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 120.87 471.30 86.37 153.21 153.21 153.21 1,259.05 153.21 1,753.62 1,259.05 153.21 1,995.38 86.37 86.37 0.00 0.00 0.00 0.00 468.78 468.78 468.78 158.97 158.97 289.77 289.77 749.54 86.37 86.37 158.97 86.37 86.37 86.37 158.97 86.37 86.37 86.37 158.97 86.37 86.37 86.37 86.37 86.37 86.37 86.37 86.37 468.78 468.78 468.78 945.97 1,753.62 1,753.62

Critical PDD Access Update to Hospital ACS Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 138.53 540.18 99.00 175.60 175.60 175.60 1,443.08 175.60 2,009.94 1,443.08 175.60 2,287.03 99.00 99.00 0.00 0.00 0.00 0.00 537.30 537.30 537.30 182.20 182.20 332.12 332.12 859.10 99.00 99.00 182.20 99.00 99.00 99.00 182.20 99.00 99.00 99.00 182.20 99.00 99.00 99.00 99.00 99.00 99.00 99.00 99.00 537.30 537.30 537.30 1,084.24 2,009.94 2,009.94

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

01220 01230 01232 01234 01250 01260 01270 01272 01274 01320 01340 01360 01380 01382 01390 01392 01400 01402 01404 01420 01430 01432 01440 01442 01444 01462 01464 01470 01472 01474 01480 01482 01484 01486 01490 01500 01502 01520 01522 01610 01620 01622 01630 01632 01634 01636 01638 01650 01652 01654 01656 01670 01680 01682 01710 01712 01714 01716 01730 01732 01740 01742 01744 01756 01758 01760 01770 01772 01780 01782 01810 01820 01829 01830 01832 01840 01842 01844 01850 01852 01860 01916 01920 01922 01924 01925 01926 01930 01931 01932 01933 01935 01936 01951 01952 01953 01958 01960 01961 01962 01963 01965 01966 01967 01968 01969 01990 01991 01992 01996 01999 10021 10022 10040 10060 10061 10080 10081 10120 10121 10140 10160 10180 11000 11001 11004 11005 11006 11008 11010 11011 11012 11040 11041 11042 11043 11044 11055 11056 11057 11100 11101 11200 11201 11300 11301 11302 11303 11305 11306 11307 11308 11310 11311 11312 11313 11400 11401 11402 11403 11404 11406

Anesth, procedure on femur Anesth, surgery of femur Anesth, amputation of femur Anesth, radical femur surg Anesth, upper leg surgery Anesth, upper leg veins surg Anesth, thigh arteries surg Anesth, femoral artery surg Anesth, femoral embolectomy Anesth, knee area surgery Anesth, knee area procedure Anesth, knee area surgery Anesth, knee joint procedure Anesth, dx knee arthroscopy Anesth, knee area procedure Anesth, knee area surgery Anesth, knee joint surgery Anesth, knee arthroplasty Anesth, amputation at knee Anesth, knee joint casting Anesth, knee veins surgery Anesth, knee vessel surg Anesth, knee arteries surg Anesth, knee artery surg Anesth, knee artery repair Anesth, lower leg procedure Anesth, ankle/ft arthroscopy Anesth, lower leg surgery Anesth, achilles tendon surg Anesth, lower leg surgery Anesth, lower leg bone surg Anesth, radical leg surgery Anesth, lower leg revision Anesth, ankle replacement Anesth, lower leg casting Anesth, leg arteries surg Anesth, lwr leg embolectomy Anesth, lower leg vein surg Anesth, lower leg vein surg Anesth, surgery of shoulder Anesth, shoulder procedure Anes dx shoulder arthroscopy Anesth, surgery of shoulder Anesth, surgery of shoulder Anesth, shoulder joint amput Anesth, forequarter amput Anesth, shoulder replacement Anesth, shoulder artery surg Anesth, shoulder vessel surg Anesth, shoulder vessel surg Anesth, arm-leg vessel surg Anesth, shoulder vein surg Anesth, shoulder casting Anesth, airplane cast Anesth, elbow area surgery Anesth, uppr arm tendon surg Anesth, uppr arm tendon surg Anesth, biceps tendon repair Anesth, uppr arm procedure Anesth, dx elbow arthroscopy Anesth, upper arm surgery Anesth, humerus surgery Anesth, humerus repair Anesth, radical humerus surg Anesth, humeral lesion surg Anesth, elbow replacement Anesth, uppr arm artery surg Anesth, uppr arm embolectomy Anesth, upper arm vein surg Anesth, uppr arm vein repair Anesth, lower arm surgery Anesth, lower arm procedure Anesth, dx wrist arthroscopy Anesth, lower arm surgery Anesth, wrist replacement Anesth, lwr arm artery surg Anesth, lwr arm embolectomy Anesth, vascular shunt surg Anesth, lower arm vein surg Anesth, lwr arm vein repair Anesth, lower arm casting Anesth, dx arteriography Anesth, catheterize heart Anesth, cat or MRI scan Anes, ther interven rad, art Anes, ther interven rad, car Anes, tx interv rad hrt/cran Anes, ther interven rad, vei Anes, ther interven rad, tip Anes, tx interv rad, th vein Anes, tx interv rad, cran v Anesth, perc img dx sp proc Anesth, perc img tx sp proc Anesth, burn, less 4 percent Anesth, burn, 4-9 percent Anesth, burn, each 9 percent Anesth, antepartum manipul Anesth, vaginal delivery Anesth, cs delivery Anesth, emer hysterectomy Anesth, cs hysterectomy Anesth, inc/missed ab proc Anesth, induced ab procedure Anesth/analg, vag delivery Anes/analg cs deliver add-on Anesth/analg cs hyst add-on Support for organ donor Anesth, nerve block/inj Anesth, n block/inj, prone Hosp manage cont drug admin Unlisted anesth procedure Fna w/o image Fna w/image Acne surgery Drainage of skin abscess Drainage of skin abscess Drainage of pilonidal cyst Drainage of pilonidal cyst Remove foreign body Remove foreign body Drainage of hematoma/fluid Puncture drainage of lesion Complex drainage, wound Debride infected skin Debride infected skin add-on Debride genitalia & perineum Debride abdom wall Debride genit/per/abdom wall Remove mesh from abd wall Debride skin, fx Debride skin/muscle, fx Debride skin/muscle/bone, fx Debride skin, partial Debride skin, full Debride skin/tissue Debride tissue/muscle Debride tissue/muscle/bone Trim skin lesion Trim skin lesions, 2 to 4 Trim skin lesions, over 4 Biopsy, skin lesion Biopsy, skin add-on Removal of skin tags Remove skin tags add-on Shave skin lesion Shave skin lesion Shave skin lesion Shave skin lesion Shave skin lesion Shave skin lesion Shave skin lesion Shave skin lesion Shave skin lesion Shave skin lesion Shave skin lesion Shave skin lesion Exc tr-ext b9+marg 0.5 < cm Exc tr-ext b9+marg 0.6-1 cm Exc tr-ext b9+marg 1.1-2 cm Exc tr-ext b9+marg 2.1-3 cm Exc tr-ext b9+marg 3.1-4 cm Exc tr-ext b9+marg > 4.0 cm

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0002 0004 0013 0006 0006 0006 0007 0006 0021 0007 0006 0008 0013 0013 0000 0000 0000 0000 0019 0019 0019 0015 0015 0016 0016 0682 0013 0013 0015 0013 0013 0013 0015 0013 0013 0013 0015 0013 0013 0013 0013 0013 0013 0013 0013 0019 0019 0019 0020 0021 0021

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 1.1097 4.3270 0.7930 1.4066 1.4066 1.4066 11.5594 1.4066 16.1001 11.5594 1.4066 18.3197 0.7930 0.7930 0.0000 0.0000 0.0000 0.0000 4.3039 4.3039 4.3039 1.4595 1.4595 2.6604 2.6604 6.8816 0.7930 0.7930 1.4595 0.7930 0.7930 0.7930 1.4595 0.7930 0.7930 0.7930 1.4595 0.7930 0.7930 0.7930 0.7930 0.7930 0.7930 0.7930 0.7930 4.3039 4.3039 4.3039 8.6850 16.1001 16.1001

X X

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

2 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T E T E X X X X T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T 1 1 1 1 1 1 1 T T T 3 T 3 X X X X T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 414.88 414.88 414.88 769.10 769.10 1,008.42 205.60 205.60 414.88 414.88 414.88 1,008.42 1,008.42 1,008.42 1,008.42 1,008.42 1,008.42 1,008.42 205.60 205.60 205.60 414.88 414.88 769.10 414.88 205.60 414.88 414.88 769.10 1,008.42 205.60 205.60 414.88 414.88 769.10 1,008.42 37.88 37.88 37.88 37.88 37.88 14.15 205.60 1,008.42 205.60 100.56 718.74 69.72 1,008.42 1,008.42 1,008.42 37.88 37.88 0.00 0.00 0.00 0.00 0.00 0.00 0.00 965.28 2,053.39 1,008.42 M01 205.60 M01 30.14 30.14 30.14 30.14 61.11 61.11 61.11 61.11 61.11 61.11 61.11 61.11 61.11 61.11 61.11 61.11 61.11 216.22 216.22 100.56 100.56 100.56 100.56 100.56 100.56 100.56 100.56 100.56 100.56 100.56 100.56 100.56 100.56 100.56 100.56 100.56 100.56 100.56 216.22 216.22 216.22 100.56 216.22 100.56 216.22 216.22 216.22 216.22 216.22 216.22 100.56 965.28 718.74 718.74 718.74 718.74 718.74 718.74 718.74 718.74 965.28 965.28 216.22 216.22 216.22 216.22 100.56 216.22 965.28 965.28 216.22 216.22 216.22 216.22 965.28 965.28 718.74 718.74 718.74 718.74 216.22 216.22 216.22 216.22 216.22 216.22 100.56 100.56 216.22 216.22 718.74 718.74 718.74 216.22

Children's Hospital Outpatient Fee 945.97 945.97 945.97 1,753.62 1,753.62 2,299.28 468.78 468.78 945.97 945.97 945.97 2,299.28 2,299.28 2,299.28 2,299.28 2,299.28 2,299.28 2,299.28 468.78 468.78 468.78 945.97 945.97 1,753.62 945.97 468.78 945.97 945.97 1,753.62 2,299.28 468.78 468.78 945.97 945.97 1,753.62 2,299.28 86.37 86.37 86.37 86.37 86.37 32.27 468.78 2,299.28 468.78 229.29 1,638.79 158.97 2,299.28 2,299.28 2,299.28 86.37 86.37 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2,200.94 4,681.93 2,299.28 M01 468.78 M01 68.73 68.73 68.73 68.73 139.33 139.33 139.33 139.33 139.33 139.33 139.33 139.33 139.33 139.33 139.33 139.33 139.33 493.00 493.00 229.29 229.29 229.29 229.29 229.29 229.29 229.29 229.29 229.29 229.29 229.29 229.29 229.29 229.29 229.29 229.29 229.29 229.29 229.29 493.00 493.00 493.00 229.29 493.00 229.29 493.00 493.00 493.00 493.00 493.00 493.00 229.29 2,200.94 1,638.79 1,638.79 1,638.79 1,638.79 1,638.79 1,638.79 1,638.79 1,638.79 2,200.94 2,200.94 493.00 493.00 493.00 493.00 229.29 493.00 2,200.94 2,200.94 493.00 493.00 493.00 493.00 2,200.94 2,200.94 1,638.79 1,638.79 1,638.79 1,638.79 493.00 493.00 493.00 493.00 493.00 493.00 229.29 229.29 493.00 493.00 1,638.79 1,638.79 1,638.79 493.00

Critical PDD Access Update to Hospital ACS Outpatient Fee 1,084.24 1,084.24 1,084.24 2,009.94 2,009.94 2,635.35 537.30 537.30 1,084.24 1,084.24 1,084.24 2,635.35 2,635.35 2,635.35 2,635.35 2,635.35 2,635.35 2,635.35 537.30 537.30 537.30 1,084.24 1,084.24 2,009.94 1,084.24 537.30 1,084.24 1,084.24 2,009.94 2,635.35 537.30 537.30 1,084.24 1,084.24 2,009.94 2,635.35 99.00 99.00 99.00 99.00 99.00 36.99 537.30 2,635.35 537.30 262.80 1,878.32 182.20 2,635.35 2,635.35 2,635.35 99.00 99.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2,522.63 5,366.25 2,635.35 M01 537.30 M01 78.77 78.77 78.77 78.77 159.70 159.70 159.70 159.70 159.70 159.70 159.70 159.70 159.70 159.70 159.70 159.70 159.70 565.06 565.06 262.80 262.80 262.80 262.80 262.80 262.80 262.80 262.80 262.80 262.80 262.80 262.80 262.80 262.80 262.80 262.80 262.80 262.80 262.80 565.06 565.06 565.06 262.80 565.06 262.80 565.06 565.06 565.06 565.06 565.06 565.06 262.80 2,522.63 1,878.32 1,878.32 1,878.32 1,878.32 1,878.32 1,878.32 1,878.32 1,878.32 2,522.63 2,522.63 565.06 565.06 565.06 565.06 262.80 565.06 2,522.63 2,522.63 565.06 565.06 565.06 565.06 2,522.63 2,522.63 1,878.32 1,878.32 1,878.32 1,878.32 565.06 565.06 565.06 565.06 565.06 565.06 262.80 262.80 565.06 565.06 1,878.32 1,878.32 1,878.32 565.06

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

11420 11421 11422 11423 11424 11426 11440 11441 11442 11443 11444 11446 11450 11451 11462 11463 11470 11471 11600 11601 11602 11603 11604 11606 11620 11621 11622 11623 11624 11626 11640 11641 11642 11643 11644 11646 11719 11720 11721 11730 11732 11740 11750 11752 11755 11760 11762 11765 11770 11771 11772 11900 11901 11920 11921 11922 11950 11951 11952 11954 11960 11970 11971 11975 11976 11977 11980 11981 11982 11983 12001 12002 12004 12005 12006 12007 12011 12013 12014 12015 12016 12017 12018 12020 12021 12031 12032 12034 12035 12036 12037 12041 12042 12044 12045 12046 12047 12051 12052 12053 12054 12055 12056 12057 13100 13101 13102 13120 13121 13122 13131 13132 13133 13150 13151 13152 13153 13160 14000 14001 14020 14021 14040 14041 14060 14061 14300 14350 15002 15003 15004 15005 15040 15050 15100 15101 15110 15111 15115 15116 15120 15121 15130 15131 15135 15136 15150 15151 15152 15155 15156 15157 15170 15171 15175 15176 15200 15201 15220 15221

Exc h-f-nk-sp b9+marg 0.5 < Exc h-f-nk-sp b9+marg 0.6-1 Exc h-f-nk-sp b9+marg 1.1-2 Exc h-f-nk-sp b9+marg 2.1-3 Exc h-f-nk-sp b9+marg 3.1-4 Exc h-f-nk-sp b9+marg > 4 cm Exc face-mm b9+marg 0.5 < cm Exc face-mm b9+marg 0.6-1 cm Exc face-mm b9+marg 1.1-2 cm Exc face-mm b9+marg 2.1-3 cm Exc face-mm b9+marg 3.1-4 cm Exc face-mm b9+marg > 4 cm Removal, sweat gland lesion Removal, sweat gland lesion Removal, sweat gland lesion Removal, sweat gland lesion Removal, sweat gland lesion Removal, sweat gland lesion Exc tr-ext mlg+marg 0.5 < cm Exc tr-ext mlg+marg 0.6-1 cm Exc tr-ext mlg+marg 1.1-2 cm Exc tr-ext mlg+marg 2.1-3 cm Exc tr-ext mlg+marg 3.1-4 cm Exc tr-ext mlg+marg > 4 cm Exc h-f-nk-sp mlg+marg 0.5 < Exc h-f-nk-sp mlg+marg 0.6-1 Exc h-f-nk-sp mlg+marg 1.1-2 Exc h-f-nk-sp mlg+marg 2.1-3 Exc h-f-nk-sp mlg+marg 3.1-4 Exc h-f-nk-sp mlg+mar > 4 cm Exc face-mm malig+marg 0.5 < Exc face-mm malig+marg 0.6-1 Exc face-mm malig+marg 1.1-2 Exc face-mm malig+marg 2.1-3 Exc face-mm malig+marg 3.1-4 Exc face-mm mlg+marg > 4 cm Trim nail(s) Debride nail, 1-5 Debride nail, 6 or more Removal of nail plate Remove nail plate, add-on Drain blood from under nail Removal of nail bed Remove nail bed/finger tip Biopsy, nail unit Repair of nail bed Reconstruction of nail bed Excision of nail fold, toe Removal of pilonidal lesion Removal of pilonidal lesion Removal of pilonidal lesion Injection into skin lesions Added skin lesions injection Correct skin color defects Correct skin color defects Correct skin color defects Therapy for contour defects Therapy for contour defects Therapy for contour defects Therapy for contour defects Insert tissue expander(s) Replace tissue expander Remove tissue expander(s) Insert contraceptive cap Removal of contraceptive cap Removal/reinsert contra cap Implant hormone pellet(s) Insert drug implant device Remove drug implant device Remove/insert drug implant Repair superficial wound(s) Repair superficial wound(s) Repair superficial wound(s) Repair superficial wound(s) Repair superficial wound(s) Repair superficial wound(s) Repair superficial wound(s) Repair superficial wound(s) Repair superficial wound(s) Repair superficial wound(s) Repair superficial wound(s) Repair superficial wound(s) Repair superficial wound(s) Closure of split wound Closure of split wound Layer closure of wound(s) Layer closure of wound(s) Layer closure of wound(s) Layer closure of wound(s) Layer closure of wound(s) Layer closure of wound(s) Layer closure of wound(s) Layer closure of wound(s) Layer closure of wound(s) Layer closure of wound(s) Layer closure of wound(s) Layer closure of wound(s) Layer closure of wound(s) Layer closure of wound(s) Layer closure of wound(s) Layer closure of wound(s) Layer closure of wound(s) Layer closure of wound(s) Layer closure of wound(s) Repair of wound or lesion Repair of wound or lesion Repair wound/lesion add-on Repair of wound or lesion Repair of wound or lesion Repair wound/lesion add-on Repair of wound or lesion Repair of wound or lesion Repair wound/lesion add-on Repair of wound or lesion Repair of wound or lesion Repair of wound or lesion Repair wound/lesion add-on Late closure of wound Skin tissue rearrangement Skin tissue rearrangement Skin tissue rearrangement Skin tissue rearrangement Skin tissue rearrangement Skin tissue rearrangement Skin tissue rearrangement Skin tissue rearrangement Skin tissue rearrangement Skin tissue rearrangement Wnd prep, ch/inf, trk/arm/lg Wnd prep, ch/inf addl 100 cm Wnd prep ch/inf, f/n/hf/g Wnd prep, f/n/hf/g, addl cm Harvest cultured skin graft Skin pinch graft Skin split graft Skin split graft add-on Epidrm autogrft trnk/arm/leg Epidrm autogrft t/a/l add-on Epidrm a-grft face/nck/hf/g Epidrm a-grft f/n/hf/g addl Skin split graft Skin split graft add-on Derm autograft, trnk/arm/leg Derm autograft t/a/l add-on Derm autograft face/nck/hf/g Derm autograft, f/n/hf/g add Cult epiderm grft t/arm/leg Cult epiderm grft t/a/l addl Cult epiderm graft t/a/l +% Cult epiderm graft, f/n/hf/g Cult epidrm grft f/n/hfg add Cult epiderm grft f/n/hfg +% Acell graft trunk/arms/legs Acell graft t/arm/leg add-on Acellular graft, f/n/hf/g Acell graft, f/n/hf/g add-on Skin full graft Skin full graft add-on Skin full graft Skin full graft add-on

0020 0020 0020 0021 0021 0022 0019 0019 0020 0020 0020 0022 0022 0022 0022 0022 0022 0022 0019 0019 0019 0020 0020 0021 0020 0019 0020 0020 0021 0022 0019 0019 0020 0020 0021 0022 0013 0013 0013 0013 0013 0012 0019 0022 0019 0134 0136 0015 0022 0022 0022 0013 0013 0134 0134 0134 0133 0133 0133 0133 0137 0051 0022 0000 0019 0000 0340 0340 0340 0340 0133 0133 0133 0133 0133 0133 0133 0133 0133 0133 0133 0133 0133 0135 0135 0134 0134 0134 0134 0134 0134 0134 0134 0134 0134 0134 0134 0134 0134 0134 0134 0134 0134 0134 0135 0135 0135 0134 0135 0134 0135 0135 0135 0135 0135 0135 0134 0137 0136 0136 0136 0136 0136 0136 0136 0136 0137 0137 0135 0135 0135 0135 0134 0135 0137 0137 0135 0135 0135 0135 0137 0137 0136 0136 0136 0136 0135 0135 0135 0135 0135 0135 0134 0134 0135 0135 0136 0136 0136 0135

8.6850 8.6850 8.6850 16.1001 16.1001 21.1098 4.3039 4.3039 8.6850 8.6850 8.6850 21.1098 21.1098 21.1098 21.1098 21.1098 21.1098 21.1098 4.3039 4.3039 4.3039 8.6850 8.6850 16.1001 8.6850 4.3039 8.6850 8.6850 16.1001 21.1098 4.3039 4.3039 8.6850 8.6850 16.1001 21.1098 0.7930 0.7930 0.7930 0.7930 0.7930 0.2963 4.3039 21.1098 4.3039 2.1051 15.0458 1.4595 21.1098 21.1098 21.1098 0.7930 0.7930 2.1051 2.1051 2.1051 1.2792 1.2792 1.2792 1.2792 20.2069 42.9850 21.1098 0.0000 4.3039 0.0000 0.6310 0.6310 0.6310 0.6310 1.2792 1.2792 1.2792 1.2792 1.2792 1.2792 1.2792 1.2792 1.2792 1.2792 1.2792 1.2792 1.2792 4.5263 4.5263 2.1051 2.1051 2.1051 2.1051 2.1051 2.1051 2.1051 2.1051 2.1051 2.1051 2.1051 2.1051 2.1051 2.1051 2.1051 2.1051 2.1051 2.1051 2.1051 4.5263 4.5263 4.5263 2.1051 4.5263 2.1051 4.5263 4.5263 4.5263 4.5263 4.5263 4.5263 2.1051 20.2069 15.0458 15.0458 15.0458 15.0458 15.0458 15.0458 15.0458 15.0458 20.2069 20.2069 4.5263 4.5263 4.5263 4.5263 2.1051 4.5263 20.2069 20.2069 4.5263 4.5263 4.5263 4.5263 20.2069 20.2069 15.0458 15.0458 15.0458 15.0458 4.5263 4.5263 4.5263 4.5263 4.5263 4.5263 2.1051 2.1051 4.5263 4.5263 15.0458 15.0458 15.0458 4.5263

Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book

SI dropped off when non OPPS changes made

SI dropped off when non OPPS changes made SI dropped off when non OPPS changes made

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

3 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T C C C T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T X X T T T T T T T T T T T T T T T T T T T T T T T T T T T T T C T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T 1 T T T T T T C C C T T 1 1 T 1 1 1 1 1 1 1 1 1 1 T T T T 1 1 1 1 1 T 1 1 1 1 1 1 1 1 T T T T T T T X X 1 1 1 1 T T T T T T T T T T T T T T T T T T T T T T T T T C T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T 1 1

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 718.74 216.22 718.74 718.74 216.22 216.22 216.22 216.22 216.22 216.22 216.22 216.22 100.56 100.56 100.56 100.56 100.56 100.56 216.22 216.22 216.22 216.22 216.22 216.22 965.28 965.28 965.28 965.28 965.28 965.28 965.28 965.28 965.28 0.00 965.28 965.28 965.28 965.28 718.74 965.28 0.00 0.00 0.00 965.28 965.28 0.00 0.00 1,008.42 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 965.28 965.28 965.28 965.28 0.00 0.00 0.00 0.00 0.00 1,008.42 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 965.28 965.28 965.28 965.28 1,008.42 127.09 127.09 30.14 30.14 0.00 0.00 0.00 0.00 205.60 965.28 1,008.42 1,008.42 965.28 965.28 718.74 965.28 1,008.42 1,008.42 965.28 965.28 965.28 1,008.42 1,008.42 718.74 718.74 718.74 718.74 205.60 37.88 69.72 127.09 127.09 127.09 0.00 37.88 14.15 127.09 127.09 127.09 127.09 37.88 69.72 69.72 69.72 69.72 69.72 69.72 69.72 127.09 69.72 69.72 69.72 127.09 127.09 127.09 69.72 127.09 127.09 127.09 127.09 127.09 173.51 173.51 173.51 173.51 173.51 37.88 0.00 0.00

Children's Hospital Outpatient Fee 1,638.79 493.00 1,638.79 1,638.79 493.00 493.00 493.00 493.00 493.00 493.00 493.00 493.00 229.29 229.29 229.29 229.29 229.29 229.29 493.00 493.00 493.00 493.00 493.00 493.00 2,200.94 2,200.94 2,200.94 2,200.94 2,200.94 2,200.94 2,200.94 2,200.94 2,200.94 0.00 2,200.94 2,200.94 2,200.94 2,200.94 1,638.79 2,200.94 0.00 0.00 0.00 2,200.94 2,200.94 0.00 0.00 2,299.28 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2,200.94 2,200.94 2,200.94 2,200.94 0.00 0.00 0.00 0.00 0.00 2,299.28 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2,200.94 2,200.94 2,200.94 2,200.94 2,299.28 289.77 289.77 68.73 68.73 0.00 0.00 0.00 0.00 468.78 2,200.94 2,299.28 2,299.28 2,200.94 2,200.94 1,638.79 2,200.94 2,299.28 2,299.28 2,200.94 2,200.94 2,200.94 2,299.28 2,299.28 1,638.79 1,638.79 1,638.79 1,638.79 468.78 86.37 158.97 289.77 289.77 289.77 0.00 86.37 32.27 289.77 289.77 289.77 289.77 86.37 158.97 158.97 158.97 158.97 158.97 158.97 158.97 289.77 158.97 158.97 158.97 289.77 289.77 289.77 158.97 289.77 289.77 289.77 289.77 289.77 395.61 395.61 395.61 395.61 395.61 86.37 0.00 0.00

Critical PDD Access Update to Hospital ACS Outpatient Fee 1,878.32 565.06 1,878.32 1,878.32 565.06 565.06 565.06 565.06 565.06 565.06 565.06 565.06 262.80 262.80 262.80 262.80 262.80 262.80 565.06 565.06 565.06 565.06 565.06 565.06 2,522.63 2,522.63 2,522.63 2,522.63 2,522.63 2,522.63 2,522.63 2,522.63 2,522.63 0.00 2,522.63 2,522.63 2,522.63 2,522.63 1,878.32 2,522.63 0.00 0.00 0.00 2,522.63 2,522.63 0.00 0.00 2,635.35 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2,522.63 2,522.63 2,522.63 2,522.63 0.00 0.00 0.00 0.00 0.00 2,635.35 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2,522.63 2,522.63 2,522.63 2,522.63 2,635.35 332.12 332.12 78.77 78.77 0.00 0.00 0.00 0.00 537.30 2,522.63 2,635.35 2,635.35 2,522.63 2,522.63 1,878.32 2,522.63 2,635.35 2,635.35 2,522.63 2,522.63 2,522.63 2,635.35 2,635.35 1,878.32 1,878.32 1,878.32 1,878.32 537.30 99.00 182.20 332.12 332.12 332.12 0.00 99.00 36.99 332.12 332.12 332.12 332.12 99.00 182.20 182.20 182.20 182.20 182.20 182.20 182.20 332.12 182.20 182.20 182.20 332.12 332.12 332.12 182.20 332.12 332.12 332.12 332.12 332.12 453.43 453.43 453.43 453.43 453.43 99.00 0.00 0.00

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

15240 15241 15260 15261 15300 15301 15320 15321 15330 15331 15335 15336 15340 15341 15360 15361 15365 15366 15400 15401 15420 15421 15430 15431 15570 15572 15574 15576 15600 15610 15620 15630 15650 15731 15732 15734 15736 15738 15740 15750 15756 15757 15758 15760 15770 15775 15776 15780 15781 15782 15783 15786 15787 15788 15789 15792 15793 15819 15820 15821 15822 15823 15824 15825 15826 15828 15829 15830 15832 15833 15834 15835 15836 15837 15838 15839 15840 15841 15842 15845 15847 15850 15851 15852 15860 15876 15877 15878 15879 15920 15922 15931 15933 15934 15935 15936 15937 15940 15941 15944 15945 15946 15950 15951 15952 15953 15956 15958 15999 16000 16020 16025 16030 16035 16036 17000 17003 17004 17106 17107 17108 17110 17111 17250 17260 17261 17262 17263 17264 17266 17270 17271 17272 17273 17274 17276 17280 17281 17282 17283 17284 17286 17311 17312 17313 17314 17315 17340 17360 17380

Skin full graft Skin full graft add-on Skin full graft Skin full graft add-on Apply skinallogrft, t/arm/lg Apply sknallogrft t/a/l addl Apply skin allogrft f/n/hf/g Aply sknallogrft f/n/hfg add Aply acell alogrft t/arm/leg Aply acell grft t/a/l add-on Apply acell graft, f/n/hf/g Aply acell grft f/n/hf/g add Apply cult skin substitute Apply cult skin sub add-on Apply cult derm sub, t/a/l Aply cult derm sub t/a/l add Apply cult derm sub f/n/hf/g Apply cult derm f/hf/g add Skin heterograft Skin heterograft add-on Apply skin xgraft, f/n/hf/g Apply skn xgrft f/n/hf/g add Apply acellular xenograft Apply acellular xgraft add Form skin pedicle flap Form skin pedicle flap Form skin pedicle flap Form skin pedicle flap Skin graft Skin graft Skin graft Skin graft Transfer skin pedicle flap Forehead flap w/vasc pedicle Muscle-skin graft, head/neck Muscle-skin graft, trunk Muscle-skin graft, arm Muscle-skin graft, leg Island pedicle flap graft Neurovascular pedicle graft Free myo/skin flap microvasc Free skin flap, microvasc Free fascial flap, microvasc Composite skin graft Derma-fat-fascia graft Hair transplant punch grafts Hair transplant punch grafts Abrasion treatment of skin Abrasion treatment of skin Abrasion treatment of skin Abrasion treatment of skin Abrasion, lesion, single Abrasion, lesions, add-on Chemical peel, face, epiderm Chemical peel, face, dermal Chemical peel, nonfacial Chemical peel, nonfacial Plastic surgery, neck Revision of lower eyelid Revision of lower eyelid Revision of upper eyelid Revision of upper eyelid Removal of forehead wrinkles Removal of neck wrinkles Removal of brow wrinkles Removal of face wrinkles Removal of skin wrinkles Exc skin abd Excise excessive skin tissue Excise excessive skin tissue Excise excessive skin tissue Excise excessive skin tissue Excise excessive skin tissue Excise excessive skin tissue Excise excessive skin tissue Excise excessive skin tissue Graft for face nerve palsy Graft for face nerve palsy Flap for face nerve palsy Skin and muscle repair, face Exc skin abd add-on Removal of sutures Removal of sutures Dressing change not for burn Test for blood flow in graft Suction assisted lipectomy Suction assisted lipectomy Suction assisted lipectomy Suction assisted lipectomy Removal of tail bone ulcer Removal of tail bone ulcer Remove sacrum pressure sore Remove sacrum pressure sore Remove sacrum pressure sore Remove sacrum pressure sore Remove sacrum pressure sore Remove sacrum pressure sore Remove hip pressure sore Remove hip pressure sore Remove hip pressure sore Remove hip pressure sore Remove hip pressure sore Remove thigh pressure sore Remove thigh pressure sore Remove thigh pressure sore Remove thigh pressure sore Remove thigh pressure sore Remove thigh pressure sore Removal of pressure sore Initial treatment of burn(s) Treatment of burn(s) Treatment of burn(s) Treatment of burn(s) Incision of burn scab, initi Escharotomy; add’l incision Destroy benign/premlg lesion Destroy lesions, 2-14 Destroy lesions, 15 or more Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruct lesion, 1-14 Destruct lesion, 15 or more Chemical cautery, tissue Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Mohs, 1 stage, h/n/hf/g Mohs addl stage Mohs, 1 stage, t/a/l Mohs, addl stage, t/a/l Mohs surg, addl block Cryotherapy of skin Skin peel therapy Hair removal by electrolysis

0136 0135 0136 0136 0135 0135 0135 0135 0135 0135 0135 0135 0134 0134 0134 0134 0134 0134 0135 0135 0135 0135 0135 0135 0137 0137 0137 0137 0137 0137 0137 0137 0137 0137 0137 0137 0137 0137 0136 0137 0000 0000 0000 0137 0137 0133 0133 0022 0019 0019 0016 0013 0013 0013 0015 0015 0013 0134 0137 0137 0137 0137 0137 0137 0137 0137 0137 0022 0022 0022 0022 0022 0021 0021 0021 0021 0137 0137 0137 0137 0022 0016 0016 0340 0340 0137 0137 0137 0137 0019 0137 0022 0022 0137 0137 0136 0137 0022 0022 0137 0137 0137 0022 0022 0136 0136 0136 0136 0019 0013 0015 0016 0016 0016 0000 0013 0012 0016 0016 0016 0016 0013 0015 0015 0015 0015 0015 0015 0015 0016 0015 0015 0015 0016 0016 0016 0015 0016 0016 0016 0016 0016 0694 0694 0694 0694 0694 0013 0013 0013

15.0458 4.5263 15.0458 15.0458 4.5263 4.5263 4.5263 4.5263 4.5263 4.5263 4.5263 4.5263 2.1051 2.1051 2.1051 2.1051 2.1051 2.1051 4.5263 4.5263 4.5263 4.5263 4.5263 4.5263 20.2069 20.2069 20.2069 20.2069 20.2069 20.2069 20.2069 20.2069 20.2069 20.2069 20.2069 20.2069 20.2069 20.2069 15.0458 20.2069 0.0000 0.0000 0.0000 20.2069 20.2069 1.2792 1.2792 21.1098 4.3039 4.3039 2.6604 0.7930 0.7930 0.7930 1.4595 1.4595 0.7930 2.1051 20.2069 20.2069 20.2069 20.2069 20.2069 20.2069 20.2069 20.2069 20.2069 21.1098 21.1098 21.1098 21.1098 21.1098 16.1001 16.1001 16.1001 16.1001 20.2069 20.2069 20.2069 20.2069 21.1098 2.6604 2.6604 0.6310 0.6310 20.2069 20.2069 20.2069 20.2069 4.3039 20.2069 21.1098 21.1098 20.2069 20.2069 15.0458 20.2069 21.1098 21.1098 20.2069 20.2069 20.2069 21.1098 21.1098 15.0458 15.0458 15.0458 15.0458 4.3039 0.7930 1.4595 2.6604 2.6604 2.6604 0.0000 0.7930 0.2963 2.6604 2.6604 2.6604 2.6604 0.7930 1.4595 1.4595 1.4595 1.4595 1.4595 1.4595 1.4595 2.6604 1.4595 1.4595 1.4595 2.6604 2.6604 2.6604 1.4595 2.6604 2.6604 2.6604 2.6604 2.6604 3.6321 3.6321 3.6321 3.6321 3.6321 0.7930 0.7930 0.7930

Added 1/1/07 to book

Added 1/1/07 to book

Added 1/1/07 to book

SI= T, If needed add 282N Taxonomy

SI change 1/1/07 (TR 1155)

Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book

17999 19000 19001 19020 19030 19100 19101 19102 19103 19105

Skin tissue procedure Drainage of breast lesion Drain breast lesion add-on Incision of breast lesion Injection for breast x-ray Bx breast percut w/o image Biopsy of breast, open Bx breast percut w/image Bx breast percut w/device Cryosurg ablate fa, each

T T T T N T T T T T

T T T T N T T T T T

0012 0004 0002 0008 0000 0004 0028 0005 0037 0029

0.2963 4.3270 1.1097 18.3197 0.0000 4.3270 20.6417 7.1147 13.5764 31.7134

14.15 206.70 53.01 875.13 0.00 206.70 986.05 339.87 648.54 1,514.95

32.27 471.30 120.87 1,995.38 0.00 471.30 2,248.29 774.93 1,478.74 3,454.22

36.99 540.18 138.53 2,287.03 0.00 540.18 2,576.91 888.20 1,694.88 3,959.10

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

Added 1/1/07 to book

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

4 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only T T T T T T C C N N N T T T T T T T T C C T T T T T T T T T T T T C C T C C C T T T T T T T T T T C C N N N T T T T T T T T C C T T T 1 T T T T T T 1 T C C T C C C T T T T

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 986.05 986.05 986.05 986.05 986.05 769.10 0.00 0.00 0.00 0.00 0.00 2,702.70 2,702.70 2,702.70 986.05 986.05 1,902.16 1,514.95 1,514.95 0.00 0.00 1,902.16 1,514.95 1,902.16 0.00 2,702.70 1,514.95 1,514.95 1,902.16 2,702.70 986.05 0.00 2,702.70 0.00 0.00 1,514.95 0.00 0.00 0.00 1,514.95 1,514.95 1,902.16 1,514.95

Children's Hospital Outpatient Fee 2,248.29 2,248.29 2,248.29 2,248.29 2,248.29 1,753.62 0.00 0.00 0.00 0.00 0.00 6,162.41 6,162.41 6,162.41 2,248.29 2,248.29 4,337.10 3,454.22 3,454.22 0.00 0.00 4,337.10 3,454.22 4,337.10 0.00 6,162.41 3,454.22 3,454.22 4,337.10 6,162.41 2,248.29 0.00 6,162.41 0.00 0.00 3,454.22 0.00 0.00 0.00 3,454.22 3,454.22 4,337.10 3,454.22

Critical PDD Access Update to Hospital ACS Outpatient Fee 2,576.91 2,576.91 2,576.91 2,576.91 2,576.91 2,009.94 0.00 0.00 0.00 0.00 0.00 7,063.12 7,063.12 7,063.12 2,576.91 2,576.91 4,971.02 3,959.10 3,959.10 0.00 0.00 4,971.02 3,959.10 4,971.02 0.00 7,063.12 3,959.10 3,959.10 4,971.02 7,063.12 2,576.91 0.00 7,063.12 0.00 0.00 3,959.10 0.00 0.00 0.00 3,959.10 3,959.10 4,971.02 3,959.10

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

19110 19112 19120 19125 19126 19260 19271 19272 19290 19291 19295 19296 19297 19298 19300 19301 19302 19303 19304 19305 19306 19307 19316 19318 19324 19325 19328 19330 19340 19342 19350 19355 19357 19361 19364 19366 19367 19368 19369 19370 19371 19380 19396

Nipple exploration Excise breast duct fistula Removal of breast lesion Excision, breast lesion Excision, addl breast lesion Removal of chest wall lesion Revision of chest wall Extensive chest wall surgery Place needle wire, breast Place needle wire, breast Place breast clip, percut Place po breast cath for rad Place breast cath for rad Place breast rad tube/caths Removal of breast tissue Partical mastectomy P-mastectomy w/ln removal Mast, simple, complete Mast, subq Mast, radical Mast, rad, urban type Mast, mod rad Suspension of breast Reduction of large breast Enlarge breast Enlarge breast with implant Removal of breast implant Removal of implant material Immediate breast prosthesis Delayed breast prosthesis Breast reconstruction Correct inverted nipple(s) Breast reconstruction Breast reconstruction Breast reconstruction Breast reconstruction Breast reconstruction Breast reconstruction Breast reconstruction Surgery of breast capsule Removal of breast capsule Revise breast reconstruction Design custom breast implant

0028 0028 0028 0028 0028 0021 0000 0000 0000 0000 0000 0648 0648 0648 0028 0028 0030 0029 0029 0000 0000 0030 0029 0030 0030 0648 0029 0029 0030 0648 0028 0029 0648 0000 0000 0029 0000 0000 0000 0029 0029 0030 0029

20.6417 20.6417 20.6417 20.6417 20.6417 16.1001 0.0000 0.0000 0.0000 0.0000 0.0000 56.5774 56.5774 56.5774 20.6417 20.6417 39.8191 31.7134 31.7134 0.0000 0.0000 39.8191 31.7134 39.8191 39.8191 56.5774 31.7134 31.7134 39.8191 56.5774 20.6417 31.7134 56.5774 0.0000 0.0000 31.7134 0.0000 0.0000 0.0000 31.7134 31.7134 39.8191 31.7134

X SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) X Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book

19499 20000 20005 20100 20101 20102 20103 20150 20200 20205 20206 20220 20225 20240 20245 20250 20251 20500 20501 20520 20525 20526 20550 20551 20552 20553 20555 20600 20605 20610 20612 20615 20650 20660 20661 20662 20663 20664 20665 20670 20680 20690 20692 20693 20694 20802 20805 20808 20816 20822 20824 20827 20838 20900 20902 20910 20912 20920 20922 20924 20926 20930 20931 20936 20937 20938 20950 20955 20956 20957 20962 20969 20970 20972 20973 20974 20975 20979 20982 20985 20986 20987

Breast surgery procedure Incision of abscess Incision of deep abscess Explore wound, neck Explore wound, chest Explore wound, abdomen Explore wound, extremity Excise epiphyseal bar Muscle biopsy Deep muscle biopsy Needle biopsy, muscle Bone biopsy, trocar/needle Bone biopsy, trocar/needle Bone biopsy, excisional Bone biopsy, excisional Open bone biopsy Open bone biopsy Injection of sinus tract Inject sinus tract for x-ray Removal of foreign body Removal of foreign body Ther injection, carp tunnel Inj tendon sheath/ligament Inj tendon origin/insertion Inj trigger point, 1/2 muscl Inject trigger points, =/> 3 Place ndl musc/tis for rt Drain/inject, joint/bursa Drain/inject, joint/bursa Drain/inject, joint/bursa Aspirate/inj ganglion cyst Treatment of bone cyst Insert and remove bone pin Apply, rem fixation device Application of head brace Application of pelvis brace Application of thigh brace Halo brace application Removal of fixation device Removal of support implant Removal of support implant Apply bone fixation device Apply bone fixation device Adjust bone fixation device Remove bone fixation device Replantation, arm, complete Replant forearm, complete Replantation hand, complete Replantation digit, complete Replantation digit, complete Replantation thumb, complete Replantation thumb, complete Replantation foot, complete Removal of bone for graft Removal of bone for graft Remove cartilage for graft Remove cartilage for graft Removal of fascia for graft Removal of fascia for graft Removal of tendon for graft Removal of tissue for graft Sp bone algrft morsel add-on Sp bone algrft struct add-on Sp bone agrft local add-on Sp bone agrft morsel add-on Sp bone agrft struct add-on Fluid pressure, muscle Fibula bone graft, microvasc Iliac bone graft, microvasc Mt bone graft, microvasc Other bone graft, microvasc Bone/skin graft, microvasc Bone/skin graft, iliac crest Bone/skin graft, metatarsal Bone/skin graft, great toe Electrical bone stimulation Electrical bone stimulation Us bone stimulation Ablate, bone tumor(s) perq Cptr-asst dir ms px Cptr-asst dir ms px io img Cptr-asst dir ms px pre img

T T T T T T T T T T T T T T T T T T N T T T T T T T T T T T T T T C C T T C X T T T T T T C C C C T C C C T T T T T T T T C C C C C T C C C C C C T T A N X T N N N

T T T T T T T T T T T T T T T T T T N T T T T T T T T T T T T T T C C T T C X T T T T T T C C C C T C C C T T T T T T T T C C C C C T C C C C C C T T 3 N X T N N N

0028 0006 0049 0023 0137 0137 0023 0051 0021 0021 0005 0020 0020 0022 0022 0049 0049 0251 0000 0019 0022 0204 0204 0204 0204 0204 0050 0204 0204 0204 0204 0004 0049 0000 0000 0049 0049 0000 0340 0021 0022 0050 0050 0049 0049 0000 0000 0000 0000 0054 0000 0000 0000 0050 0050 0137 0137 0136 0136 0050 0135 0000 0000 0000 0000 0000 0006 0000 0000 0000 0000 0000 0000 0056 0056 0000 0000 0340 0051 0000 0000 0000

20.6417 1.4066 21.2689 9.6341 20.2069 20.2069 9.6341 42.9850 16.1001 16.1001 7.1147 8.6850 8.6850 21.1098 21.1098 21.2689 21.2689 2.5002 0.0000 4.3039 21.1098 2.3213 2.3213 2.3213 2.3213 2.3213 29.1900 2.3213 2.3213 2.3213 2.3213 4.3270 21.2689 0.0000 0.0000 21.2689 21.2689 0.0000 0.6310 16.1001 21.1098 29.1900 29.1900 21.2689 21.2689 0.0000 0.0000 0.0000 0.0000 26.3105 0.0000 0.0000 0.0000 29.1900 29.1900 20.2069 20.2069 15.0458 15.0458 29.1900 4.5263 0.0000 0.0000 0.0000 0.0000 0.0000 1.4066 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 44.2687 44.2687 0.0000 0.0000 0.6310 42.9850 0.0000 0.0000 0.0000

986.05 67.19 1,016.02 460.22 965.28 965.28 460.22 2,053.39 769.10 769.10 339.87 414.88 414.88 1,008.42 1,008.42 1,016.02 1,016.02 119.43 0.00 205.60 1,008.42 110.89 110.89 110.89 110.89 110.89 1,394.41 110.89 110.89 110.89 110.89 206.70 1,016.02 0.00 0.00 1,016.02 1,016.02 0.00 30.14 769.10 1,008.42 1,394.41 1,394.41 1,016.02 1,016.02 0.00 0.00 0.00 0.00 1,256.85 0.00 0.00 0.00 1,394.41 1,394.41 965.28 965.28 718.74 718.74 1,394.41 216.22 0.00 0.00 0.00 0.00 0.00 67.19 0.00 0.00 0.00 0.00 0.00 0.00 2,114.72 2,114.72 M01 0.00 30.14 2,053.39 0.00 0.00 0.00

2,248.29 153.21 2,316.61 1,049.35 2,200.94 2,200.94 1,049.35 4,681.93 1,753.62 1,753.62 774.93 945.97 945.97 2,299.28 2,299.28 2,316.61 2,316.61 272.32 0.00 468.78 2,299.28 252.84 252.84 252.84 252.84 252.84 3,179.37 252.84 252.84 252.84 252.84 471.30 2,316.61 0.00 0.00 2,316.61 2,316.61 0.00 68.73 1,753.62 2,299.28 3,179.37 3,179.37 2,316.61 2,316.61 0.00 0.00 0.00 0.00 2,865.74 0.00 0.00 0.00 3,179.37 3,179.37 2,200.94 2,200.94 1,638.79 1,638.79 3,179.37 493.00 0.00 0.00 0.00 0.00 0.00 153.21 0.00 0.00 0.00 0.00 0.00 0.00 4,821.75 4,821.75 M01 0.00 68.73 4,681.93 0.00 0.00 0.00

2,576.91 175.60 2,655.21 1,202.72 2,522.63 2,522.63 1,202.72 5,366.25 2,009.94 2,009.94 888.20 1,084.24 1,084.24 2,635.35 2,635.35 2,655.21 2,655.21 312.12 0.00 537.30 2,635.35 289.79 289.79 289.79 289.79 289.79 3,644.08 289.79 289.79 289.79 289.79 540.18 2,655.21 0.00 0.00 2,655.21 2,655.21 0.00 78.77 2,009.94 2,635.35 3,644.08 3,644.08 2,655.21 2,655.21 0.00 0.00 0.00 0.00 3,284.60 0.00 0.00 0.00 3,644.08 3,644.08 2,522.63 2,522.63 1,878.32 1,878.32 3,644.08 565.06 0.00 0.00 0.00 0.00 0.00 175.60 0.00 0.00 0.00 0.00 0.00 0.00 5,526.50 5,526.50 M01 0.00 78.77 5,366.25 0.00 0.00 0.00

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

X

Description Change Description Change Description Change Description Change Description Change

x x x x x

X

X X X SI= T, effect. 05/01/06 If needed add 282N Taxonomy

20999 21010 21015 21025 21026 21029 21030 21031 21032 21034 21040 21044 21045 21046 21047 21048 21049 21050 21060 21070 21073 21076 21077 21079 21080 21081 21082 21083 21084 21085 21086 21087 21088

Musculoskeletal surgery Incision of jaw joint Resection of facial tumor Excision of bone, lower jaw Excision of facial bone(s) Contour of face bone lesion Excise max/zygoma b9 tumor Remove exostosis, mandible Remove exostosis, maxilla Excise max/zygoma mlg tumor Excise mandible lesion Removal of jaw bone lesion Extensive jaw surgery Remove mandible cyst complex Excise lwr jaw cyst w/repair Remove maxilla cyst complex Excis uppr jaw cyst w/repair Removal of jaw joint Remove jaw joint cartilage Remove coronoid process Mnpj of tmj w/anesth Prepare face/oral prosthesis Prepare face/oral prosthesis Prepare face/oral prosthesis Prepare face/oral prosthesis Prepare face/oral prosthesis Prepare face/oral prosthesis Prepare face/oral prosthesis Prepare face/oral prosthesis Prepare face/oral prosthesis Prepare face/oral prosthesis Prepare face/oral prosthesis Prepare face/oral prosthesis

T T T T T T T T T T T T C T T T T T T T T T T T T T T T T T T T T

T T T T T T T T T T T T C T T T T T T T T T T T T T T T T T T T T

0049 0254 0253 0256 0256 0256 0254 0254 0254 0256 0254 0256 0000 0256 0256 0256 0256 0256 0256 0256 0252 0254 0256 0256 0256 0256 0256 0256 0256 0253 0256 0256 0256

21.2689 23.9765 16.3288 39.8776 39.8776 39.8776 23.9765 23.9765 23.9765 39.8776 23.9765 39.8776 0.0000 39.8776 39.8776 39.8776 39.8776 39.8776 39.8776 39.8776 7.4474 23.9765 39.8776 39.8776 39.8776 39.8776 39.8776 39.8776 39.8776 16.3288 39.8776 39.8776 39.8776

1,016.02 1,145.36 780.03 1,904.95 1,904.95 1,904.95 1,145.36 1,145.36 1,145.36 1,904.95 1,145.36 1,904.95 0.00 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95 355.76 1,145.36 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95 780.03 1,904.95 1,904.95 1,904.95

2,316.61 2,611.52 1,778.53 4,343.47 4,343.47 4,343.47 2,611.52 2,611.52 2,611.52 4,343.47 2,611.52 4,343.47 0.00 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47 811.17 2,611.52 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47 1,778.53 4,343.47 4,343.47 4,343.47

2,655.21 2,993.23 2,038.49 4,978.32 4,978.32 4,978.32 2,993.23 2,993.23 2,993.23 4,978.32 2,993.23 4,978.32 0.00 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32 929.73 2,993.23 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32 2,038.49 4,978.32 4,978.32 4,978.32

X

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

5 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee

Children's Hospital Outpatient Fee

Critical PDD Access Update to Hospital ACS Outpatient Fee

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

21089 21100 21110 21116 21120 21121 21122 21123 21125 21127 21137 21138 21139 21141 21142 21143 21145 21146 21147 21150 21151 21154 21155 21159 21160 21172 21175 21179 21180 21181 21182 21183 21184 21188 21193 21194 21195 21196 21198 21199 21206 21208 21209 21210 21215 21230 21235 21240 21242 21243 21244 21245 21246 21247 21248 21249 21255 21256 21260 21261 21263 21267 21268 21270 21275 21280 21282 21295 21296

Prepare face/oral prosthesis Maxillofacial fixation Interdental fixation Injection, jaw joint x-ray Reconstruction of chin Reconstruction of chin Reconstruction of chin Reconstruction of chin Augmentation, lower jaw bone Augmentation, lower jaw bone Reduction of forehead Reduction of forehead Reduction of forehead Reconstruct midface, lefort Reconstruct midface, lefort Reconstruct midface, lefort Reconstruct midface, lefort Reconstruct midface, lefort Reconstruct midface, lefort Reconstruct midface, lefort Reconstruct midface, lefort Reconstruct midface, lefort Reconstruct midface, lefort Reconstruct midface, lefort Reconstruct midface, lefort Reconstruct orbit/forehead Reconstruct orbit/forehead Reconstruct entire forehead Reconstruct entire forehead Contour cranial bone lesion Reconstruct cranial bone Reconstruct cranial bone Reconstruct cranial bone Reconstruction of midface Reconst lwr jaw w/o graft Reconst lwr jaw w/graft Reconst lwr jaw w/o fixation Reconst lwr jaw w/fixation Reconstr lwr jaw segment Reconstr lwr jaw w/advance Reconstruct upper jaw bone Augmentation of facial bones Reduction of facial bones Face bone graft Lower jaw bone graft Rib cartilage graft Ear cartilage graft Reconstruction of jaw joint Reconstruction of jaw joint Reconstruction of jaw joint Reconstruction of lower jaw Reconstruction of jaw Reconstruction of jaw Reconstruct lower jaw bone Reconstruction of jaw Reconstruction of jaw Reconstruct lower jaw bone Reconstruction of orbit Revise eye sockets Revise eye sockets Revise eye sockets Revise eye sockets Revise eye sockets Augmentation, cheek bone Revision, orbitofacial bones Revision of eyelid Revision of eyelid Revision of jaw muscle/bone Revision of jaw muscle/bone

T T T N T T T T T T T T T C C C C C C T C C C C C C T C C T C C C C C C T C T T T T T T T T T T T T T T T C T T C C T T T T C T T T T T T

T T T N T T T T T T T T T C C C C C C T C C C C C C T C C T C C C C C C T C T T T T T T T T T T T T T T T C T T C C T T T T C T T T T T T

0251 0256 0252 0000 0254 0254 0254 0254 0254 0256 0254 0256 0256 0000 0000 0000 0000 0000 0000 0256 0000 0000 0000 0000 0000 0000 0256 0000 0000 0254 0000 0000 0000 0000 0000 0000 0256 0000 0256 0256 0256 0256 0256 0256 0256 0256 0254 0256 0256 0256 0256 0256 0256 0000 0256 0256 0000 0000 0256 0256 0256 0256 0000 0256 0256 0256 0253 0252 0254

2.5002 39.8776 7.4474 0.0000 23.9765 23.9765 23.9765 23.9765 23.9765 39.8776 23.9765 39.8776 39.8776 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 39.8776 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 39.8776 0.0000 0.0000 23.9765 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 39.8776 0.0000 39.8776 39.8776 39.8776 39.8776 39.8776 39.8776 39.8776 39.8776 23.9765 39.8776 39.8776 39.8776 39.8776 39.8776 39.8776 0.0000 39.8776 39.8776 0.0000 0.0000 39.8776 39.8776 39.8776 39.8776 0.0000 39.8776 39.8776 39.8776 16.3288 7.4474 23.9765

119.43 1,904.95 355.76 0.00 1,145.36 1,145.36 1,145.36 1,145.36 1,145.36 1,904.95 1,145.36 1,904.95 1,904.95 0.00 0.00 0.00 0.00 0.00 0.00 1,904.95 0.00 0.00 0.00 0.00 0.00 0.00 1,904.95 0.00 0.00 1,145.36 0.00 0.00 0.00 0.00 0.00 0.00 1,904.95 0.00 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95 1,145.36 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95 0.00 1,904.95 1,904.95 0.00 0.00 1,904.95 1,904.95 1,904.95 1,904.95 0.00 1,904.95 1,904.95 1,904.95 780.03 355.76 1,145.36

272.32 4,343.47 811.17 0.00 2,611.52 2,611.52 2,611.52 2,611.52 2,611.52 4,343.47 2,611.52 4,343.47 4,343.47 0.00 0.00 0.00 0.00 0.00 0.00 4,343.47 0.00 0.00 0.00 0.00 0.00 0.00 4,343.47 0.00 0.00 2,611.52 0.00 0.00 0.00 0.00 0.00 0.00 4,343.47 0.00 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47 2,611.52 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47 0.00 4,343.47 4,343.47 0.00 0.00 4,343.47 4,343.47 4,343.47 4,343.47 0.00 4,343.47 4,343.47 4,343.47 1,778.53 811.17 2,611.52

312.12 4,978.32 929.73 0.00 2,993.23 2,993.23 2,993.23 2,993.23 2,993.23 4,978.32 2,993.23 4,978.32 4,978.32 0.00 0.00 0.00 0.00 0.00 0.00 4,978.32 0.00 0.00 0.00 0.00 0.00 0.00 4,978.32 0.00 0.00 2,993.23 0.00 0.00 0.00 0.00 0.00 0.00 4,978.32 0.00 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32 2,993.23 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32 0.00 4,978.32 4,978.32 0.00 0.00 4,978.32 4,978.32 4,978.32 4,978.32 0.00 4,978.32 4,978.32 4,978.32 2,038.49 929.73 2,993.23

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

21299 21310 21315 21320 21325 21330 21335 21336 21337 21338 21339 21340 21343 21344 21345 21346 21347 21348 21355 21356 21360 21365 21366 21385 21386 21387 21390 21395 21400 21401 21406 21407 21408 21421 21422 21423 21431 21432 21433 21435 21436 21440 21445 21450 21451 21452 21453 21454 21461 21462 21465 21470 21480 21485 21490 21495 21497

Cranio/maxillofacial surgery Treatment of nose fracture Treatment of nose fracture Treatment of nose fracture Treatment of nose fracture Treatment of nose fracture Treatment of nose fracture Treat nasal septal fracture Treat nasal septal fracture Treat nasoethmoid fracture Treat nasoethmoid fracture Treatment of nose fracture Treatment of sinus fracture Treatment of sinus fracture Treat nose/jaw fracture Treat nose/jaw fracture Treat nose/jaw fracture Treat nose/jaw fracture Treat cheek bone fracture Treat cheek bone fracture Treat cheek bone fracture Treat cheek bone fracture Treat cheek bone fracture Treat eye socket fracture Treat eye socket fracture Treat eye socket fracture Treat eye socket fracture Treat eye socket fracture Treat eye socket fracture Treat eye socket fracture Treat eye socket fracture Treat eye socket fracture Treat eye socket fracture Treat mouth roof fracture Treat mouth roof fracture Treat mouth roof fracture Treat craniofacial fracture Treat craniofacial fracture Treat craniofacial fracture Treat craniofacial fracture Treat craniofacial fracture Treat dental ridge fracture Treat dental ridge fracture Treat lower jaw fracture Treat lower jaw fracture Treat lower jaw fracture Treat lower jaw fracture Treat lower jaw fracture Treat lower jaw fracture Treat lower jaw fracture Treat lower jaw fracture Treat lower jaw fracture Reset dislocated jaw Reset dislocated jaw Repair dislocated jaw Treat hyoid bone fracture Interdental wiring

T T T T T T T T T T T T C C T C C C T T T T C T C C T C T T T T T T C C C C C C C T T T T T T T T T T T T T T T T

T T T T T T T T T T T T C C T C C C T T T T C T C C T C T T T T T T C C C C C C C T T T T T T T T T T T T T T T T

0251 0251 0251 0253 0254 0254 0254 0062 0253 0254 0254 0256 0000 0000 0254 0000 0000 0000 0256 0254 0254 0256 0000 0256 0000 0000 0256 0000 0252 0253 0256 0256 0256 0254 0000 0000 0000 0000 0000 0000 0000 0254 0254 0251 0252 0253 0256 0254 0256 0256 0256 0256 0251 0253 0256 0253 0253

2.5002 2.5002 2.5002 16.3288 23.9765 23.9765 23.9765 26.1592 16.3288 23.9765 23.9765 39.8776 0.0000 0.0000 23.9765 0.0000 0.0000 0.0000 39.8776 23.9765 23.9765 39.8776 0.0000 39.8776 0.0000 0.0000 39.8776 0.0000 7.4474 16.3288 39.8776 39.8776 39.8776 23.9765 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 23.9765 23.9765 2.5002 7.4474 16.3288 39.8776 23.9765 39.8776 39.8776 39.8776 39.8776 2.5002 16.3288 39.8776 16.3288 16.3288

119.43 119.43 119.43 780.03 1,145.36 1,145.36 1,145.36 1,249.62 780.03 1,145.36 1,145.36 1,904.95 0.00 0.00 1,145.36 0.00 0.00 0.00 1,904.95 1,145.36 1,145.36 1,904.95 0.00 1,904.95 0.00 0.00 1,904.95 0.00 355.76 780.03 1,904.95 1,904.95 1,904.95 1,145.36 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1,145.36 1,145.36 119.43 355.76 780.03 1,904.95 1,145.36 1,904.95 1,904.95 1,904.95 1,904.95 119.43 780.03 1,904.95 780.03 780.03

272.32 272.32 272.32 1,778.53 2,611.52 2,611.52 2,611.52 2,849.26 1,778.53 2,611.52 2,611.52 4,343.47 0.00 0.00 2,611.52 0.00 0.00 0.00 4,343.47 2,611.52 2,611.52 4,343.47 0.00 4,343.47 0.00 0.00 4,343.47 0.00 811.17 1,778.53 4,343.47 4,343.47 4,343.47 2,611.52 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2,611.52 2,611.52 272.32 811.17 1,778.53 4,343.47 2,611.52 4,343.47 4,343.47 4,343.47 4,343.47 272.32 1,778.53 4,343.47 1,778.53 1,778.53

312.12 312.12 312.12 2,038.49 2,993.23 2,993.23 2,993.23 3,265.71 2,038.49 2,993.23 2,993.23 4,978.32 0.00 0.00 2,993.23 0.00 0.00 0.00 4,978.32 2,993.23 2,993.23 4,978.32 0.00 4,978.32 0.00 0.00 4,978.32 0.00 929.73 2,038.49 4,978.32 4,978.32 4,978.32 2,993.23 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2,993.23 2,993.23 312.12 929.73 2,038.49 4,978.32 2,993.23 4,978.32 4,978.32 4,978.32 4,978.32 312.12 2,038.49 4,978.32 2,038.49 2,038.49

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

X X X

21499 21501 21502 21510 21550 21555 21556 21557 21600 21610 21615 21616 21620 21627 21630 21632 21685 21700 21705 21720 21725 21740 21742 21743 21750 21800 21805 21810 21820 21825

Head surgery procedure Drain neck/chest lesion Drain chest lesion Drainage of bone lesion Biopsy of neck/chest Remove lesion, neck/chest Remove lesion, neck/chest Remove tumor, neck/chest Partial removal of rib Partial removal of rib Removal of rib Removal of rib and nerves Partial removal of sternum Sternal debridement Extensive sternum surgery Extensive sternum surgery Hyoid myotomy & suspension Revision of neck muscle Revision of neck muscle/rib Revision of neck muscle Revision of neck muscle Reconstruction of sternum Repair stern/nuss w/o scope Repair sternum/nuss w/scope Repair of sternum separation Treatment of rib fracture Treatment of rib fracture Treatment of rib fracture(s) Treat sternum fracture Treat sternum fracture

T T T C T T T T T T C C C C C C T T C T T C T T C T T C T C

T T T C T T T T T T C C C C C C T T C T T C T T C T T C T C

0251 0008 0049 0000 0020 0022 0022 0022 0050 0050 0000 0000 0000 0000 0000 0000 0252 0049 0000 0049 0006 0000 0051 0051 0000 0043 0062 0000 0043 0000

2.5002 18.3197 21.2689 0.0000 8.6850 21.1098 21.1098 21.1098 29.1900 29.1900 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 7.4474 21.2689 0.0000 21.2689 1.4066 0.0000 42.9850 42.9850 0.0000 1.7682 26.1592 0.0000 1.7682 0.0000

119.43 875.13 1,016.02 0.00 414.88 1,008.42 1,008.42 1,008.42 1,394.41 1,394.41 0.00 0.00 0.00 0.00 0.00 0.00 355.76 1,016.02 0.00 1,016.02 67.19 0.00 2,053.39 2,053.39 0.00 84.47 1,249.62 0.00 84.47 0.00

272.32 1,995.38 2,316.61 0.00 945.97 2,299.28 2,299.28 2,299.28 3,179.37 3,179.37 0.00 0.00 0.00 0.00 0.00 0.00 811.17 2,316.61 0.00 2,316.61 153.21 0.00 4,681.93 4,681.93 0.00 192.59 2,849.26 0.00 192.59 0.00

312.12 2,287.03 2,655.21 0.00 1,084.24 2,635.35 2,635.35 2,635.35 3,644.08 3,644.08 0.00 0.00 0.00 0.00 0.00 0.00 929.73 2,655.21 0.00 2,655.21 175.60 0.00 5,366.25 5,366.25 0.00 220.74 3,265.71 0.00 220.74 0.00

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

6 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee

Children's Hospital Outpatient Fee

Critical PDD Access Update to Hospital ACS Outpatient Fee

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

21899 21920 21925 21930 21935 22010 22015 22100 22101 22102 22103 22110 22112 22114 22116 22206 22207 22208 22210 22212 22214 22216 22220 22222 22224 22226 22305 22310 22315 22318 22319 22325 22326 22327 22328 22505 22520 22521 22522 22523 22524 22525 22526 22527 22532 22533 22534 22548 22554 22556 22558 22585 22590 22595 22600 22610 22612 22614 22630 22632 22800 22802 22804 22808 22810 22812 22818 22819 22830 22840 22841 22842 22843 22844 22845 22846 22847 22848 22849 22850 22851 22852 22855 22857 22862 22865 22899 22900

Neck/chest surgery procedure Biopsy soft tissue of back Biopsy soft tissue of back Remove lesion, back or flank Remove tumor, back I&d, p-spine, c/t/cerv-thor I&d, p-spine, l/s/ls Remove part of neck vertebra Remove part, thorax vertebra Remove part, lumbar vertebra Remove extra spine segment Remove part of neck vertebra Remove part, thorax vertebra Remove part, lumbar vertebra Remove extra spine segment Cut spine 3 col, thor Cut spine 3 col, lumb Cut spine 3 col, addl seg Revision of neck spine Revision of thorax spine Revision of lumbar spine Revise, extra spine segment Revision of neck spine Revision of thorax spine Revision of lumbar spine Revise, extra spine segment Treat spine process fracture Treat spine fracture Treat spine fracture Treat odontoid fx w/o graft Treat odontoid fx w/graft Treat spine fracture Treat neck spine fracture Treat thorax spine fracture Treat each add spine fx Manipulation of spine Percut vertebroplasty thor Percut vertebroplasty lumb Percut vertebroplasty add’l Percut kyphoplasty, thor Percut kyphoplasty, lumbar Percut kyphoplasty, add-on Idet, single level Idet, 1 or more levels Lat thorax spine fusion Lat lumbar spine fusion Lat thor/lumb, add’l seg Neck spine fusion Neck spine fusion Thorax spine fusion Lumbar spine fusion Additional spinal fusion Spine & skull spinal fusion Neck spinal fusion Neck spine fusion Thorax spine fusion Lumbar spine fusion Spine fusion, extra segment Lumbar spine fusion Spine fusion, extra segment Fusion of spine Fusion of spine Fusion of spine Fusion of spine Fusion of spine Fusion of spine Kyphectomy, 1-2 segments Kyphectomy, 3 or more Exploration of spinal fusion Insert spine fixation device Insert spine fixation device Insert spine fixation device Insert spine fixation device Insert spine fixation device Insert spine fixation device Insert spine fixation device Insert spine fixation device Insert pelv fixation device Reinsert spinal fixation Remove spine fixation device Apply spine prosth device Remove spine fixation device Remove spine fixation device Lumbar artif diskectomy Revise lumbar artif disc Remove lumb artif disc Spine surgery procedure Remove abdominal wall lesion

T T T T T C C T T T T C C C C C C C C C C C C T C C T T T C C C C C C T T T T T T T T T C C C C C C C C C C C C T T C C C C C C C C C C C C C C C C C C C C C C T C C C C C T T

T T T T T C C T T T T C C C C C C C C C C C C T C C T T T C C C C C C T T T T T T T T T C C C C C C C C C C C C T T C C C C C C C C C C C C C C C C C C C C C C T C C C C C T T

0251 0020 0022 0022 0022 0000 0000 0208 0208 0208 0208 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0208 0000 0000 0043 0043 0043 0000 0000 0000 0000 0000 0000 0045 0050 0050 0050 0052 0052 0052 0050 0050 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0208 0208 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0049 0000 0000 0000 0000 0000 0049 0022

2.5002 8.6850 21.1098 21.1098 21.1098 0.0000 0.0000 46.7724 46.7724 46.7724 46.7724 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 46.7724 0.0000 0.0000 1.7682 1.7682 1.7682 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 14.7658 29.1900 29.1900 29.1900 79.4244 79.4244 79.4244 29.1900 29.1900 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 46.7724 46.7724 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 21.2689 0.0000 0.0000 0.0000 0.0000 0.0000 21.2689 21.1098

119.43 414.88 1,008.42 1,008.42 1,008.42 0.00 0.00 2,234.32 2,234.32 2,234.32 2,234.32 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2,234.32 0.00 0.00 84.47 84.47 84.47 0.00 0.00 0.00 0.00 0.00 0.00 705.36 1,394.41 1,394.41 1,394.41 3,794.10 3,794.10 3,794.10 1,394.41 1,394.41 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2,234.32 2,234.32 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1,016.02 0.00 0.00 0.00 0.00 0.00 1,016.02 1,008.42

272.32 945.97 2,299.28 2,299.28 2,299.28 0.00 0.00 5,094.45 5,094.45 5,094.45 5,094.45 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 5,094.45 0.00 0.00 192.59 192.59 192.59 0.00 0.00 0.00 0.00 0.00 0.00 1,608.29 3,179.37 3,179.37 3,179.37 8,650.91 8,650.91 8,650.91 3,179.37 3,179.37 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 5,094.45 5,094.45 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2,316.61 0.00 0.00 0.00 0.00 0.00 2,316.61 2,299.28

312.12 1,084.24 2,635.35 2,635.35 2,635.35 0.00 0.00 5,839.07 5,839.07 5,839.07 5,839.07 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 5,839.07 0.00 0.00 220.74 220.74 220.74 0.00 0.00 0.00 0.00 0.00 0.00 1,843.36 3,644.08 3,644.08 3,644.08 9,915.34 9,915.34 9,915.34 3,644.08 3,644.08 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 5,839.07 5,839.07 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2,655.21 0.00 0.00 0.00 0.00 0.00 2,655.21 2,635.35

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

X X X

Added 1/1/07 to book Added 1/1/07 to book

SI change 1/1/07 (TR 1155)

Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book

22999 23000 23020 23030 23031 23035 23040 23044 23065 23066 23075 23076 23077 23100 23101 23105 23106 23107 23120 23125 23130 23140 23145 23146 23150 23155 23156 23170 23172 23174 23180 23182 23184 23190 23195 23200 23210 23220 23221 23222 23330 23331 23332 23350 23395 23397 23400 23405 23406 23410 23412 23415 23420 23430 23440 23450 23455 23460 23462 23465 23466 23470 23472 23480 23485 23490 23491 23500 23505 23515 23520

Abdomen surgery procedure Removal of calcium deposits Release shoulder joint Drain shoulder lesion Drain shoulder bursa Drain shoulder bone lesion Exploratory shoulder surgery Exploratory shoulder surgery Biopsy shoulder tissues Biopsy shoulder tissues Removal of shoulder lesion Removal of shoulder lesion Remove tumor of shoulder Biopsy of shoulder joint Shoulder joint surgery Remove shoulder joint lining Incision of collarbone joint Explore treat shoulder joint Partial removal, collar bone Removal of collar bone Remove shoulder bone, part Removal of bone lesion Removal of bone lesion Removal of bone lesion Removal of humerus lesion Removal of humerus lesion Removal of humerus lesion Remove collar bone lesion Remove shoulder blade lesion Remove humerus lesion Remove collar bone lesion Remove shoulder blade lesion Remove humerus lesion Partial removal of scapula Removal of head of humerus Removal of collar bone Removal of shoulder blade Partial removal of humerus Partial removal of humerus Partial removal of humerus Remove shoulder foreign body Remove shoulder foreign body Remove shoulder foreign body Injection for shoulder x-ray Muscle transfer,shoulder/arm Muscle transfers Fixation of shoulder blade Incision of tendon & muscle Incise tendon(s) & muscle(s) Repair rotator cuff, acute Repair rotator cuff, chronic Release of shoulder ligament Repair of shoulder Repair biceps tendon Remove/transplant tendon Repair shoulder capsule Repair shoulder capsule Repair shoulder capsule Repair shoulder capsule Repair shoulder capsule Repair shoulder capsule Reconstruct shoulder joint Reconstruct shoulder joint Revision of collar bone Revision of collar bone Reinforce clavicle Reinforce shoulder bones Treat clavicle fracture Treat clavicle fracture Treat clavicle fracture Treat clavicle dislocation

T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T C C C C C T T C N T T T T T T T T T T T T T T T T T T C T T T T T T T T

T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T C C C C C T T C N T T T T T T T T T T T T T T T T T T C T T T T T T T T

0049 0021 0051 0008 0008 0049 0050 0050 0020 0022 0021 0022 0022 0049 0050 0050 0050 0050 0050 0050 0051 0049 0050 0050 0050 0050 0050 0050 0050 0050 0050 0050 0050 0050 0050 0000 0000 0000 0000 0000 0020 0022 0000 0000 0051 0052 0050 0050 0050 0051 0051 0051 0051 0051 0051 0052 0052 0052 0051 0052 0051 0425 0000 0051 0052 0051 0052 0043 0043 0064 0043

21.2689 16.1001 42.9850 18.3197 18.3197 21.2689 29.1900 29.1900 8.6850 21.1098 16.1001 21.1098 21.1098 21.2689 29.1900 29.1900 29.1900 29.1900 29.1900 29.1900 42.9850 21.2689 29.1900 29.1900 29.1900 29.1900 29.1900 29.1900 29.1900 29.1900 29.1900 29.1900 29.1900 29.1900 29.1900 0.0000 0.0000 0.0000 0.0000 0.0000 8.6850 21.1098 0.0000 0.0000 42.9850 79.4244 29.1900 29.1900 29.1900 42.9850 42.9850 42.9850 42.9850 42.9850 42.9850 79.4244 79.4244 79.4244 42.9850 79.4244 42.9850 122.2057 0.0000 42.9850 79.4244 42.9850 79.4244 1.7682 1.7682 59.2233 1.7682

1,016.02 769.10 2,053.39 875.13 875.13 1,016.02 1,394.41 1,394.41 414.88 1,008.42 769.10 1,008.42 1,008.42 1,016.02 1,394.41 1,394.41 1,394.41 1,394.41 1,394.41 1,394.41 2,053.39 1,016.02 1,394.41 1,394.41 1,394.41 1,394.41 1,394.41 1,394.41 1,394.41 1,394.41 1,394.41 1,394.41 1,394.41 1,394.41 1,394.41 0.00 0.00 0.00 0.00 0.00 414.88 1,008.42 0.00 0.00 2,053.39 3,794.10 1,394.41 1,394.41 1,394.41 2,053.39 2,053.39 2,053.39 2,053.39 2,053.39 2,053.39 3,794.10 3,794.10 3,794.10 2,053.39 3,794.10 2,053.39 5,837.77 0.00 2,053.39 3,794.10 2,053.39 3,794.10 84.47 84.47 2,829.10 84.47

2,316.61 1,753.62 4,681.93 1,995.38 1,995.38 2,316.61 3,179.37 3,179.37 945.97 2,299.28 1,753.62 2,299.28 2,299.28 2,316.61 3,179.37 3,179.37 3,179.37 3,179.37 3,179.37 3,179.37 4,681.93 2,316.61 3,179.37 3,179.37 3,179.37 3,179.37 3,179.37 3,179.37 3,179.37 3,179.37 3,179.37 3,179.37 3,179.37 3,179.37 3,179.37 0.00 0.00 0.00 0.00 0.00 945.97 2,299.28 0.00 0.00 4,681.93 8,650.91 3,179.37 3,179.37 3,179.37 4,681.93 4,681.93 4,681.93 4,681.93 4,681.93 4,681.93 8,650.91 8,650.91 8,650.91 4,681.93 8,650.91 4,681.93 13,310.64 0.00 4,681.93 8,650.91 4,681.93 8,650.91 192.59 192.59 6,450.60 192.59

2,655.21 2,009.94 5,366.25 2,287.03 2,287.03 2,655.21 3,644.08 3,644.08 1,084.24 2,635.35 2,009.94 2,635.35 2,635.35 2,655.21 3,644.08 3,644.08 3,644.08 3,644.08 3,644.08 3,644.08 5,366.25 2,655.21 3,644.08 3,644.08 3,644.08 3,644.08 3,644.08 3,644.08 3,644.08 3,644.08 3,644.08 3,644.08 3,644.08 3,644.08 3,644.08 0.00 0.00 0.00 0.00 0.00 1,084.24 2,635.35 0.00 0.00 5,366.25 9,915.34 3,644.08 3,644.08 3,644.08 5,366.25 5,366.25 5,366.25 5,366.25 5,366.25 5,366.25 9,915.34 9,915.34 9,915.34 5,366.25 9,915.34 5,366.25 15,256.16 0.00 5,366.25 9,915.34 5,366.25 9,915.34 220.74 220.74 7,393.44 220.74

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

7 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only T T T T T T T T T T T T T T T T T T T T T T T T T T T C C T T T T T T T T T T T T T T T T T T T T T T T T T T T T C C T

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 84.47 1,963.78 1,249.62 84.47 84.47 1,963.78 1,963.78 84.47 84.47 2,829.10 84.47 84.47 2,829.10 2,829.10 84.47 84.47 2,829.10 84.47 705.36 1,963.78 84.47 2,829.10 84.47 1,963.78 705.36 3,794.10 2,053.39 0.00 0.00 718.74

Children's Hospital Outpatient Fee 192.59 4,477.60 2,849.26 192.59 192.59 4,477.60 4,477.60 192.59 192.59 6,450.60 192.59 192.59 6,450.60 6,450.60 192.59 192.59 6,450.60 192.59 1,608.29 4,477.60 192.59 6,450.60 192.59 4,477.60 1,608.29 8,650.91 4,681.93 0.00 0.00 1,638.79

Critical PDD Access Update to Hospital ACS Outpatient Fee 220.74 5,132.06 3,265.71 220.74 220.74 5,132.06 5,132.06 220.74 220.74 7,393.44 220.74 220.74 7,393.44 7,393.44 220.74 220.74 7,393.44 220.74 1,843.36 5,132.06 220.74 7,393.44 220.74 5,132.06 1,843.36 9,915.34 5,366.25 0.00 0.00 1,878.32

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

23525 23530 23532 23540 23545 23550 23552 23570 23575 23585 23600 23605 23615 23616 23620 23625 23630 23650 23655 23660 23665 23670 23675 23680 23700 23800 23802 23900 23920 23921

Treat clavicle dislocation Treat clavicle dislocation Treat clavicle dislocation Treat clavicle dislocation Treat clavicle dislocation Treat clavicle dislocation Treat clavicle dislocation Treat shoulder blade fx Treat shoulder blade fx Treat scapula fracture Treat humerus fracture Treat humerus fracture Treat humerus fracture Treat humerus fracture Treat humerus fracture Treat humerus fracture Treat humerus fracture Treat shoulder dislocation Treat shoulder dislocation Treat shoulder dislocation Treat dislocation/fracture Treat dislocation/fracture Treat dislocation/fracture Treat dislocation/fracture Fixation of shoulder Fusion of shoulder joint Fusion of shoulder joint Amputation of arm & girdle Amputation at shoulder joint Amputation follow-up surgery

0043 0063 0062 0043 0043 0063 0063 0043 0043 0064 0043 0043 0064 0064 0043 0043 0064 0043 0045 0063 0043 0064 0043 0063 0045 0052 0051 0000 0000 0136

1.7682 41.1091 26.1592 1.7682 1.7682 41.1091 41.1091 1.7682 1.7682 59.2233 1.7682 1.7682 59.2233 59.2233 1.7682 1.7682 59.2233 1.7682 14.7658 41.1091 1.7682 59.2233 1.7682 41.1091 14.7658 79.4244 42.9850 0.0000 0.0000 15.0458

23929 23930 23931 23935 24000 24006 24065 24066 24075 24076 24077 24100 24101 24102 24105 24110 24115 24116 24120 24125 24126 24130 24134 24136 24138 24140 24145 24147 24149 24150 24151 24152 24153 24155 24160 24164 24200 24201 24220 24300 24301 24305 24310 24320 24330 24331 24332 24340 24341 24342 24343 24344 24345 24346

Shoulder surgery procedure Drainage of arm lesion Drainage of arm bursa Drain arm/elbow bone lesion Exploratory elbow surgery Release elbow joint Biopsy arm/elbow soft tissue Biopsy arm/elbow soft tissue Remove arm/elbow lesion Remove arm/elbow lesion Remove tumor of arm/elbow Biopsy elbow joint lining Explore/treat elbow joint Remove elbow joint lining Removal of elbow bursa Remove humerus lesion Remove/graft bone lesion Remove/graft bone lesion Remove elbow lesion Remove/graft bone lesion Remove/graft bone lesion Removal of head of radius Removal of arm bone lesion Remove radius bone lesion Remove elbow bone lesion Partial removal of arm bone Partial removal of radius Partial removal of elbow Radical resection of elbow Extensive humerus surgery Extensive humerus surgery Extensive radius surgery Extensive radius surgery Removal of elbow joint Remove elbow joint implant Remove radius head implant Removal of arm foreign body Removal of arm foreign body Injection for elbow x-ray Manipulate elbow w/anesth Muscle/tendon transfer Arm tendon lengthening Revision of arm tendon Repair of arm tendon Revision of arm muscles Revision of arm muscles Tenolysis, triceps Repair of biceps tendon Repair arm tendon/muscle Repair of ruptured tendon Repr elbow lat ligmnt w/tiss Reconstruct elbow lat ligmnt Repr elbw med ligmnt w/tissu Reconstruct elbow med ligmnt

T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T N T T T T T T T T T T T T T T T

T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T N T T T T T T T T T T T T T T T

0043 0008 0008 0049 0050 0050 0021 0021 0021 0022 0022 0049 0050 0050 0049 0049 0050 0050 0049 0050 0050 0050 0050 0050 0050 0050 0050 0050 0050 0051 0052 0051 0052 0051 0050 0050 0019 0021 0000 0045 0050 0050 0049 0051 0052 0051 0049 0051 0051 0051 0050 0052 0050 0051

1.7682 18.3197 18.3197 21.2689 29.1900 29.1900 16.1001 16.1001 16.1001 21.1098 21.1098 21.2689 29.1900 29.1900 21.2689 21.2689 29.1900 29.1900 21.2689 29.1900 29.1900 29.1900 29.1900 29.1900 29.1900 29.1900 29.1900 29.1900 29.1900 42.9850 79.4244 42.9850 79.4244 42.9850 29.1900 29.1900 4.3039 16.1001 0.0000 14.7658 29.1900 29.1900 21.2689 42.9850 79.4244 42.9850 21.2689 42.9850 42.9850 42.9850 29.1900 79.4244 29.1900 42.9850

84.47 875.13 875.13 1,016.02 1,394.41 1,394.41 769.10 769.10 769.10 1,008.42 1,008.42 1,016.02 1,394.41 1,394.41 1,016.02 1,016.02 1,394.41 1,394.41 1,016.02 1,394.41 1,394.41 1,394.41 1,394.41 1,394.41 1,394.41 1,394.41 1,394.41 1,394.41 1,394.41 2,053.39 3,794.10 2,053.39 3,794.10 2,053.39 1,394.41 1,394.41 205.60 769.10 0.00 705.36 1,394.41 1,394.41 1,016.02 2,053.39 3,794.10 2,053.39 1,016.02 2,053.39 2,053.39 2,053.39 1,394.41 3,794.10 1,394.41 2,053.39

192.59 1,995.38 1,995.38 2,316.61 3,179.37 3,179.37 1,753.62 1,753.62 1,753.62 2,299.28 2,299.28 2,316.61 3,179.37 3,179.37 2,316.61 2,316.61 3,179.37 3,179.37 2,316.61 3,179.37 3,179.37 3,179.37 3,179.37 3,179.37 3,179.37 3,179.37 3,179.37 3,179.37 3,179.37 4,681.93 8,650.91 4,681.93 8,650.91 4,681.93 3,179.37 3,179.37 468.78 1,753.62 0.00 1,608.29 3,179.37 3,179.37 2,316.61 4,681.93 8,650.91 4,681.93 2,316.61 4,681.93 4,681.93 4,681.93 3,179.37 8,650.91 3,179.37 4,681.93

220.74 2,287.03 2,287.03 2,655.21 3,644.08 3,644.08 2,009.94 2,009.94 2,009.94 2,635.35 2,635.35 2,655.21 3,644.08 3,644.08 2,655.21 2,655.21 3,644.08 3,644.08 2,655.21 3,644.08 3,644.08 3,644.08 3,644.08 3,644.08 3,644.08 3,644.08 3,644.08 3,644.08 3,644.08 5,366.25 9,915.34 5,366.25 9,915.34 5,366.25 3,644.08 3,644.08 537.30 2,009.94 0.00 1,843.36 3,644.08 3,644.08 2,655.21 5,366.25 9,915.34 5,366.25 2,655.21 5,366.25 5,366.25 5,366.25 3,644.08 9,915.34 3,644.08 5,366.25

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

24357 24358 24359 24360 24361 24362 24363 24365 24366 24400 24410 24420 24430 24435 24470 24495 24498 24500 24505 24515 24516 24530 24535 24538 24545 24546 24560 24565 24566 24575 24576 24577 24579 24582 24586 24587 24600 24605 24615 24620 24635 24640 24650 24655 24665 24666 24670 24675 24685 24800 24802 24900 24920 24925 24930 24931 24935 24940

Repair elbow, perc Repair elbow w/deb, open Repair elbow deb/attch open Reconstruct elbow joint Reconstruct elbow joint Reconstruct elbow joint Replace elbow joint Reconstruct head of radius Reconstruct head of radius Revision of humerus Revision of humerus Revision of humerus Repair of humerus Repair humerus with graft Revision of elbow joint Decompression of forearm Reinforce humerus Treat humerus fracture Treat humerus fracture Treat humerus fracture Treat humerus fracture Treat humerus fracture Treat humerus fracture Treat humerus fracture Treat humerus fracture Treat humerus fracture Treat humerus fracture Treat humerus fracture Treat humerus fracture Treat humerus fracture Treat humerus fracture Treat humerus fracture Treat humerus fracture Treat humerus fracture Treat elbow fracture Treat elbow fracture Treat elbow dislocation Treat elbow dislocation Treat elbow dislocation Treat elbow fracture Treat elbow fracture Treat elbow dislocation Treat radius fracture Treat radius fracture Treat radius fracture Treat radius fracture Treat ulnar fracture Treat ulnar fracture Treat ulnar fracture Fusion of elbow joint Fusion/graft of elbow joint Amputation of upper arm Amputation of upper arm Amputation follow-up surgery Amputation follow-up surgery Amputate upper arm & implant Revision of amputation Revision of upper arm

T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T C C T C C T C

T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T C C T C C T C

0050 0050 0050 0047 0425 0048 0425 0047 0425 0050 0050 0051 0052 0052 0051 0050 0052 0043 0043 0064 0064 0043 0043 0062 0064 0064 0043 0043 0062 0064 0043 0043 0064 0062 0064 0064 0043 0045 0064 0043 0064 0043 0043 0043 0063 0064 0043 0043 0063 0051 0051 0000 0000 0049 0000 0000 0052 0000

29.1900 29.1900 29.1900 35.9040 122.2057 50.8876 122.2057 35.9040 122.2057 29.1900 29.1900 42.9850 79.4244 79.4244 42.9850 29.1900 79.4244 1.7682 1.7682 59.2233 59.2233 1.7682 1.7682 26.1592 59.2233 59.2233 1.7682 1.7682 26.1592 59.2233 1.7682 1.7682 59.2233 26.1592 59.2233 59.2233 1.7682 14.7658 59.2233 1.7682 59.2233 1.7682 1.7682 1.7682 41.1091 59.2233 1.7682 1.7682 41.1091 42.9850 42.9850 0.0000 0.0000 21.2689 0.0000 0.0000 79.4244 0.0000

1,394.41 1,394.41 1,394.41 1,715.13 5,837.77 2,430.90 5,837.77 1,715.13 5,837.77 1,394.41 1,394.41 2,053.39 3,794.10 3,794.10 2,053.39 1,394.41 3,794.10 84.47 84.47 2,829.10 2,829.10 84.47 84.47 1,249.62 2,829.10 2,829.10 84.47 84.47 1,249.62 2,829.10 84.47 84.47 2,829.10 1,249.62 2,829.10 2,829.10 84.47 705.36 2,829.10 84.47 2,829.10 84.47 84.47 84.47 1,963.78 2,829.10 84.47 84.47 1,963.78 2,053.39 2,053.39 0.00 0.00 1,016.02 0.00 0.00 3,794.10 0.00

3,179.37 3,179.37 3,179.37 3,910.66 13,310.64 5,542.68 13,310.64 3,910.66 13,310.64 3,179.37 3,179.37 4,681.93 8,650.91 8,650.91 4,681.93 3,179.37 8,650.91 192.59 192.59 6,450.60 6,450.60 192.59 192.59 2,849.26 6,450.60 6,450.60 192.59 192.59 2,849.26 6,450.60 192.59 192.59 6,450.60 2,849.26 6,450.60 6,450.60 192.59 1,608.29 6,450.60 192.59 6,450.60 192.59 192.59 192.59 4,477.60 6,450.60 192.59 192.59 4,477.60 4,681.93 4,681.93 0.00 0.00 2,316.61 0.00 0.00 8,650.91 0.00

3,644.08 3,644.08 3,644.08 4,482.26 15,256.16 6,352.81 15,256.16 4,482.26 15,256.16 3,644.08 3,644.08 5,366.25 9,915.34 9,915.34 5,366.25 3,644.08 9,915.34 220.74 220.74 7,393.44 7,393.44 220.74 220.74 3,265.71 7,393.44 7,393.44 220.74 220.74 3,265.71 7,393.44 220.74 220.74 7,393.44 3,265.71 7,393.44 7,393.44 220.74 1,843.36 7,393.44 220.74 7,393.44 220.74 220.74 220.74 5,132.06 7,393.44 220.74 220.74 5,132.06 5,366.25 5,366.25 0.00 0.00 2,655.21 0.00 0.00 9,915.34 0.00 SI= T, effect. 05/01/06 If needed add 282N Taxonomy

X X X

24999 25000 25001 25020 25023 25024 25025 25028 25031 25035 25040 25065

Upper arm/elbow surgery Incision of tendon sheath Incise flexor carpi radialis Decompress forearm 1 space Decompress forearm 1 space Decompress forearm 2 spaces Decompress forearm 2 spaces Drainage of forearm lesion Drainage of forearm bursa Treat forearm bone lesion Explore/treat wrist joint Biopsy forearm soft tissues

T T T T T T T T T T T T

T T T T T T T T T T T T

0043 0049 0049 0049 0050 0050 0050 0049 0049 0049 0050 0020

1.7682 21.2689 21.2689 21.2689 29.1900 29.1900 29.1900 21.2689 21.2689 21.2689 29.1900 8.6850

84.47 1,016.02 1,016.02 1,016.02 1,394.41 1,394.41 1,394.41 1,016.02 1,016.02 1,016.02 1,394.41 414.88

192.59 2,316.61 2,316.61 2,316.61 3,179.37 3,179.37 3,179.37 2,316.61 2,316.61 2,316.61 3,179.37 945.97

220.74 2,655.21 2,655.21 2,655.21 3,644.08 3,644.08 3,644.08 2,655.21 2,655.21 2,655.21 3,644.08 1,084.24

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

8 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T N T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T C C T C C C T C C T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T N T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T C C T C C C T C C T T

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 1,008.42 769.10 1,008.42 1,008.42 1,016.02 1,016.02 1,394.41 1,394.41 1,394.41 1,016.02 1,016.02 786.47 786.47 1,016.02 1,016.02 1,394.41 1,394.41 1,394.41 1,394.41 1,394.41 1,394.41 1,394.41 1,394.41 1,394.41 1,394.41 1,394.41 2,053.39 1,256.85 1,256.85 1,394.41 1,394.41 0.00 1,016.02 1,394.41 1,394.41 84.47 1,394.41 1,394.41 1,394.41 1,394.41 1,394.41 1,394.41 1,394.41 1,394.41 1,394.41 1,016.02 1,394.41 1,394.41 2,053.39 2,053.39 2,053.39 3,794.10 2,053.39 1,715.13 2,053.39 2,053.39 3,794.10 2,053.39 1,394.41 1,394.41 2,053.39 2,053.39 1,394.41 2,053.39 1,394.41 2,053.39 786.47 3,794.10 3,794.10 3,794.10 3,794.10 2,053.39 2,053.39 1,256.85 1,256.85 3,794.10 5,837.77 5,837.77 2,430.90 2,430.90 2,430.90 5,837.77 1,715.13 1,715.13 2,053.39 2,053.39 2,053.39 2,053.39 2,053.39 84.47 84.47 1,963.78 84.47 1,963.78 1,963.78 84.47 84.47 1,963.78 84.47 84.47 2,829.10 2,829.10 84.47 84.47 1,249.62 2,829.10 2,829.10 2,829.10 84.47 84.47 1,963.78 84.47 84.47 1,963.78 84.47 1,249.62 1,963.78 84.47 1,249.62 1,249.62 84.47 1,249.62 84.47 1,249.62 84.47 1,249.62 3,794.10 2,053.39 3,794.10 786.47 3,794.10 3,794.10 0.00 0.00 1,016.02 0.00 0.00 0.00 1,016.02 0.00 0.00 718.74 1,016.02

Children's Hospital Outpatient Fee 2,299.28 1,753.62 2,299.28 2,299.28 2,316.61 2,316.61 3,179.37 3,179.37 3,179.37 2,316.61 2,316.61 1,793.23 1,793.23 2,316.61 2,316.61 3,179.37 3,179.37 3,179.37 3,179.37 3,179.37 3,179.37 3,179.37 3,179.37 3,179.37 3,179.37 3,179.37 4,681.93 2,865.74 2,865.74 3,179.37 3,179.37 0.00 2,316.61 3,179.37 3,179.37 192.59 3,179.37 3,179.37 3,179.37 3,179.37 3,179.37 3,179.37 3,179.37 3,179.37 3,179.37 2,316.61 3,179.37 3,179.37 4,681.93 4,681.93 4,681.93 8,650.91 4,681.93 3,910.66 4,681.93 4,681.93 8,650.91 4,681.93 3,179.37 3,179.37 4,681.93 4,681.93 3,179.37 4,681.93 3,179.37 4,681.93 1,793.23 8,650.91 8,650.91 8,650.91 8,650.91 4,681.93 4,681.93 2,865.74 2,865.74 8,650.91 13,310.64 13,310.64 5,542.68 5,542.68 5,542.68 13,310.64 3,910.66 3,910.66 4,681.93 4,681.93 4,681.93 4,681.93 4,681.93 192.59 192.59 4,477.60 192.59 4,477.60 4,477.60 192.59 192.59 4,477.60 192.59 192.59 6,450.60 6,450.60 192.59 192.59 2,849.26 6,450.60 6,450.60 6,450.60 192.59 192.59 4,477.60 192.59 192.59 4,477.60 192.59 2,849.26 4,477.60 192.59 2,849.26 2,849.26 192.59 2,849.26 192.59 2,849.26 192.59 2,849.26 8,650.91 4,681.93 8,650.91 1,793.23 8,650.91 8,650.91 0.00 0.00 2,316.61 0.00 0.00 0.00 2,316.61 0.00 0.00 1,638.79 2,316.61

Critical PDD Access Update to Hospital ACS Outpatient Fee 2,635.35 2,009.94 2,635.35 2,635.35 2,655.21 2,655.21 3,644.08 3,644.08 3,644.08 2,655.21 2,655.21 2,055.33 2,055.33 2,655.21 2,655.21 3,644.08 3,644.08 3,644.08 3,644.08 3,644.08 3,644.08 3,644.08 3,644.08 3,644.08 3,644.08 3,644.08 5,366.25 3,284.60 3,284.60 3,644.08 3,644.08 0.00 2,655.21 3,644.08 3,644.08 220.74 3,644.08 3,644.08 3,644.08 3,644.08 3,644.08 3,644.08 3,644.08 3,644.08 3,644.08 2,655.21 3,644.08 3,644.08 5,366.25 5,366.25 5,366.25 9,915.34 5,366.25 4,482.26 5,366.25 5,366.25 9,915.34 5,366.25 3,644.08 3,644.08 5,366.25 5,366.25 3,644.08 5,366.25 3,644.08 5,366.25 2,055.33 9,915.34 9,915.34 9,915.34 9,915.34 5,366.25 5,366.25 3,284.60 3,284.60 9,915.34 15,256.16 15,256.16 6,352.81 6,352.81 6,352.81 15,256.16 4,482.26 4,482.26 5,366.25 5,366.25 5,366.25 5,366.25 5,366.25 220.74 220.74 5,132.06 220.74 5,132.06 5,132.06 220.74 220.74 5,132.06 220.74 220.74 7,393.44 7,393.44 220.74 220.74 3,265.71 7,393.44 7,393.44 7,393.44 220.74 220.74 5,132.06 220.74 220.74 5,132.06 220.74 3,265.71 5,132.06 220.74 3,265.71 3,265.71 220.74 3,265.71 220.74 3,265.71 220.74 3,265.71 9,915.34 5,366.25 9,915.34 2,055.33 9,915.34 9,915.34 0.00 0.00 2,655.21 0.00 0.00 0.00 2,655.21 0.00 0.00 1,878.32 2,655.21

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

25066 25075 25076 25077 25085 25100 25101 25105 25107 25109 25110 25111 25112 25115 25116 25118 25119 25120 25125 25126 25130 25135 25136 25145 25150 25151 25170 25210 25215 25230 25240 25246 25248 25250 25251 25259 25260 25263 25265 25270 25272 25274 25275 25280 25290 25295 25300 25301 25310 25312 25315 25316 25320 25332 25335 25337 25350 25355 25360 25365 25370 25375 25390 25391 25392 25393 25394 25400 25405 25415 25420 25425 25426 25430 25431 25440 25441 25442 25443 25444 25445 25446 25447 25449 25450 25455 25490 25491 25492 25500 25505 25515 25520 25525 25526 25530 25535 25545 25560 25565 25574 25575 25600 25605 25606 25607 25608 25609 25622 25624 25628 25630 25635 25645 25650 25651 25652 25660 25670 25671 25675 25676 25680 25685 25690 25695 25800 25805 25810 25820 25825 25830 25900 25905 25907 25909 25915 25920 25922 25924 25927 25929 25931

Biopsy forearm soft tissues Removal forearm lesion subcu Removal forearm lesion deep Remove tumor, forearm/wrist Incision of wrist capsule Biopsy of wrist joint Explore/treat wrist joint Remove wrist joint lining Remove wrist joint cartilage Excise tendon forearm/wrist Remove wrist tendon lesion Remove wrist tendon lesion Reremove wrist tendon lesion Remove wrist/forearm lesion Remove wrist/forearm lesion Excise wrist tendon sheath Partial removal of ulna Removal of forearm lesion Remove/graft forearm lesion Remove/graft forearm lesion Removal of wrist lesion Remove & graft wrist lesion Remove & graft wrist lesion Remove forearm bone lesion Partial removal of ulna Partial removal of radius Extensive forearm surgery Removal of wrist bone Removal of wrist bones Partial removal of radius Partial removal of ulna Injection for wrist x-ray Remove forearm foreign body Removal of wrist prosthesis Removal of wrist prosthesis Manipulate wrist w/anesthes Repair forearm tendon/muscle Repair forearm tendon/muscle Repair forearm tendon/muscle Repair forearm tendon/muscle Repair forearm tendon/muscle Repair forearm tendon/muscle Repair forearm tendon sheath Revise wrist/forearm tendon Incise wrist/forearm tendon Release wrist/forearm tendon Fusion of tendons at wrist Fusion of tendons at wrist Transplant forearm tendon Transplant forearm tendon Revise palsy hand tendon(s) Revise palsy hand tendon(s) Repair/revise wrist joint Revise wrist joint Realignment of hand Reconstruct ulna/radioulnar Revision of radius Revision of radius Revision of ulna Revise radius & ulna Revise radius or ulna Revise radius & ulna Shorten radius or ulna Lengthen radius or ulna Shorten radius & ulna Lengthen radius & ulna Repair carpal bone, shorten Repair radius or ulna Repair/graft radius or ulna Repair radius & ulna Repair/graft radius & ulna Repair/graft radius or ulna Repair/graft radius & ulna Vasc graft into carpal bone Repair nonunion carpal bone Repair/graft wrist bone Reconstruct wrist joint Reconstruct wrist joint Reconstruct wrist joint Reconstruct wrist joint Reconstruct wrist joint Wrist replacement Repair wrist joint(s) Remove wrist joint implant Revision of wrist joint Revision of wrist joint Reinforce radius Reinforce ulna Reinforce radius and ulna Treat fracture of radius Treat fracture of radius Treat fracture of radius Treat fracture of radius Treat fracture of radius Treat fracture of radius Treat fracture of ulna Treat fracture of ulna Treat fracture of ulna Treat fracture radius & ulna Treat fracture radius & ulna Treat fracture radius & ulna Treat fracture radius/ulna Treat fracture radius/ulna Treat fracture radius/ulna Treat fx distal radial Treat fx rad extra-articul Treat fx rad intra-articul Treat fx radial 3+ frag Treat wrist bone fracture Treat wrist bone fracture Treat wrist bone fracture Treat wrist bone fracture Treat wrist bone fracture Treat wrist bone fracture Treat wrist bone fracture Pin ulnar styloid fracture Treat fracture ulnar styloid Treat wrist dislocation Treat wrist dislocation Pin radioulnar dislocation Treat wrist dislocation Treat wrist dislocation Treat wrist fracture Treat wrist fracture Treat wrist dislocation Treat wrist dislocation Fusion of wrist joint Fusion/graft of wrist joint Fusion/graft of wrist joint Fusion of hand bones Fuse hand bones with graft Fusion, radioulnar jnt/ulna Amputation of forearm Amputation of forearm Amputation follow-up surgery Amputation follow-up surgery Amputation of forearm Amputate hand at wrist Amputate hand at wrist Amputation follow-up surgery Amputation of hand Amputation follow-up surgery Amputation follow-up surgery

0022 0021 0022 0022 0049 0049 0050 0050 0050 0049 0049 0053 0053 0049 0049 0050 0050 0050 0050 0050 0050 0050 0050 0050 0050 0050 0051 0054 0054 0050 0050 0000 0049 0050 0050 0043 0050 0050 0050 0050 0050 0050 0050 0050 0050 0049 0050 0050 0051 0051 0051 0052 0051 0047 0051 0051 0052 0051 0050 0050 0051 0051 0050 0051 0050 0051 0053 0052 0052 0052 0052 0051 0051 0054 0054 0052 0425 0425 0048 0048 0048 0425 0047 0047 0051 0051 0051 0051 0051 0043 0043 0063 0043 0063 0063 0043 0043 0063 0043 0043 0064 0064 0043 0043 0062 0064 0064 0064 0043 0043 0063 0043 0043 0063 0043 0062 0063 0043 0062 0062 0043 0062 0043 0062 0043 0062 0052 0051 0052 0053 0052 0052 0000 0000 0049 0000 0000 0000 0049 0000 0000 0136 0049

21.1098 16.1001 21.1098 21.1098 21.2689 21.2689 29.1900 29.1900 29.1900 21.2689 21.2689 16.4637 16.4637 21.2689 21.2689 29.1900 29.1900 29.1900 29.1900 29.1900 29.1900 29.1900 29.1900 29.1900 29.1900 29.1900 42.9850 26.3105 26.3105 29.1900 29.1900 0.0000 21.2689 29.1900 29.1900 1.7682 29.1900 29.1900 29.1900 29.1900 29.1900 29.1900 29.1900 29.1900 29.1900 21.2689 29.1900 29.1900 42.9850 42.9850 42.9850 79.4244 42.9850 35.9040 42.9850 42.9850 79.4244 42.9850 29.1900 29.1900 42.9850 42.9850 29.1900 42.9850 29.1900 42.9850 16.4637 79.4244 79.4244 79.4244 79.4244 42.9850 42.9850 26.3105 26.3105 79.4244 122.2057 122.2057 50.8876 50.8876 50.8876 122.2057 35.9040 35.9040 42.9850 42.9850 42.9850 42.9850 42.9850 1.7682 1.7682 41.1091 1.7682 41.1091 41.1091 1.7682 1.7682 41.1091 1.7682 1.7682 59.2233 59.2233 1.7682 1.7682 26.1592 59.2233 59.2233 59.2233 1.7682 1.7682 41.1091 1.7682 1.7682 41.1091 1.7682 26.1592 41.1091 1.7682 26.1592 26.1592 1.7682 26.1592 1.7682 26.1592 1.7682 26.1592 79.4244 42.9850 79.4244 16.4637 79.4244 79.4244 0.0000 0.0000 21.2689 0.0000 0.0000 0.0000 21.2689 0.0000 0.0000 15.0458 21.2689

Added 1/1/07 to book

Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book

X SI= T, effect. 05/01/06 If needed add 282N Taxonomy

25999 26010 26011 26020 26025 26030 26034 26035 26037 26040 26045 26055 26060 26070 26075 26080 26100 26105

Forearm or wrist surgery Drainage of finger abscess Drainage of finger abscess Drain hand tendon sheath Drainage of palm bursa Drainage of palm bursa(s) Treat hand bone lesion Decompress fingers/hand Decompress fingers/hand Release palm contracture Release palm contracture Incise finger tendon sheath Incision of finger tendon Explore/treat hand joint Explore/treat finger joint Explore/treat finger joint Biopsy hand joint lining Biopsy finger joint lining

T T T T T T T T T T T T T T T T T T

T T T T T T T T T T T T T T T T T T

0043 0006 0007 0053 0053 0053 0053 0053 0053 0054 0054 0053 0053 0053 0053 0053 0053 0053

1.7682 1.4066 11.5594 16.4637 16.4637 16.4637 16.4637 16.4637 16.4637 26.3105 26.3105 16.4637 16.4637 16.4637 16.4637 16.4637 16.4637 16.4637

84.47 67.19 552.19 786.47 786.47 786.47 786.47 786.47 786.47 1,256.85 1,256.85 786.47 786.47 786.47 786.47 786.47 786.47 786.47

192.59 153.21 1,259.05 1,793.23 1,793.23 1,793.23 1,793.23 1,793.23 1,793.23 2,865.74 2,865.74 1,793.23 1,793.23 1,793.23 1,793.23 1,793.23 1,793.23 1,793.23

220.74 175.60 1,443.08 2,055.33 2,055.33 2,055.33 2,055.33 2,055.33 2,055.33 3,284.60 3,284.60 2,055.33 2,055.33 2,055.33 2,055.33 2,055.33 2,055.33 2,055.33

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

9 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T C C C T C T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T C C C T C T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 786.47 1,008.42 1,008.42 1,008.42 1,256.85 1,256.85 786.47 786.47 1,256.85 786.47 786.47 786.47 786.47 786.47 786.47 786.47 1,256.85 786.47 786.47 786.47 786.47 786.47 786.47 1,256.85 786.47 786.47 786.47 769.10 84.47 1,256.85 1,256.85 1,256.85 1,256.85 1,256.85 1,256.85 1,256.85 1,256.85 1,256.85 1,256.85 786.47 1,256.85 1,256.85 1,256.85 786.47 1,256.85 1,256.85 1,256.85 786.47 786.47 1,256.85 786.47 786.47 1,256.85 786.47 1,256.85 786.47 786.47 786.47 786.47 786.47 786.47 786.47 786.47 786.47 1,256.85 1,256.85 1,256.85 1,256.85 1,256.85 1,256.85 1,256.85 1,256.85 1,256.85 1,256.85 1,256.85 786.47 1,256.85 786.47 1,256.85 1,256.85 1,256.85 1,256.85 786.47 786.47 1,715.13 2,430.90 1,715.13 2,430.90 786.47 1,256.85 786.47 1,256.85 1,256.85 1,256.85 1,256.85 0.00 0.00 0.00 1,256.85 0.00 786.47 1,256.85 1,256.85 1,256.85 1,256.85 1,256.85 786.47 786.47 786.47 1,256.85 786.47 786.47 84.47 84.47 84.47 1,249.62 1,963.78 84.47 84.47 1,249.62 1,963.78 84.47 84.47 1,249.62 1,249.62 2,829.10 84.47 84.47 84.47 1,249.62 84.47 84.47 1,249.62 1,249.62 84.47 84.47 1,249.62 84.47 84.47 1,249.62 1,249.62 84.47 705.36 1,249.62 1,249.62 1,256.85 1,256.85 1,256.85 1,256.85 1,256.85 1,256.85 1,256.85 1,256.85 1,256.85 1,256.85 1,256.85 1,256.85 786.47 786.47

Children's Hospital Outpatient Fee 1,793.23 2,299.28 2,299.28 2,299.28 2,865.74 2,865.74 1,793.23 1,793.23 2,865.74 1,793.23 1,793.23 1,793.23 1,793.23 1,793.23 1,793.23 1,793.23 2,865.74 1,793.23 1,793.23 1,793.23 1,793.23 1,793.23 1,793.23 2,865.74 1,793.23 1,793.23 1,793.23 1,753.62 192.59 2,865.74 2,865.74 2,865.74 2,865.74 2,865.74 2,865.74 2,865.74 2,865.74 2,865.74 2,865.74 1,793.23 2,865.74 2,865.74 2,865.74 1,793.23 2,865.74 2,865.74 2,865.74 1,793.23 1,793.23 2,865.74 1,793.23 1,793.23 2,865.74 1,793.23 2,865.74 1,793.23 1,793.23 1,793.23 1,793.23 1,793.23 1,793.23 1,793.23 1,793.23 1,793.23 2,865.74 2,865.74 2,865.74 2,865.74 2,865.74 2,865.74 2,865.74 2,865.74 2,865.74 2,865.74 2,865.74 1,793.23 2,865.74 1,793.23 2,865.74 2,865.74 2,865.74 2,865.74 1,793.23 1,793.23 3,910.66 5,542.68 3,910.66 5,542.68 1,793.23 2,865.74 1,793.23 2,865.74 2,865.74 2,865.74 2,865.74 0.00 0.00 0.00 2,865.74 0.00 1,793.23 2,865.74 2,865.74 2,865.74 2,865.74 2,865.74 1,793.23 1,793.23 1,793.23 2,865.74 1,793.23 1,793.23 192.59 192.59 192.59 2,849.26 4,477.60 192.59 192.59 2,849.26 4,477.60 192.59 192.59 2,849.26 2,849.26 6,450.60 192.59 192.59 192.59 2,849.26 192.59 192.59 2,849.26 2,849.26 192.59 192.59 2,849.26 192.59 192.59 2,849.26 2,849.26 192.59 1,608.29 2,849.26 2,849.26 2,865.74 2,865.74 2,865.74 2,865.74 2,865.74 2,865.74 2,865.74 2,865.74 2,865.74 2,865.74 2,865.74 2,865.74 1,793.23 1,793.23

Critical PDD Access Update to Hospital ACS Outpatient Fee 2,055.33 2,635.35 2,635.35 2,635.35 3,284.60 3,284.60 2,055.33 2,055.33 3,284.60 2,055.33 2,055.33 2,055.33 2,055.33 2,055.33 2,055.33 2,055.33 3,284.60 2,055.33 2,055.33 2,055.33 2,055.33 2,055.33 2,055.33 3,284.60 2,055.33 2,055.33 2,055.33 2,009.94 220.74 3,284.60 3,284.60 3,284.60 3,284.60 3,284.60 3,284.60 3,284.60 3,284.60 3,284.60 3,284.60 2,055.33 3,284.60 3,284.60 3,284.60 2,055.33 3,284.60 3,284.60 3,284.60 2,055.33 2,055.33 3,284.60 2,055.33 2,055.33 3,284.60 2,055.33 3,284.60 2,055.33 2,055.33 2,055.33 2,055.33 2,055.33 2,055.33 2,055.33 2,055.33 2,055.33 3,284.60 3,284.60 3,284.60 3,284.60 3,284.60 3,284.60 3,284.60 3,284.60 3,284.60 3,284.60 3,284.60 2,055.33 3,284.60 2,055.33 3,284.60 3,284.60 3,284.60 3,284.60 2,055.33 2,055.33 4,482.26 6,352.81 4,482.26 6,352.81 2,055.33 3,284.60 2,055.33 3,284.60 3,284.60 3,284.60 3,284.60 0.00 0.00 0.00 3,284.60 0.00 2,055.33 3,284.60 3,284.60 3,284.60 3,284.60 3,284.60 2,055.33 2,055.33 2,055.33 3,284.60 2,055.33 2,055.33 220.74 220.74 220.74 3,265.71 5,132.06 220.74 220.74 3,265.71 5,132.06 220.74 220.74 3,265.71 3,265.71 7,393.44 220.74 220.74 220.74 3,265.71 220.74 220.74 3,265.71 3,265.71 220.74 220.74 3,265.71 220.74 220.74 3,265.71 3,265.71 220.74 1,843.36 3,265.71 3,265.71 3,284.60 3,284.60 3,284.60 3,284.60 3,284.60 3,284.60 3,284.60 3,284.60 3,284.60 3,284.60 3,284.60 3,284.60 2,055.33 2,055.33

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

26110 26115 26116 26117 26121 26123 26125 26130 26135 26140 26145 26160 26170 26180 26185 26200 26205 26210 26215 26230 26235 26236 26250 26255 26260 26261 26262 26320 26340 26350 26352 26356 26357 26358 26370 26372 26373 26390 26392 26410 26412 26415 26416 26418 26420 26426 26428 26432 26433 26434 26437 26440 26442 26445 26449 26450 26455 26460 26471 26474 26476 26477 26478 26479 26480 26483 26485 26489 26490 26492 26494 26496 26497 26498 26499 26500 26502 26508 26510 26516 26517 26518 26520 26525 26530 26531 26535 26536 26540 26541 26542 26545 26546 26548 26550 26551 26553 26554 26555 26556 26560 26561 26562 26565 26567 26568 26580 26587 26590 26591 26593 26596 26600 26605 26607 26608 26615 26641 26645 26650 26665 26670 26675 26676 26685 26686 26700 26705 26706 26715 26720 26725 26727 26735 26740 26742 26746 26750 26755 26756 26765 26770 26775 26776 26785 26820 26841 26842 26843 26844 26850 26852 26860 26861 26862 26863 26910 26951 26952

Biopsy finger joint lining Removal hand lesion subcut Removal hand lesion, deep Remove tumor, hand/finger Release palm contracture Release palm contracture Release palm contracture Remove wrist joint lining Revise finger joint, each Revise finger joint, each Tendon excision, palm/finger Remove tendon sheath lesion Removal of palm tendon, each Removal of finger tendon Remove finger bone Remove hand bone lesion Remove/graft bone lesion Removal of finger lesion Remove/graft finger lesion Partial removal of hand bone Partial removal, finger bone Partial removal, finger bone Extensive hand surgery Extensive hand surgery Extensive finger surgery Extensive finger surgery Partial removal of finger Removal of implant from hand Manipulate finger w/anesth Repair finger/hand tendon Repair/graft hand tendon Repair finger/hand tendon Repair finger/hand tendon Repair/graft hand tendon Repair finger/hand tendon Repair/graft hand tendon Repair finger/hand tendon Revise hand/finger tendon Repair/graft hand tendon Repair hand tendon Repair/graft hand tendon Excision, hand/finger tendon Graft hand or finger tendon Repair finger tendon Repair/graft finger tendon Repair finger/hand tendon Repair/graft finger tendon Repair finger tendon Repair finger tendon Repair/graft finger tendon Realignment of tendons Release palm/finger tendon Release palm & finger tendon Release hand/finger tendon Release forearm/hand tendon Incision of palm tendon Incision of finger tendon Incise hand/finger tendon Fusion of finger tendons Fusion of finger tendons Tendon lengthening Tendon shortening Lengthening of hand tendon Shortening of hand tendon Transplant hand tendon Transplant/graft hand tendon Transplant palm tendon Transplant/graft palm tendon Revise thumb tendon Tendon transfer with graft Hand tendon/muscle transfer Revise thumb tendon Finger tendon transfer Finger tendon transfer Revision of finger Hand tendon reconstruction Hand tendon reconstruction Release thumb contracture Thumb tendon transfer Fusion of knuckle joint Fusion of knuckle joints Fusion of knuckle joints Release knuckle contracture Release finger contracture Revise knuckle joint Revise knuckle with implant Revise finger joint Revise/implant finger joint Repair hand joint Repair hand joint with graft Repair hand joint with graft Reconstruct finger joint Repair nonunion hand Reconstruct finger joint Construct thumb replacement Great toe-hand transfer Single transfer, toe-hand Double transfer, toe-hand Positional change of finger Toe joint transfer Repair of web finger Repair of web finger Repair of web finger Correct metacarpal flaw Correct finger deformity Lengthen metacarpal/finger Repair hand deformity Reconstruct extra finger Repair finger deformity Repair muscles of hand Release muscles of hand Excision constricting tissue Treat metacarpal fracture Treat metacarpal fracture Treat metacarpal fracture Treat metacarpal fracture Treat metacarpal fracture Treat thumb dislocation Treat thumb fracture Treat thumb fracture Treat thumb fracture Treat hand dislocation Treat hand dislocation Pin hand dislocation Treat hand dislocation Treat hand dislocation Treat knuckle dislocation Treat knuckle dislocation Pin knuckle dislocation Treat knuckle dislocation Treat finger fracture, each Treat finger fracture, each Treat finger fracture, each Treat finger fracture, each Treat finger fracture, each Treat finger fracture, each Treat finger fracture, each Treat finger fracture, each Treat finger fracture, each Pin finger fracture, each Treat finger fracture, each Treat finger dislocation Treat finger dislocation Pin finger dislocation Treat finger dislocation Thumb fusion with graft Fusion of thumb Thumb fusion with graft Fusion of hand joint Fusion/graft of hand joint Fusion of knuckle Fusion of knuckle with graft Fusion of finger joint Fusion of finger jnt, add-on Fusion/graft of finger joint Fuse/graft added joint Amputate metacarpal bone Amputation of finger/thumb Amputation of finger/thumb

0053 0022 0022 0022 0054 0054 0053 0053 0054 0053 0053 0053 0053 0053 0053 0053 0054 0053 0053 0053 0053 0053 0053 0054 0053 0053 0053 0021 0043 0054 0054 0054 0054 0054 0054 0054 0054 0054 0054 0053 0054 0054 0054 0053 0054 0054 0054 0053 0053 0054 0053 0053 0054 0053 0054 0053 0053 0053 0053 0053 0053 0053 0053 0053 0054 0054 0054 0054 0054 0054 0054 0054 0054 0054 0054 0053 0054 0053 0054 0054 0054 0054 0053 0053 0047 0048 0047 0048 0053 0054 0053 0054 0054 0054 0054 0000 0000 0000 0054 0000 0053 0054 0054 0054 0054 0054 0053 0053 0053 0054 0053 0053 0043 0043 0043 0062 0063 0043 0043 0062 0063 0043 0043 0062 0062 0064 0043 0043 0043 0062 0043 0043 0062 0062 0043 0043 0062 0043 0043 0062 0062 0043 0045 0062 0062 0054 0054 0054 0054 0054 0054 0054 0054 0054 0054 0054 0054 0053 0053

16.4637 21.1098 21.1098 21.1098 26.3105 26.3105 16.4637 16.4637 26.3105 16.4637 16.4637 16.4637 16.4637 16.4637 16.4637 16.4637 26.3105 16.4637 16.4637 16.4637 16.4637 16.4637 16.4637 26.3105 16.4637 16.4637 16.4637 16.1001 1.7682 26.3105 26.3105 26.3105 26.3105 26.3105 26.3105 26.3105 26.3105 26.3105 26.3105 16.4637 26.3105 26.3105 26.3105 16.4637 26.3105 26.3105 26.3105 16.4637 16.4637 26.3105 16.4637 16.4637 26.3105 16.4637 26.3105 16.4637 16.4637 16.4637 16.4637 16.4637 16.4637 16.4637 16.4637 16.4637 26.3105 26.3105 26.3105 26.3105 26.3105 26.3105 26.3105 26.3105 26.3105 26.3105 26.3105 16.4637 26.3105 16.4637 26.3105 26.3105 26.3105 26.3105 16.4637 16.4637 35.9040 50.8876 35.9040 50.8876 16.4637 26.3105 16.4637 26.3105 26.3105 26.3105 26.3105 0.0000 0.0000 0.0000 26.3105 0.0000 16.4637 26.3105 26.3105 26.3105 26.3105 26.3105 16.4637 16.4637 16.4637 26.3105 16.4637 16.4637 1.7682 1.7682 1.7682 26.1592 41.1091 1.7682 1.7682 26.1592 41.1091 1.7682 1.7682 26.1592 26.1592 59.2233 1.7682 1.7682 1.7682 26.1592 1.7682 1.7682 26.1592 26.1592 1.7682 1.7682 26.1592 1.7682 1.7682 26.1592 26.1592 1.7682 14.7658 26.1592 26.1592 26.3105 26.3105 26.3105 26.3105 26.3105 26.3105 26.3105 26.3105 26.3105 26.3105 26.3105 26.3105 16.4637 16.4637

26989 26990

Hand/finger surgery Drainage of pelvis lesion

T T

T T

0043 0049

1.7682 21.2689

84.47 1,016.02

192.59 2,316.61

220.74 2,655.21

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

10 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only T C T T T C T C C T T C T T T T T T T C T T T T T C C C C C C C T T T C C N N B T T T T T T C C C C C C C C C C C C C C C C C C C C C C C C C T T T T C T C C T C C C C T C T C T C C C T C T T C C T T C C T T T C C T C C C C C C T C T T T C T C C T T C T T T T T T T C T T T T T C C C C C C C T T T C C N N B T T T T T T C C C C C C C C C C C C C C C C C C C C C C C C C T T T T C T C C T C C C C T C T C T C C C T C T T C C T T C C T T T C C T C C C C C C

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 1,016.02 0.00 1,016.02 1,394.41 1,394.41 0.00 1,394.41 0.00 0.00 2,053.39 2,053.39 0.00 414.88 414.88 1,008.42 1,008.42 1,008.42 1,016.02 1,016.02 0.00 1,016.02 1,016.02 1,016.02 1,394.41 1,394.41 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1,394.41 414.88 1,016.02 0.00 0.00 0.00 0.00 0.00 1,394.41 1,394.41 2,053.39 2,053.39 2,053.39 2,053.39 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 84.47 705.36 84.47 1,963.78 0.00 1,394.41 0.00 0.00 84.47 0.00 0.00 0.00 0.00 84.47 0.00 1,394.41 0.00 84.47 0.00 0.00 0.00 84.47 0.00 84.47 705.36 0.00 0.00 84.47 705.36 0.00 0.00 84.47 705.36 84.47 0.00 0.00 705.36 0.00 0.00 0.00 0.00 0.00 0.00

Children's Hospital Outpatient Fee 2,316.61 0.00 2,316.61 3,179.37 3,179.37 0.00 3,179.37 0.00 0.00 4,681.93 4,681.93 0.00 945.97 945.97 2,299.28 2,299.28 2,299.28 2,316.61 2,316.61 0.00 2,316.61 2,316.61 2,316.61 3,179.37 3,179.37 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3,179.37 945.97 2,316.61 0.00 0.00 0.00 0.00 0.00 3,179.37 3,179.37 4,681.93 4,681.93 4,681.93 4,681.93 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 192.59 1,608.29 192.59 4,477.60 0.00 3,179.37 0.00 0.00 192.59 0.00 0.00 0.00 0.00 192.59 0.00 3,179.37 0.00 192.59 0.00 0.00 0.00 192.59 0.00 192.59 1,608.29 0.00 0.00 192.59 1,608.29 0.00 0.00 192.59 1,608.29 192.59 0.00 0.00 1,608.29 0.00 0.00 0.00 0.00 0.00 0.00

Critical PDD Access Update to Hospital ACS Outpatient Fee 2,655.21 0.00 2,655.21 3,644.08 3,644.08 0.00 3,644.08 0.00 0.00 5,366.25 5,366.25 0.00 1,084.24 1,084.24 2,635.35 2,635.35 2,635.35 2,655.21 2,655.21 0.00 2,655.21 2,655.21 2,655.21 3,644.08 3,644.08 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3,644.08 1,084.24 2,655.21 0.00 0.00 0.00 0.00 0.00 3,644.08 3,644.08 5,366.25 5,366.25 5,366.25 5,366.25 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 220.74 1,843.36 220.74 5,132.06 0.00 3,644.08 0.00 0.00 220.74 0.00 0.00 0.00 0.00 220.74 0.00 3,644.08 0.00 220.74 0.00 0.00 0.00 220.74 0.00 220.74 1,843.36 0.00 0.00 220.74 1,843.36 0.00 0.00 220.74 1,843.36 220.74 0.00 0.00 1,843.36 0.00 0.00 0.00 0.00 0.00 0.00

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

26991 26992 27000 27001 27003 27005 27006 27025 27030 27033 27035 27036 27040 27041 27047 27048 27049 27050 27052 27054 27060 27062 27065 27066 27067 27070 27071 27075 27076 27077 27078 27079 27080 27086 27087 27090 27091 27093 27095 27096 27097 27098 27100 27105 27110 27111 27120 27122 27125 27130 27132 27134 27137 27138 27140 27146 27147 27151 27156 27158 27161 27165 27170 27175 27176 27177 27178 27179 27181 27185 27187 27193 27194 27200 27202 27215 27216 27217 27218 27220 27222 27226 27227 27228 27230 27232 27235 27236 27238 27240 27244 27245 27246 27248 27250 27252 27253 27254 27256 27257 27258 27259 27265 27266 27267 27268 27269 27275 27280 27282 27284 27286 27290 27295

Drainage of pelvis bursa Drainage of bone lesion Incision of hip tendon Incision of hip tendon Incision of hip tendon Incision of hip tendon Incision of hip tendons Incision of hip/thigh fascia Drainage of hip joint Exploration of hip joint Denervation of hip joint Excision of hip joint/muscle Biopsy of soft tissues Biopsy of soft tissues Remove hip/pelvis lesion Remove hip/pelvis lesion Remove tumor, hip/pelvis Biopsy of sacroiliac joint Biopsy of hip joint Removal of hip joint lining Removal of ischial bursa Remove femur lesion/bursa Removal of hip bone lesion Removal of hip bone lesion Remove/graft hip bone lesion Partial removal of hip bone Partial removal of hip bone Extensive hip surgery Extensive hip surgery Extensive hip surgery Extensive hip surgery Extensive hip surgery Removal of tail bone Remove hip foreign body Remove hip foreign body Removal of hip prosthesis Removal of hip prosthesis Injection for hip x-ray Injection for hip x-ray Inject sacroiliac joint Revision of hip tendon Transfer tendon to pelvis Transfer of abdominal muscle Transfer of spinal muscle Transfer of iliopsoas muscle Transfer of iliopsoas muscle Reconstruction of hip socket Reconstruction of hip socket Partial hip replacement Total hip arthroplasty Total hip arthroplasty Revise hip joint replacement Revise hip joint replacement Revise hip joint replacement Transplant femur ridge Incision of hip bone Revision of hip bone Incision of hip bones Revision of hip bones Revision of pelvis Incision of neck of femur Incision/fixation of femur Repair/graft femur head/neck Treat slipped epiphysis Treat slipped epiphysis Treat slipped epiphysis Treat slipped epiphysis Revise head/neck of femur Treat slipped epiphysis Revision of femur epiphysis Reinforce hip bones Treat pelvic ring fracture Treat pelvic ring fracture Treat tail bone fracture Treat tail bone fracture Treat pelvic fracture(s) Treat pelvic ring fracture Treat pelvic ring fracture Treat pelvic ring fracture Treat hip socket fracture Treat hip socket fracture Treat hip wall fracture Treat hip fracture(s) Treat hip fracture(s) Treat thigh fracture Treat thigh fracture Treat thigh fracture Treat thigh fracture Treat thigh fracture Treat thigh fracture Treat thigh fracture Treat thigh fracture Treat thigh fracture Treat thigh fracture Treat hip dislocation Treat hip dislocation Treat hip dislocation Treat hip dislocation Treat hip dislocation Treat hip dislocation Treat hip dislocation Treat hip dislocation Treat hip dislocation Treat hip dislocation Cltx thigh fx Cltx thigh fx w/mnpj Optx thigh fx Manipulation of hip joint Fusion of sacroiliac joint Fusion of pubic bones Fusion of hip joint Fusion of hip joint Amputation of leg at hip Amputation of leg at hip

0049 0000 0049 0050 0050 0000 0050 0000 0000 0051 0051 0000 0020 0020 0022 0022 0022 0049 0049 0000 0049 0049 0049 0050 0050 0000 0000 0000 0000 0000 0000 0000 0050 0020 0049 0000 0000 0000 0000 0000 0050 0050 0051 0051 0051 0051 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0043 0045 0043 0063 0000 0050 0000 0000 0043 0000 0000 0000 0000 0043 0000 0050 0000 0043 0000 0000 0000 0043 0000 0043 0045 0000 0000 0043 0045 0000 0000 0043 0045 0043 0000 0000 0045 0000 0000 0000 0000 0000 0000

21.2689 0.0000 21.2689 29.1900 29.1900 0.0000 29.1900 0.0000 0.0000 42.9850 42.9850 0.0000 8.6850 8.6850 21.1098 21.1098 21.1098 21.2689 21.2689 0.0000 21.2689 21.2689 21.2689 29.1900 29.1900 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 29.1900 8.6850 21.2689 0.0000 0.0000 0.0000 0.0000 0.0000 29.1900 29.1900 42.9850 42.9850 42.9850 42.9850 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 1.7682 14.7658 1.7682 41.1091 0.0000 29.1900 0.0000 0.0000 1.7682 0.0000 0.0000 0.0000 0.0000 1.7682 0.0000 29.1900 0.0000 1.7682 0.0000 0.0000 0.0000 1.7682 0.0000 1.7682 14.7658 0.0000 0.0000 1.7682 14.7658 0.0000 0.0000 1.7682 14.7658 1.7682 0.0000 0.0000 14.7658 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

X

X X X

27299 27301 27303 27305 27306 27307 27310 27323 27324 27325 27326 27327 27328 27329 27330 27331 27332 27333 27334 27335 27340 27345 27347 27350 27355 27356 27357 27358 27360 27365 27370 27372 27380 27381 27385 27386 27390 27391 27392 27393 27394 27395 27396 27397 27400 27403 27405

Pelvis/hip joint surgery Drain thigh/knee lesion Drainage of bone lesion Incise thigh tendon & fascia Incision of thigh tendon Incision of thigh tendons Exploration of knee joint Biopsy, thigh soft tissues Biopsy, thigh soft tissues Neurectomy, hamstring Neurectomy, popliteal Removal of thigh lesion Removal of thigh lesion Remove tumor, thigh/knee Biopsy, knee joint lining Explore/treat knee joint Removal of knee cartilage Removal of knee cartilage Remove knee joint lining Remove knee joint lining Removal of kneecap bursa Removal of knee cyst Remove knee cyst Removal of kneecap Remove femur lesion Remove femur lesion/graft Remove femur lesion/graft Remove femur lesion/fixation Partial removal, leg bone(s) Extensive leg surgery Injection for knee x-ray Removal of foreign body Repair of kneecap tendon Repair/graft kneecap tendon Repair of thigh muscle Repair/graft of thigh muscle Incision of thigh tendon Incision of thigh tendons Incision of thigh tendons Lengthening of thigh tendon Lengthening of thigh tendons Lengthening of thigh tendons Transplant of thigh tendon Transplants of thigh tendons Revise thigh muscles/tendons Repair of knee cartilage Repair of knee ligament

T T C T T T T T T T T T T T T T T T T T T T T T T T T T T C N T T T T T T T T T T T T T T T T

T T C T T T T T T T T T T T T T T T T T T T T T T T T T T C N T T T T T T T T T T T T T T T T

0043 0008 0000 0049 0049 0049 0050 0020 0022 0220 0220 0022 0022 0022 0050 0050 0050 0050 0050 0050 0049 0049 0049 0050 0050 0050 0050 0050 0050 0000 0000 0022 0049 0049 0049 0049 0049 0049 0049 0050 0050 0051 0050 0051 0051 0050 0051

1.7682 18.3197 0.0000 21.2689 21.2689 21.2689 29.1900 8.6850 21.1098 18.0518 18.0518 21.1098 21.1098 21.1098 29.1900 29.1900 29.1900 29.1900 29.1900 29.1900 21.2689 21.2689 21.2689 29.1900 29.1900 29.1900 29.1900 29.1900 29.1900 0.0000 0.0000 21.1098 21.2689 21.2689 21.2689 21.2689 21.2689 21.2689 21.2689 29.1900 29.1900 42.9850 29.1900 42.9850 42.9850 29.1900 42.9850

84.47 875.13 0.00 1,016.02 1,016.02 1,016.02 1,394.41 414.88 1,008.42 862.33 862.33 1,008.42 1,008.42 1,008.42 1,394.41 1,394.41 1,394.41 1,394.41 1,394.41 1,394.41 1,016.02 1,016.02 1,016.02 1,394.41 1,394.41 1,394.41 1,394.41 1,394.41 1,394.41 0.00 0.00 1,008.42 1,016.02 1,016.02 1,016.02 1,016.02 1,016.02 1,016.02 1,016.02 1,394.41 1,394.41 2,053.39 1,394.41 2,053.39 2,053.39 1,394.41 2,053.39

192.59 1,995.38 0.00 2,316.61 2,316.61 2,316.61 3,179.37 945.97 2,299.28 1,966.20 1,966.20 2,299.28 2,299.28 2,299.28 3,179.37 3,179.37 3,179.37 3,179.37 3,179.37 3,179.37 2,316.61 2,316.61 2,316.61 3,179.37 3,179.37 3,179.37 3,179.37 3,179.37 3,179.37 0.00 0.00 2,299.28 2,316.61 2,316.61 2,316.61 2,316.61 2,316.61 2,316.61 2,316.61 3,179.37 3,179.37 4,681.93 3,179.37 4,681.93 4,681.93 3,179.37 4,681.93

220.74 2,287.03 0.00 2,655.21 2,655.21 2,655.21 3,644.08 1,084.24 2,635.35 2,253.59 2,253.59 2,635.35 2,635.35 2,635.35 3,644.08 3,644.08 3,644.08 3,644.08 3,644.08 3,644.08 2,655.21 2,655.21 2,655.21 3,644.08 3,644.08 3,644.08 3,644.08 3,644.08 3,644.08 0.00 0.00 2,635.35 2,655.21 2,655.21 2,655.21 2,655.21 2,655.21 2,655.21 2,655.21 3,644.08 3,644.08 5,366.25 3,644.08 5,366.25 5,366.25 3,644.08 5,366.25

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

Added 1/1/07 to book Added 1/1/07 to book

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

11 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only T T T T T T T T T T T T T T T T T T T T T C T C C C C C C C C C C C T C C C C C C C T T T T T T T T C C T T T C C C T T C T T T T C C T C T T C C C T T T T C C C C T C C T T T T T T T T T T T T T T T T T T T T T C T C C C C C C C C C C C T C C C C C C C T T T T T T T T C C T T T C C C T T C T T T T C C T C T T C C C T T T T C C C C T C C

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 3,794.10 2,053.39 2,183.43 2,183.43 2,053.39 2,053.39 2,053.39 2,053.39 2,053.39 1,394.41 2,053.39 3,794.10 3,794.10 2,053.39 2,053.39 1,715.13 2,430.90 1,715.13 1,715.13 1,715.13 1,715.13 0.00 13,121.06 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1,394.41 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1,016.02 1,016.02 1,016.02 1,016.02 84.47 84.47 84.47 84.47 0.00 0.00 84.47 1,249.62 84.47 0.00 0.00 0.00 84.47 84.47 0.00 84.47 1,963.78 84.47 84.47 0.00 0.00 84.47 0.00 84.47 705.36 0.00 0.00 0.00 84.47 705.36 1,963.78 705.36 0.00 0.00 0.00 0.00 1,016.02 0.00 0.00

Children's Hospital Outpatient Fee 8,650.91 4,681.93 4,978.43 4,978.43 4,681.93 4,681.93 4,681.93 4,681.93 4,681.93 3,179.37 4,681.93 8,650.91 8,650.91 4,681.93 4,681.93 3,910.66 5,542.68 3,910.66 3,910.66 3,910.66 3,910.66 0.00 29,917.22 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3,179.37 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2,316.61 2,316.61 2,316.61 2,316.61 192.59 192.59 192.59 192.59 0.00 0.00 192.59 2,849.26 192.59 0.00 0.00 0.00 192.59 192.59 0.00 192.59 4,477.60 192.59 192.59 0.00 0.00 192.59 0.00 192.59 1,608.29 0.00 0.00 0.00 192.59 1,608.29 4,477.60 1,608.29 0.00 0.00 0.00 0.00 2,316.61 0.00 0.00

Critical PDD Access Update to Hospital ACS Outpatient Fee 9,915.34 5,366.25 5,706.09 5,706.09 5,366.25 5,366.25 5,366.25 5,366.25 5,366.25 3,644.08 5,366.25 9,915.34 9,915.34 5,366.25 5,366.25 4,482.26 6,352.81 4,482.26 4,482.26 4,482.26 4,482.26 0.00 34,289.99 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3,644.08 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2,655.21 2,655.21 2,655.21 2,655.21 220.74 220.74 220.74 220.74 0.00 0.00 220.74 3,265.71 220.74 0.00 0.00 0.00 220.74 220.74 0.00 220.74 5,132.06 220.74 220.74 0.00 0.00 220.74 0.00 220.74 1,843.36 0.00 0.00 0.00 220.74 1,843.36 5,132.06 1,843.36 0.00 0.00 0.00 0.00 2,655.21 0.00 0.00

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

27407 27409 27412 27415 27416 27418 27420 27422 27424 27425 27427 27428 27429 27430 27435 27437 27438 27440 27441 27442 27443 27445 27446 27447 27448 27450 27454 27455 27457 27465 27466 27468 27470 27472 27475 27477 27479 27485 27486 27487 27488 27495 27496 27497 27498 27499 27500 27501 27502 27503 27506 27507 27508 27509 27510 27511 27513 27514 27516 27517 27519 27520 27524 27530 27532 27535 27536 27538 27540 27550 27552 27556 27557 27558 27560 27562 27566 27570 27580 27590 27591 27592 27594 27596 27598

Repair of knee ligament Repair of knee ligaments Autochondrocyte implant knee Osteochondral knee allograft Osteochondral knee autograft Repair degenerated kneecap Revision of unstable kneecap Revision of unstable kneecap Revision/removal of kneecap Lat retinacular release open Reconstruction, knee Reconstruction, knee Reconstruction, knee Revision of thigh muscles Incision of knee joint Revise kneecap Revise kneecap with implant Revision of knee joint Revision of knee joint Revision of knee joint Revision of knee joint Revision of knee joint Revision of knee joint Total knee arthroplasty Incision of thigh Incision of thigh Realignment of thigh bone Realignment of knee Realignment of knee Shortening of thigh bone Lengthening of thigh bone Shorten/lengthen thighs Repair of thigh Repair/graft of thigh Surgery to stop leg growth Surgery to stop leg growth Surgery to stop leg growth Surgery to stop leg growth Revise/replace knee joint Revise/replace knee joint Removal of knee prosthesis Reinforce thigh Decompression of thigh/knee Decompression of thigh/knee Decompression of thigh/knee Decompression of thigh/knee Treatment of thigh fracture Treatment of thigh fracture Treatment of thigh fracture Treatment of thigh fracture Treatment of thigh fracture Treatment of thigh fracture Treatment of thigh fracture Treatment of thigh fracture Treatment of thigh fracture Treatment of thigh fracture Treatment of thigh fracture Treatment of thigh fracture Treat thigh fx growth plate Treat thigh fx growth plate Treat thigh fx growth plate Treat kneecap fracture Treat kneecap fracture Treat knee fracture Treat knee fracture Treat knee fracture Treat knee fracture Treat knee fracture(s) Treat knee fracture Treat knee dislocation Treat knee dislocation Treat knee dislocation Treat knee dislocation Treat knee dislocation Treat kneecap dislocation Treat kneecap dislocation Treat kneecap dislocation Fixation of knee joint Fusion of knee Amputate leg at thigh Amputate leg at thigh Amputate leg at thigh Amputation follow-up surgery Amputation follow-up surgery Amputate lower leg at knee

0052 0051 0042 0042 0051 0051 0051 0051 0051 0050 0051 0052 0052 0051 0051 0047 0048 0047 0047 0047 0047 0000 0681 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0050 0000 0000 0000 0000 0000 0000 0000 0049 0049 0049 0049 0043 0043 0043 0043 0000 0000 0043 0062 0043 0000 0000 0000 0043 0043 0000 0043 0063 0043 0043 0000 0000 0043 0000 0043 0045 0000 0000 0000 0043 0045 0063 0045 0000 0000 0000 0000 0049 0000 0000

79.4244 42.9850 45.7072 45.7072 42.9850 42.9850 42.9850 42.9850 42.9850 29.1900 42.9850 79.4244 79.4244 42.9850 42.9850 35.9040 50.8876 35.9040 35.9040 35.9040 35.9040 0.0000 274.6715 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 29.1900 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 21.2689 21.2689 21.2689 21.2689 1.7682 1.7682 1.7682 1.7682 0.0000 0.0000 1.7682 26.1592 1.7682 0.0000 0.0000 0.0000 1.7682 1.7682 0.0000 1.7682 41.1091 1.7682 1.7682 0.0000 0.0000 1.7682 0.0000 1.7682 14.7658 0.0000 0.0000 0.0000 1.7682 14.7658 41.1091 14.7658 0.0000 0.0000 0.0000 0.0000 21.2689 0.0000 0.0000

X

27599 27600 27601 27602 27603 27604 27605 27606 27607 27610 27612 27613 27614 27615 27618 27619 27620 27625 27626 27630 27635 27637 27638 27640 27641 27645 27646 27647 27648 27650 27652 27654 27656 27658 27659 27664 27665 27675 27676 27680 27681 27685 27686 27687 27690 27691 27692 27695 27696 27698 27700 27702 27703 27704 27705 27707 27709 27712 27715 27720 27722 27724 27725 27726 27727 27730 27732 27734 27740 27742 27745 27750 27752 27756 27758 27759

Leg surgery procedure Decompression of lower leg Decompression of lower leg Decompression of lower leg Drain lower leg lesion Drain lower leg bursa Incision of achilles tendon Incision of achilles tendon Treat lower leg bone lesion Explore/treat ankle joint Exploration of ankle joint Biopsy lower leg soft tissue Biopsy lower leg soft tissue Remove tumor, lower leg Remove lower leg lesion Remove lower leg lesion Explore/treat ankle joint Remove ankle joint lining Remove ankle joint lining Removal of tendon lesion Remove lower leg bone lesion Remove/graft leg bone lesion Remove/graft leg bone lesion Partial removal of tibia Partial removal of fibula Extensive lower leg surgery Extensive lower leg surgery Extensive ankle/heel surgery Injection for ankle x-ray Repair achilles tendon Repair/graft achilles tendon Repair of achilles tendon Repair leg fascia defect Repair of leg tendon, each Repair of leg tendon, each Repair of leg tendon, each Repair of leg tendon, each Repair lower leg tendons Repair lower leg tendons Release of lower leg tendon Release of lower leg tendons Revision of lower leg tendon Revise lower leg tendons Revision of calf tendon Revise lower leg tendon Revise lower leg tendon Revise additional leg tendon Repair of ankle ligament Repair of ankle ligaments Repair of ankle ligament Revision of ankle joint Reconstruct ankle joint Reconstruction, ankle joint Removal of ankle implant Incision of tibia Incision of fibula Incision of tibia & fibula Realignment of lower leg Revision of lower leg Repair of tibia Repair/graft of tibia Repair/graft of tibia Repair of lower leg Repair fibula nonunion Repair of lower leg Repair of tibia epiphysis Repair of fibula epiphysis Repair lower leg epiphyses Repair of leg epiphyses Repair of leg epiphyses Reinforce tibia Treatment of tibia fracture Treatment of tibia fracture Treatment of tibia fracture Treatment of tibia fracture Treatment of tibia fracture

T T T T T T T T T T T T T T T T T T T T T T T T T C C T N T T T T T T T T T T T T T T T T T T T T T T C C T T T T C C T T C C T C T T T T T T T T T T T

T T T T T T T T T T T T T T T T T T T T T T T T T C C T N T T T T T T T T T T T T T T T T T T T T T T C C T T T T C C T T C C T C T T T T T T T T T T T

0043 0049 0049 0049 0008 0049 0055 0049 0049 0050 0050 0020 0022 0050 0021 0022 0050 0050 0050 0049 0050 0050 0050 0051 0050 0000 0000 0051 0000 0051 0052 0051 0049 0049 0049 0049 0050 0049 0050 0050 0050 0050 0050 0050 0051 0051 0051 0050 0050 0050 0047 0000 0000 0049 0051 0049 0050 0000 0000 0063 0064 0000 0000 0062 0000 0050 0050 0050 0050 0051 0052 0043 0043 0062 0063 0064

1.7682 21.2689 21.2689 21.2689 18.3197 21.2689 20.8284 21.2689 21.2689 29.1900 29.1900 8.6850 21.1098 29.1900 16.1001 21.1098 29.1900 29.1900 29.1900 21.2689 29.1900 29.1900 29.1900 42.9850 29.1900 0.0000 0.0000 42.9850 0.0000 42.9850 79.4244 42.9850 21.2689 21.2689 21.2689 21.2689 29.1900 21.2689 29.1900 29.1900 29.1900 29.1900 29.1900 29.1900 42.9850 42.9850 42.9850 29.1900 29.1900 29.1900 35.9040 0.0000 0.0000 21.2689 42.9850 21.2689 29.1900 0.0000 0.0000 41.1091 59.2233 0.0000 0.0000 26.1592 0.0000 29.1900 29.1900 29.1900 29.1900 42.9850 79.4244 1.7682 1.7682 26.1592 41.1091 59.2233

84.47 1,016.02 1,016.02 1,016.02 875.13 1,016.02 994.97 1,016.02 1,016.02 1,394.41 1,394.41 414.88 1,008.42 1,394.41 769.10 1,008.42 1,394.41 1,394.41 1,394.41 1,016.02 1,394.41 1,394.41 1,394.41 2,053.39 1,394.41 0.00 0.00 2,053.39 0.00 2,053.39 3,794.10 2,053.39 1,016.02 1,016.02 1,016.02 1,016.02 1,394.41 1,016.02 1,394.41 1,394.41 1,394.41 1,394.41 1,394.41 1,394.41 2,053.39 2,053.39 2,053.39 1,394.41 1,394.41 1,394.41 1,715.13 0.00 0.00 1,016.02 2,053.39 1,016.02 1,394.41 0.00 0.00 1,963.78 2,829.10 0.00 0.00 1,249.62 0.00 1,394.41 1,394.41 1,394.41 1,394.41 2,053.39 3,794.10 84.47 84.47 1,249.62 1,963.78 2,829.10

192.59 2,316.61 2,316.61 2,316.61 1,995.38 2,316.61 2,268.63 2,316.61 2,316.61 3,179.37 3,179.37 945.97 2,299.28 3,179.37 1,753.62 2,299.28 3,179.37 3,179.37 3,179.37 2,316.61 3,179.37 3,179.37 3,179.37 4,681.93 3,179.37 0.00 0.00 4,681.93 0.00 4,681.93 8,650.91 4,681.93 2,316.61 2,316.61 2,316.61 2,316.61 3,179.37 2,316.61 3,179.37 3,179.37 3,179.37 3,179.37 3,179.37 3,179.37 4,681.93 4,681.93 4,681.93 3,179.37 3,179.37 3,179.37 3,910.66 0.00 0.00 2,316.61 4,681.93 2,316.61 3,179.37 0.00 0.00 4,477.60 6,450.60 0.00 0.00 2,849.26 0.00 3,179.37 3,179.37 3,179.37 3,179.37 4,681.93 8,650.91 192.59 192.59 2,849.26 4,477.60 6,450.60

220.74 2,655.21 2,655.21 2,655.21 2,287.03 2,655.21 2,600.22 2,655.21 2,655.21 3,644.08 3,644.08 1,084.24 2,635.35 3,644.08 2,009.94 2,635.35 3,644.08 3,644.08 3,644.08 2,655.21 3,644.08 3,644.08 3,644.08 5,366.25 3,644.08 0.00 0.00 5,366.25 0.00 5,366.25 9,915.34 5,366.25 2,655.21 2,655.21 2,655.21 2,655.21 3,644.08 2,655.21 3,644.08 3,644.08 3,644.08 3,644.08 3,644.08 3,644.08 5,366.25 5,366.25 5,366.25 3,644.08 3,644.08 3,644.08 4,482.26 0.00 0.00 2,655.21 5,366.25 2,655.21 3,644.08 0.00 0.00 5,132.06 7,393.44 0.00 0.00 3,265.71 0.00 3,644.08 3,644.08 3,644.08 3,644.08 5,366.25 9,915.34 220.74 220.74 3,265.71 5,132.06 7,393.44

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

X X

X

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

12 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T C C C T C C T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T C C C T C C T T T T

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 84.47 84.47 1,963.78 84.47 84.47 1,963.78 84.47 84.47 1,963.78 84.47 84.47 1,963.78 84.47 84.47 1,963.78 84.47 84.47 1,963.78 2,829.10 84.47 84.47 1,963.78 2,829.10 2,829.10 1,963.78 84.47 84.47 1,963.78 84.47 705.36 1,963.78 1,963.78 705.36 3,794.10 3,794.10 0.00 0.00 0.00 1,016.02 0.00 0.00 1,394.41 1,016.02 1,016.02 1,016.02

Children's Hospital Outpatient Fee 192.59 192.59 4,477.60 192.59 192.59 4,477.60 192.59 192.59 4,477.60 192.59 192.59 4,477.60 192.59 192.59 4,477.60 192.59 192.59 4,477.60 6,450.60 192.59 192.59 4,477.60 6,450.60 6,450.60 4,477.60 192.59 192.59 4,477.60 192.59 1,608.29 4,477.60 4,477.60 1,608.29 8,650.91 8,650.91 0.00 0.00 0.00 2,316.61 0.00 0.00 3,179.37 2,316.61 2,316.61 2,316.61

Critical PDD Access Update to Hospital ACS Outpatient Fee 220.74 220.74 5,132.06 220.74 220.74 5,132.06 220.74 220.74 5,132.06 220.74 220.74 5,132.06 220.74 220.74 5,132.06 220.74 220.74 5,132.06 7,393.44 220.74 220.74 5,132.06 7,393.44 7,393.44 5,132.06 220.74 220.74 5,132.06 220.74 1,843.36 5,132.06 5,132.06 1,843.36 9,915.34 9,915.34 0.00 0.00 0.00 2,655.21 0.00 0.00 3,644.08 2,655.21 2,655.21 2,655.21

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule x x x X X X

27760 27762 27766 27767 27768 27769 27780 27781 27784 27786 27788 27792 27808 27810 27814 27816 27818 27822 27823 27824 27825 27826 27827 27828 27829 27830 27831 27832 27840 27842 27846 27848 27860 27870 27871 27880 27881 27882 27884 27886 27888 27889 27892 27893 27894

Cltx medial ankle fx Cltx med ankle fx w/mnpj Optx medial ankle fx Cltx post ankle fx Cltx post ankle fx w/mnpj Optx post ankle fx Treatment of fibula fracture Treatment of fibula fracture Treatment of fibula fracture Treatment of ankle fracture Treatment of ankle fracture Treatment of ankle fracture Treatment of ankle fracture Treatment of ankle fracture Treatment of ankle fracture Treatment of ankle fracture Treatment of ankle fracture Treatment of ankle fracture Treatment of ankle fracture Treat lower leg fracture Treat lower leg fracture Treat lower leg fracture Treat lower leg fracture Treat lower leg fracture Treat lower leg joint Treat lower leg dislocation Treat lower leg dislocation Treat lower leg dislocation Treat ankle dislocation Treat ankle dislocation Treat ankle dislocation Treat ankle dislocation Fixation of ankle joint Fusion of ankle joint, open Fusion of tibiofibular joint Amputation of lower leg Amputation of lower leg Amputation of lower leg Amputation follow-up surgery Amputation follow-up surgery Amputation of foot at ankle Amputation of foot at ankle Decompression of leg Decompression of leg Decompression of leg

0043 0043 0063 0043 0043 0063 0043 0043 0063 0043 0043 0063 0043 0043 0063 0043 0043 0063 0064 0043 0043 0063 0064 0064 0063 0043 0043 0063 0043 0045 0063 0063 0045 0052 0052 0000 0000 0000 0049 0000 0000 0050 0049 0049 0049

1.7682 1.7682 41.1091 1.7682 1.7682 41.1091 1.7682 1.7682 41.1091 1.7682 1.7682 41.1091 1.7682 1.7682 41.1091 1.7682 1.7682 41.1091 59.2233 1.7682 1.7682 41.1091 59.2233 59.2233 41.1091 1.7682 1.7682 41.1091 1.7682 14.7658 41.1091 41.1091 14.7658 79.4244 79.4244 0.0000 0.0000 0.0000 21.2689 0.0000 0.0000 29.1900 21.2689 21.2689 21.2689

Description Change Description Change Description Change

27899 28001 28002 28003 28005 28008 28010 28011 28020 28022 28024 28035 28043 28045 28046 28050 28052 28054 28055 28060 28062 28070 28072 28080 28086 28088 28090 28092 28100 28102 28103 28104 28106 28107 28108 28110 28111 28112 28113 28114 28116 28118 28119 28120 28122 28124 28126 28130 28140 28150 28153 28160 28171 28173 28175 28190 28192 28193 28200 28202 28208 28210 28220 28222 28225 28226 28230 28232 28234 28238 28240 28250 28260 28261 28262 28264 28270 28272 28280 28285 28286 28288 28289 28290 28292 28293 28294 28296 28297 28298 28299 28300 28302 28304 28305 28306 28307 28308 28309 28310 28312 28313 28315 28320 28322 28340 28341 28344 28345 28360 28400 28405 28406 28415 28420 28430

Leg/ankle surgery procedure Drainage of bursa of foot Treatment of foot infection Treatment of foot infection Treat foot bone lesion Incision of foot fascia Incision of toe tendon Incision of toe tendons Exploration of foot joint Exploration of foot joint Exploration of toe joint Decompression of tibia nerve Excision of foot lesion Excision of foot lesion Resection of tumor, foot Biopsy of foot joint lining Biopsy of foot joint lining Biopsy of toe joint lining Neurectomy, foot Partial removal, foot fascia Removal of foot fascia Removal of foot joint lining Removal of foot joint lining Removal of foot lesion Excise foot tendon sheath Excise foot tendon sheath Removal of foot lesion Removal of toe lesions Removal of ankle/heel lesion Remove/graft foot lesion Remove/graft foot lesion Removal of foot lesion Remove/graft foot lesion Remove/graft foot lesion Removal of toe lesions Part removal of metatarsal Part removal of metatarsal Part removal of metatarsal Part removal of metatarsal Removal of metatarsal heads Revision of foot Removal of heel bone Removal of heel spur Part removal of ankle/heel Partial removal of foot bone Partial removal of toe Partial removal of toe Removal of ankle bone Removal of metatarsal Removal of toe Partial removal of toe Partial removal of toe Extensive foot surgery Extensive foot surgery Extensive foot surgery Removal of foot foreign body Removal of foot foreign body Removal of foot foreign body Repair of foot tendon Repair/graft of foot tendon Repair of foot tendon Repair/graft of foot tendon Release of foot tendon Release of foot tendons Release of foot tendon Release of foot tendons Incision of foot tendon(s) Incision of toe tendon Incision of foot tendon Revision of foot tendon Release of big toe Revision of foot fascia Release of midfoot joint Revision of foot tendon Revision of foot and ankle Release of midfoot joint Release of foot contracture Release of toe joint, each Fusion of toes Repair of hammertoe Repair of hammertoe Partial removal of foot bone Repair hallux rigidus Correction of bunion Correction of bunion Correction of bunion Correction of bunion Correction of bunion Correction of bunion Correction of bunion Correction of bunion Incision of heel bone Incision of ankle bone Incision of midfoot bones Incise/graft midfoot bones Incision of metatarsal Incision of metatarsal Incision of metatarsal Incision of metatarsals Revision of big toe Revision of toe Repair deformity of toe Removal of sesamoid bone Repair of foot bones Repair of metatarsals Resect enlarged toe tissue Resect enlarged toe Repair extra toe(s) Repair webbed toe(s) Reconstruct cleft foot Treatment of heel fracture Treatment of heel fracture Treatment of heel fracture Treat heel fracture Treat/graft heel fracture Treatment of ankle fracture

T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T

T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T

0043 0007 0049 0049 0055 0055 0055 0055 0055 0055 0055 0220 0022 0055 0055 0055 0055 0055 0220 0055 0055 0055 0055 0055 0055 0055 0055 0055 0055 0056 0056 0055 0056 0056 0055 0055 0055 0055 0055 0055 0055 0055 0055 0055 0055 0055 0055 0055 0055 0055 0055 0055 0055 0055 0055 0019 0021 0020 0055 0055 0055 0056 0055 0055 0055 0055 0055 0055 0055 0056 0055 0055 0055 0055 0055 0056 0055 0055 0055 0055 0055 0055 0055 0057 0057 0057 0057 0057 0057 0057 0057 0056 0055 0056 0056 0055 0055 0055 0056 0055 0055 0055 0055 0056 0056 0055 0055 0055 0055 0056 0043 0043 0062 0064 0063 0043

1.7682 11.5594 21.2689 21.2689 20.8284 20.8284 20.8284 20.8284 20.8284 20.8284 20.8284 18.0518 21.1098 20.8284 20.8284 20.8284 20.8284 20.8284 18.0518 20.8284 20.8284 20.8284 20.8284 20.8284 20.8284 20.8284 20.8284 20.8284 20.8284 44.2687 44.2687 20.8284 44.2687 44.2687 20.8284 20.8284 20.8284 20.8284 20.8284 20.8284 20.8284 20.8284 20.8284 20.8284 20.8284 20.8284 20.8284 20.8284 20.8284 20.8284 20.8284 20.8284 20.8284 20.8284 20.8284 4.3039 16.1001 8.6850 20.8284 20.8284 20.8284 44.2687 20.8284 20.8284 20.8284 20.8284 20.8284 20.8284 20.8284 44.2687 20.8284 20.8284 20.8284 20.8284 20.8284 44.2687 20.8284 20.8284 20.8284 20.8284 20.8284 20.8284 20.8284 29.4167 29.4167 29.4167 29.4167 29.4167 29.4167 29.4167 29.4167 44.2687 20.8284 44.2687 44.2687 20.8284 20.8284 20.8284 44.2687 20.8284 20.8284 20.8284 20.8284 44.2687 44.2687 20.8284 20.8284 20.8284 20.8284 44.2687 1.7682 1.7682 26.1592 59.2233 41.1091 1.7682

84.47 552.19 1,016.02 1,016.02 994.97 994.97 994.97 994.97 994.97 994.97 994.97 862.33 1,008.42 994.97 994.97 994.97 994.97 994.97 862.33 994.97 994.97 994.97 994.97 994.97 994.97 994.97 994.97 994.97 994.97 2,114.72 2,114.72 994.97 2,114.72 2,114.72 994.97 994.97 994.97 994.97 994.97 994.97 994.97 994.97 994.97 994.97 994.97 994.97 994.97 994.97 994.97 994.97 994.97 994.97 994.97 994.97 994.97 205.60 769.10 414.88 994.97 994.97 994.97 2,114.72 994.97 994.97 994.97 994.97 994.97 994.97 994.97 2,114.72 994.97 994.97 994.97 994.97 994.97 2,114.72 994.97 994.97 994.97 994.97 994.97 994.97 994.97 1,405.24 1,405.24 1,405.24 1,405.24 1,405.24 1,405.24 1,405.24 1,405.24 2,114.72 994.97 2,114.72 2,114.72 994.97 994.97 994.97 2,114.72 994.97 994.97 994.97 994.97 2,114.72 2,114.72 994.97 994.97 994.97 994.97 2,114.72 84.47 84.47 1,249.62 2,829.10 1,963.78 84.47

192.59 1,259.05 2,316.61 2,316.61 2,268.63 2,268.63 2,268.63 2,268.63 2,268.63 2,268.63 2,268.63 1,966.20 2,299.28 2,268.63 2,268.63 2,268.63 2,268.63 2,268.63 1,966.20 2,268.63 2,268.63 2,268.63 2,268.63 2,268.63 2,268.63 2,268.63 2,268.63 2,268.63 2,268.63 4,821.75 4,821.75 2,268.63 4,821.75 4,821.75 2,268.63 2,268.63 2,268.63 2,268.63 2,268.63 2,268.63 2,268.63 2,268.63 2,268.63 2,268.63 2,268.63 2,268.63 2,268.63 2,268.63 2,268.63 2,268.63 2,268.63 2,268.63 2,268.63 2,268.63 2,268.63 468.78 1,753.62 945.97 2,268.63 2,268.63 2,268.63 4,821.75 2,268.63 2,268.63 2,268.63 2,268.63 2,268.63 2,268.63 2,268.63 4,821.75 2,268.63 2,268.63 2,268.63 2,268.63 2,268.63 4,821.75 2,268.63 2,268.63 2,268.63 2,268.63 2,268.63 2,268.63 2,268.63 3,204.07 3,204.07 3,204.07 3,204.07 3,204.07 3,204.07 3,204.07 3,204.07 4,821.75 2,268.63 4,821.75 4,821.75 2,268.63 2,268.63 2,268.63 4,821.75 2,268.63 2,268.63 2,268.63 2,268.63 4,821.75 4,821.75 2,268.63 2,268.63 2,268.63 2,268.63 4,821.75 192.59 192.59 2,849.26 6,450.60 4,477.60 192.59

220.74 1,443.08 2,655.21 2,655.21 2,600.22 2,600.22 2,600.22 2,600.22 2,600.22 2,600.22 2,600.22 2,253.59 2,635.35 2,600.22 2,600.22 2,600.22 2,600.22 2,600.22 2,253.59 2,600.22 2,600.22 2,600.22 2,600.22 2,600.22 2,600.22 2,600.22 2,600.22 2,600.22 2,600.22 5,526.50 5,526.50 2,600.22 5,526.50 5,526.50 2,600.22 2,600.22 2,600.22 2,600.22 2,600.22 2,600.22 2,600.22 2,600.22 2,600.22 2,600.22 2,600.22 2,600.22 2,600.22 2,600.22 2,600.22 2,600.22 2,600.22 2,600.22 2,600.22 2,600.22 2,600.22 537.30 2,009.94 1,084.24 2,600.22 2,600.22 2,600.22 5,526.50 2,600.22 2,600.22 2,600.22 2,600.22 2,600.22 2,600.22 2,600.22 5,526.50 2,600.22 2,600.22 2,600.22 2,600.22 2,600.22 5,526.50 2,600.22 2,600.22 2,600.22 2,600.22 2,600.22 2,600.22 2,600.22 3,672.38 3,672.38 3,672.38 3,672.38 3,672.38 3,672.38 3,672.38 3,672.38 5,526.50 2,600.22 5,526.50 5,526.50 2,600.22 2,600.22 2,600.22 5,526.50 2,600.22 2,600.22 2,600.22 2,600.22 5,526.50 5,526.50 2,600.22 2,600.22 2,600.22 2,600.22 5,526.50 220.74 220.74 3,265.71 7,393.44 5,132.06 220.74

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

Added 1/1/07 to book

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

13 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T C C T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T C C T T T T

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 84.47 1,249.62 1,963.78 2,114.72 84.47 84.47 1,249.62 1,963.78 84.47 84.47 1,249.62 1,963.78 84.47 84.47 1,249.62 1,249.62 84.47 84.47 1,249.62 84.47 1,249.62 84.47 1,249.62 1,249.62 1,963.78 84.47 84.47 1,249.62 1,249.62 84.47 84.47 1,249.62 1,963.78 84.47 705.36 1,249.62 1,249.62 84.47 705.36 1,249.62 1,249.62 2,114.72 3,794.10 2,114.72 2,114.72 2,114.72 2,114.72 2,114.72 2,114.72 994.97 2,114.72 0.00 0.00 994.97 994.97 994.97 1,394.41

Children's Hospital Outpatient Fee 192.59 2,849.26 4,477.60 4,821.75 192.59 192.59 2,849.26 4,477.60 192.59 192.59 2,849.26 4,477.60 192.59 192.59 2,849.26 2,849.26 192.59 192.59 2,849.26 192.59 2,849.26 192.59 2,849.26 2,849.26 4,477.60 192.59 192.59 2,849.26 2,849.26 192.59 192.59 2,849.26 4,477.60 192.59 1,608.29 2,849.26 2,849.26 192.59 1,608.29 2,849.26 2,849.26 4,821.75 8,650.91 4,821.75 4,821.75 4,821.75 4,821.75 4,821.75 4,821.75 2,268.63 4,821.75 0.00 0.00 2,268.63 2,268.63 2,268.63 3,179.37

Critical PDD Access Update to Hospital ACS Outpatient Fee 220.74 3,265.71 5,132.06 5,526.50 220.74 220.74 3,265.71 5,132.06 220.74 220.74 3,265.71 5,132.06 220.74 220.74 3,265.71 3,265.71 220.74 220.74 3,265.71 220.74 3,265.71 220.74 3,265.71 3,265.71 5,132.06 220.74 220.74 3,265.71 3,265.71 220.74 220.74 3,265.71 5,132.06 220.74 1,843.36 3,265.71 3,265.71 220.74 1,843.36 3,265.71 3,265.71 5,526.50 9,915.34 5,526.50 5,526.50 5,526.50 5,526.50 5,526.50 5,526.50 2,600.22 5,526.50 0.00 0.00 2,600.22 2,600.22 2,600.22 3,644.08

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

28435 28436 28445 28446 28450 28455 28456 28465 28470 28475 28476 28485 28490 28495 28496 28505 28510 28515 28525 28530 28531 28540 28545 28546 28555 28570 28575 28576 28585 28600 28605 28606 28615 28630 28635 28636 28645 28660 28665 28666 28675 28705 28715 28725 28730 28735 28737 28740 28750 28755 28760 28800 28805 28810 28820 28825 28890

Treatment of ankle fracture Treatment of ankle fracture Treat ankle fracture Osteochondral talus autogrft Treat midfoot fracture, each Treat midfoot fracture, each Treat midfoot fracture Treat midfoot fracture, each Treat metatarsal fracture Treat metatarsal fracture Treat metatarsal fracture Treat metatarsal fracture Treat big toe fracture Treat big toe fracture Treat big toe fracture Treat big toe fracture Treatment of toe fracture Treatment of toe fracture Treat toe fracture Treat sesamoid bone fracture Treat sesamoid bone fracture Treat foot dislocation Treat foot dislocation Treat foot dislocation Repair foot dislocation Treat foot dislocation Treat foot dislocation Treat foot dislocation Repair foot dislocation Treat foot dislocation Treat foot dislocation Treat foot dislocation Repair foot dislocation Treat toe dislocation Treat toe dislocation Treat toe dislocation Repair toe dislocation Treat toe dislocation Treat toe dislocation Treat toe dislocation Repair of toe dislocation Fusion of foot bones Fusion of foot bones Fusion of foot bones Fusion of foot bones Fusion of foot bones Revision of foot bones Fusion of foot bones Fusion of big toe joint Fusion of big toe joint Fusion of big toe joint Amputation of midfoot Amputation thru metatarsal Amputation toe & metatarsal Amputation of toe Partial amputation of toe High energy eswt, plantar f

0043 0062 0063 0056 0043 0043 0062 0063 0043 0043 0062 0063 0043 0043 0062 0062 0043 0043 0062 0043 0062 0043 0062 0062 0063 0043 0043 0062 0062 0043 0043 0062 0063 0043 0045 0062 0062 0043 0045 0062 0062 0056 0052 0056 0056 0056 0056 0056 0056 0055 0056 0000 0000 0055 0055 0055 0050

1.7682 26.1592 41.1091 44.2687 1.7682 1.7682 26.1592 41.1091 1.7682 1.7682 26.1592 41.1091 1.7682 1.7682 26.1592 26.1592 1.7682 1.7682 26.1592 1.7682 26.1592 1.7682 26.1592 26.1592 41.1091 1.7682 1.7682 26.1592 26.1592 1.7682 1.7682 26.1592 41.1091 1.7682 14.7658 26.1592 26.1592 1.7682 14.7658 26.1592 26.1592 44.2687 79.4244 44.2687 44.2687 44.2687 44.2687 44.2687 44.2687 20.8284 44.2687 0.0000 0.0000 20.8284 20.8284 20.8284 29.1900

X

28899 29000 29010 29015 29020 29025 29035 29040 29044 29046 29049 29055 29058 29065 29075 29085 29086 29105 29125 29126 29130 29131 29200 29220 29240 29260 29280 29305 29325 29345 29355 29358 29365 29405 29425 29435 29440 29445 29450 29505 29515 29520 29530 29540 29550 29580 29590 29700 29705 29710 29715 29720 29730 29740 29750

Foot/toes surgery procedure Application of body cast Application of body cast Application of body cast Application of body cast Application of body cast Application of body cast Application of body cast Application of body cast Application of body cast Application of figure eight Application of shoulder cast Application of shoulder cast Application of long arm cast Application of forearm cast Apply hand/wrist cast Apply finger cast Apply long arm splint Apply forearm splint Apply forearm splint Application of finger splint Application of finger splint Strapping of chest Strapping of low back Strapping of shoulder Strapping of elbow or wrist Strapping of hand or finger Application of hip cast Application of hip casts Application of long leg cast Application of long leg cast Apply long leg cast brace Application of long leg cast Apply short leg cast Apply short leg cast Apply short leg cast Addition of walker to cast Apply rigid leg cast Application of leg cast Application, long leg splint Application lower leg splint Strapping of hip Strapping of knee Strapping of ankle and/or ft Strapping of toes Application of paste boot Application of foot splint Removal/revision of cast Removal/revision of cast Removal/revision of cast Removal/revision of cast Repair of body cast Windowing of cast Wedging of cast Wedging of clubfoot cast

T S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S

T S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S

0043 0058 0426 0426 0058 0058 0426 0058 0426 0426 0058 0426 0058 0426 0426 0058 0058 0058 0058 0058 0058 0058 0058 0058 0058 0058 0058 0426 0426 0426 0426 0426 0426 0426 0426 0426 0058 0426 0058 0058 0058 0058 0058 0058 0058 0058 0058 0058 0058 0426 0058 0058 0058 0058 0058

1.7682 1.0931 2.2910 2.2910 1.0931 1.0931 2.2910 1.0931 2.2910 2.2910 1.0931 2.2910 1.0931 2.2910 2.2910 1.0931 1.0931 1.0931 1.0931 1.0931 1.0931 1.0931 1.0931 1.0931 1.0931 1.0931 1.0931 2.2910 2.2910 2.2910 2.2910 2.2910 2.2910 2.2910 2.2910 2.2910 1.0931 2.2910 1.0931 1.0931 1.0931 1.0931 1.0931 1.0931 1.0931 1.0931 1.0931 1.0931 1.0931 2.2910 1.0931 1.0931 1.0931 1.0931 1.0931

84.47 52.22 109.44 109.44 52.22 52.22 109.44 52.22 109.44 109.44 52.22 109.44 52.22 109.44 109.44 52.22 52.22 52.22 52.22 52.22 52.22 52.22 52.22 52.22 52.22 52.22 52.22 109.44 109.44 109.44 109.44 109.44 109.44 109.44 109.44 109.44 52.22 109.44 52.22 52.22 52.22 52.22 52.22 52.22 52.22 52.22 52.22 52.22 52.22 109.44 52.22 52.22 52.22 52.22 52.22

192.59 119.06 249.54 249.54 119.06 119.06 249.54 119.06 249.54 249.54 119.06 249.54 119.06 249.54 249.54 119.06 119.06 119.06 119.06 119.06 119.06 119.06 119.06 119.06 119.06 119.06 119.06 249.54 249.54 249.54 249.54 249.54 249.54 249.54 249.54 249.54 119.06 249.54 119.06 119.06 119.06 119.06 119.06 119.06 119.06 119.06 119.06 119.06 119.06 249.54 119.06 119.06 119.06 119.06 119.06

220.74 136.46 286.01 286.01 136.46 136.46 286.01 136.46 286.01 286.01 136.46 286.01 136.46 286.01 286.01 136.46 136.46 136.46 136.46 136.46 136.46 136.46 136.46 136.46 136.46 136.46 136.46 286.01 286.01 286.01 286.01 286.01 286.01 286.01 286.01 286.01 136.46 286.01 136.46 136.46 136.46 136.46 136.46 136.46 136.46 136.46 136.46 136.46 136.46 286.01 136.46 136.46 136.46 136.46 136.46

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

29799 29800 29804 29805 29806 29807 29819 29820 29821 29822 29823 29824 29825 29826 29827 29828 29830 29834 29835 29836 29837 29838 29840 29843 29844 29845 29846 29847 29848 29850 29851 29855 29856 29860 29861 29862 29863 29866 29867 29868 29870 29871 29873 29874 29875 29876 29877

Casting/strapping procedure Jaw arthroscopy/surgery Jaw arthroscopy/surgery Shoulder arthroscopy, dx Shoulder arthroscopy/surgery Shoulder arthroscopy/surgery Shoulder arthroscopy/surgery Shoulder arthroscopy/surgery Shoulder arthroscopy/surgery Shoulder arthroscopy/surgery Shoulder arthroscopy/surgery Shoulder arthroscopy/surgery Shoulder arthroscopy/surgery Shoulder arthroscopy/surgery Arthroscop rotator cuff repr Arthroscopy biceps tenodesis Elbow arthroscopy Elbow arthroscopy/surgery Elbow arthroscopy/surgery Elbow arthroscopy/surgery Elbow arthroscopy/surgery Elbow arthroscopy/surgery Wrist arthroscopy Wrist arthroscopy/surgery Wrist arthroscopy/surgery Wrist arthroscopy/surgery Wrist arthroscopy/surgery Wrist arthroscopy/surgery Wrist endoscopy/surgery Knee arthroscopy/surgery Knee arthroscopy/surgery Tibial arthroscopy/surgery Tibial arthroscopy/surgery Hip arthroscopy, dx Hip arthroscopy/surgery Hip arthroscopy/surgery Hip arthroscopy/surgery Autgrft implnt, knee w/scope Allgrft implnt, knee w/scope Meniscal trnspl, knee w/scpe Knee arthroscopy, dx Knee arthroscopy/drainage Knee arthroscopy/surgery Knee arthroscopy/surgery Knee arthroscopy/surgery Knee arthroscopy/surgery Knee arthroscopy/surgery

S T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T

S T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T

0058 0041 0041 0041 0042 0042 0042 0042 0042 0041 0042 0041 0042 0042 0042 0042 0041 0041 0041 0041 0041 0041 0041 0041 0041 0041 0041 0042 0041 0041 0042 0042 0042 0042 0042 0042 0042 0042 0042 0042 0041 0041 0041 0041 0041 0041 0041

1.0931 28.7803 28.7803 28.7803 45.7072 45.7072 45.7072 45.7072 45.7072 28.7803 45.7072 28.7803 45.7072 45.7072 45.7072 45.7072 28.7803 28.7803 28.7803 28.7803 28.7803 28.7803 28.7803 28.7803 28.7803 28.7803 28.7803 45.7072 28.7803 28.7803 45.7072 45.7072 45.7072 45.7072 45.7072 45.7072 45.7072 45.7072 45.7072 45.7072 28.7803 28.7803 28.7803 28.7803 28.7803 28.7803 28.7803

52.22 1,374.83 1,374.83 1,374.83 2,183.43 2,183.43 2,183.43 2,183.43 2,183.43 1,374.83 2,183.43 1,374.83 2,183.43 2,183.43 2,183.43 2,183.43 1,374.83 1,374.83 1,374.83 1,374.83 1,374.83 1,374.83 1,374.83 1,374.83 1,374.83 1,374.83 1,374.83 2,183.43 1,374.83 1,374.83 2,183.43 2,183.43 2,183.43 2,183.43 2,183.43 2,183.43 2,183.43 2,183.43 2,183.43 2,183.43 1,374.83 1,374.83 1,374.83 1,374.83 1,374.83 1,374.83 1,374.83

119.06 3,134.75 3,134.75 3,134.75 4,978.43 4,978.43 4,978.43 4,978.43 4,978.43 3,134.75 4,978.43 3,134.75 4,978.43 4,978.43 4,978.43 4,978.43 3,134.75 3,134.75 3,134.75 3,134.75 3,134.75 3,134.75 3,134.75 3,134.75 3,134.75 3,134.75 3,134.75 4,978.43 3,134.75 3,134.75 4,978.43 4,978.43 4,978.43 4,978.43 4,978.43 4,978.43 4,978.43 4,978.43 4,978.43 4,978.43 3,134.75 3,134.75 3,134.75 3,134.75 3,134.75 3,134.75 3,134.75

136.46 3,592.93 3,592.93 3,592.93 5,706.09 5,706.09 5,706.09 5,706.09 5,706.09 3,592.93 5,706.09 3,592.93 5,706.09 5,706.09 5,706.09 5,706.09 3,592.93 3,592.93 3,592.93 3,592.93 3,592.93 3,592.93 3,592.93 3,592.93 3,592.93 3,592.93 3,592.93 5,706.09 3,592.93 3,592.93 5,706.09 5,706.09 5,706.09 5,706.09 5,706.09 5,706.09 5,706.09 5,706.09 5,706.09 5,706.09 3,592.93 3,592.93 3,592.93 3,592.93 3,592.93 3,592.93 3,592.93

SI= S, effect. 05/01/06 If needed add 282N Taxonomy

X

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

14 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 1,374.83 1,374.83 1,374.83 1,374.83 1,374.83 1,374.83 2,183.43 1,374.83 1,374.83 2,183.43 2,183.43 2,183.43 2,183.43 994.97 1,374.83 1,374.83 1,374.83 1,374.83 2,183.43 1,374.83 1,374.83 1,374.83 1,374.83 1,374.83 1,374.83 2,183.43

Children's Hospital Outpatient Fee 3,134.75 3,134.75 3,134.75 3,134.75 3,134.75 3,134.75 4,978.43 3,134.75 3,134.75 4,978.43 4,978.43 4,978.43 4,978.43 2,268.63 3,134.75 3,134.75 3,134.75 3,134.75 4,978.43 3,134.75 3,134.75 3,134.75 3,134.75 3,134.75 3,134.75 4,978.43

Critical PDD Access Update to Hospital ACS Outpatient Fee 3,592.93 3,592.93 3,592.93 3,592.93 3,592.93 3,592.93 5,706.09 3,592.93 3,592.93 5,706.09 5,706.09 5,706.09 5,706.09 2,600.22 3,592.93 3,592.93 3,592.93 3,592.93 5,706.09 3,592.93 3,592.93 3,592.93 3,592.93 3,592.93 3,592.93 5,706.09

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

29879 29880 29881 29882 29883 29884 29885 29886 29887 29888 29889 29891 29892 29893 29894 29895 29897 29898 29899 29900 29901 29902 29904 29905 29906 29907

Knee arthroscopy/surgery Knee arthroscopy/surgery Knee arthroscopy/surgery Knee arthroscopy/surgery Knee arthroscopy/surgery Knee arthroscopy/surgery Knee arthroscopy/surgery Knee arthroscopy/surgery Knee arthroscopy/surgery Knee arthroscopy/surgery Knee arthroscopy/surgery Ankle arthroscopy/surgery Ankle arthroscopy/surgery Scope, plantar fasciotomy Ankle arthroscopy/surgery Ankle arthroscopy/surgery Ankle arthroscopy/surgery Ankle arthroscopy/surgery Ankle arthroscopy/surgery Mcp joint arthroscopy, dx Mcp joint arthroscopy, surg Mcp joint arthroscopy, surg Subtalar arthro w/fb rmvl Subtalar arthro w/exc Subtalar arthro w/deb Subtalar arthro w/fusion

0041 0041 0041 0041 0041 0041 0042 0041 0041 0042 0042 0042 0042 0055 0041 0041 0041 0041 0042 0041 0041 0041 0041 0041 0041 0042

28.7803 28.7803 28.7803 28.7803 28.7803 28.7803 45.7072 28.7803 28.7803 45.7072 45.7072 45.7072 45.7072 20.8284 28.7803 28.7803 28.7803 28.7803 45.7072 28.7803 28.7803 28.7803 28.7803 28.7803 28.7803 45.7072

X X X X SI= T, effect. 05/01/06 If needed add 282N Taxonomy

29999 30000 30020 30100 30110 30115 30117 30118 30120 30124 30125 30130 30140 30150 30160 30200 30210 30220 30300 30310 30320 30400 30410 30420 30430 30435 30450 30460 30462 30465 30520 30540 30545 30560 30580 30600 30620 30630 30801 30802 30901 30903 30905 30906 30915 30920 30930

Arthroscopy of joint Drainage of nose lesion Drainage of nose lesion Intranasal biopsy Removal of nose polyp(s) Removal of nose polyp(s) Removal of intranasal lesion Removal of intranasal lesion Revision of nose Removal of nose lesion Removal of nose lesion Removal of turbinate bones Removal of turbinate bones Partial removal of nose Removal of nose Injection treatment of nose Nasal sinus therapy Insert nasal septal button Remove nasal foreign body Remove nasal foreign body Remove nasal foreign body Reconstruction of nose Reconstruction of nose Reconstruction of nose Revision of nose Revision of nose Revision of nose Revision of nose Revision of nose Repair nasal stenosis Repair of nasal septum Repair nasal defect Repair nasal defect Release of nasal adhesions Repair upper jaw fistula Repair mouth/nose fistula Intranasal reconstruction Repair nasal septum defect Cauterization, inner nose Cauterization, inner nose Control of nosebleed Control of nosebleed Control of nosebleed Repeat control of nosebleed Ligation, nasal sinus artery Ligation, upper jaw artery Therapy, fracture of nose

T T T T T T T T T T T T T T T T T T X T T T T T T T T T T T T T T T T T T T T T T T T T T T T

T T T T T T T T T T T T T T T T T T X T T 1 1 T 1 1 1 T T T T T T T T T T T T T T T T T T T T

0041 0251 0251 0252 0253 0253 0253 0254 0253 0252 0256 0253 0254 0256 0256 0252 0252 0252 0340 0253 0253 0256 0256 0256 0254 0256 0256 0256 0256 0256 0254 0256 0256 0251 0256 0256 0256 0254 0252 0252 0250 0250 0250 0250 0092 0092 0253

28.7803 2.5002 2.5002 7.4474 16.3288 16.3288 16.3288 23.9765 16.3288 7.4474 39.8776 16.3288 23.9765 39.8776 39.8776 7.4474 7.4474 7.4474 0.6310 16.3288 16.3288 39.8776 39.8776 39.8776 23.9765 39.8776 39.8776 39.8776 39.8776 39.8776 23.9765 39.8776 39.8776 2.5002 39.8776 39.8776 39.8776 23.9765 7.4474 7.4474 1.1251 1.1251 1.1251 1.1251 25.8410 25.8410 16.3288

1,374.83 119.43 119.43 355.76 780.03 780.03 780.03 1,145.36 780.03 355.76 1,904.95 780.03 1,145.36 1,904.95 1,904.95 355.76 355.76 355.76 30.14 780.03 780.03 0.00 0.00 1,904.95 0.00 0.00 0.00 1,904.95 1,904.95 1,904.95 1,145.36 1,904.95 1,904.95 119.43 1,904.95 1,904.95 1,904.95 1,145.36 355.76 355.76 53.75 53.75 53.75 53.75 1,234.42 1,234.42 780.03

3,134.75 272.32 272.32 811.17 1,778.53 1,778.53 1,778.53 2,611.52 1,778.53 811.17 4,343.47 1,778.53 2,611.52 4,343.47 4,343.47 811.17 811.17 811.17 68.73 1,778.53 1,778.53 0.00 0.00 4,343.47 0.00 0.00 0.00 4,343.47 4,343.47 4,343.47 2,611.52 4,343.47 4,343.47 272.32 4,343.47 4,343.47 4,343.47 2,611.52 811.17 811.17 122.55 122.55 122.55 122.55 2,814.60 2,814.60 1,778.53

3,592.93 312.12 312.12 929.73 2,038.49 2,038.49 2,038.49 2,993.23 2,038.49 929.73 4,978.32 2,038.49 2,993.23 4,978.32 4,978.32 929.73 929.73 929.73 78.77 2,038.49 2,038.49 0.00 0.00 4,978.32 0.00 0.00 0.00 4,978.32 4,978.32 4,978.32 2,993.23 4,978.32 4,978.32 312.12 4,978.32 4,978.32 4,978.32 2,993.23 929.73 929.73 140.46 140.46 140.46 140.46 3,225.99 3,225.99 2,038.49

30999 31000 31002 31020 31030 31032 31040 31050 31051 31070 31075 31080 31081 31084 31085 31086 31087 31090 31200 31201 31205 31225 31230 31231 31233 31235 31237 31238 31239 31240 31254 31255 31256 31267 31276 31287 31288 31290 31291 31292 31293 31294

Nasal surgery procedure Irrigation, maxillary sinus Irrigation, sphenoid sinus Exploration, maxillary sinus Exploration, maxillary sinus Explore sinus, remove polyps Exploration behind upper jaw Exploration, sphenoid sinus Sphenoid sinus surgery Exploration of frontal sinus Exploration of frontal sinus Removal of frontal sinus Removal of frontal sinus Removal of frontal sinus Removal of frontal sinus Removal of frontal sinus Removal of frontal sinus Exploration of sinuses Removal of ethmoid sinus Removal of ethmoid sinus Removal of ethmoid sinus Removal of upper jaw Removal of upper jaw Nasal endoscopy, dx Nasal/sinus endoscopy, dx Nasal/sinus endoscopy, dx Nasal/sinus endoscopy, surg Nasal/sinus endoscopy, surg Nasal/sinus endoscopy, surg Nasal/sinus endoscopy, surg Revision of ethmoid sinus Removal of ethmoid sinus Exploration maxillary sinus Endoscopy, maxillary sinus Sinus endoscopy, surgical Nasal/sinus endoscopy, surg Nasal/sinus endoscopy, surg Nasal/sinus endoscopy, surg Nasal/sinus endoscopy, surg Nasal/sinus endoscopy, surg Nasal/sinus endoscopy, surg Nasal/sinus endoscopy, surg

T T T T T T T T T T T T T T T T T T T T T C C T T T T T T T T T T T T T T C C T T T

T T T T T T T T T T T T T T T T T T T T T C C T T T T T T T T T T T T T T C C T T T

0251 0251 0252 0254 0256 0256 0254 0256 0256 0254 0256 0256 0256 0256 0256 0256 0256 0256 0256 0256 0256 0000 0000 0072 0072 0074 0074 0074 0075 0074 0075 0075 0075 0075 0075 0075 0075 0000 0000 0075 0075 0075

2.5002 2.5002 7.4474 23.9765 39.8776 39.8776 23.9765 39.8776 39.8776 23.9765 39.8776 39.8776 39.8776 39.8776 39.8776 39.8776 39.8776 39.8776 39.8776 39.8776 39.8776 0.0000 0.0000 1.6115 1.6115 17.0160 17.0160 17.0160 22.7191 17.0160 22.7191 22.7191 22.7191 22.7191 22.7191 22.7191 22.7191 0.0000 0.0000 22.7191 22.7191 22.7191

119.43 119.43 355.76 1,145.36 1,904.95 1,904.95 1,145.36 1,904.95 1,904.95 1,145.36 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95 0.00 0.00 76.98 76.98 812.85 812.85 812.85 1,085.29 812.85 1,085.29 1,085.29 1,085.29 1,085.29 1,085.29 1,085.29 1,085.29 0.00 0.00 1,085.29 1,085.29 1,085.29

272.32 272.32 811.17 2,611.52 4,343.47 4,343.47 2,611.52 4,343.47 4,343.47 2,611.52 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47 0.00 0.00 175.52 175.52 1,853.38 1,853.38 1,853.38 2,474.56 1,853.38 2,474.56 2,474.56 2,474.56 2,474.56 2,474.56 2,474.56 2,474.56 0.00 0.00 2,474.56 2,474.56 2,474.56

312.12 312.12 929.73 2,993.23 4,978.32 4,978.32 2,993.23 4,978.32 4,978.32 2,993.23 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32 0.00 0.00 201.18 201.18 2,124.28 2,124.28 2,124.28 2,836.25 2,124.28 2,836.25 2,836.25 2,836.25 2,836.25 2,836.25 2,836.25 2,836.25 0.00 0.00 2,836.25 2,836.25 2,836.25

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

31299 31300 31320 31360 31365 31367 31368 31370 31375 31380 31382 31390 31395 31400 31420 31500 31502 31505 31510 31511 31512 31513 31515 31520 31525 31526 31527 31528 31529 31530 31531 31535 31536 31540 31541 31545 31546 31560 31561 31570 31571 31575

Sinus surgery procedure Removal of larynx lesion Diagnostic incision, larynx Removal of larynx Removal of larynx Partial removal of larynx Partial removal of larynx Partial removal of larynx Partial removal of larynx Partial removal of larynx Partial removal of larynx Removal of larynx & pharynx Reconstruct larynx & pharynx Revision of larynx Removal of epiglottis Insert emergency airway Change of windpipe airway Diagnostic laryngoscopy Laryngoscopy with biopsy Remove foreign body, larynx Removal of larynx lesion Injection into vocal cord Laryngoscopy for aspiration Diagnostic laryngoscopy Diagnostic laryngoscopy Diagnostic laryngoscopy Laryngoscopy for treatment Laryngoscopy and dilation Laryngoscopy and dilation Operative laryngoscopy Operative laryngoscopy Operative laryngoscopy Operative laryngoscopy Operative laryngoscopy Operative laryngoscopy Remove vc lesion w/scope Remove vc lesion scope/graft Operative laryngoscopy Operative laryngoscopy Laryngoscopy with injection Laryngoscopy with injection Diagnostic laryngoscopy

T T T C C C C C C C C C C T T S S T T T T T T T T T T T T T T T T T T T T T T T T T

T T T C C C C C C C C C C T T S S T T T T T T T T T T T T T T T T T T T T T T T T T

0251 0254 0256 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0256 0256 0094 0078 0071 0074 0072 0074 0072 0074 0072 0074 0075 0075 0074 0074 0075 0075 0075 0075 0075 0075 0075 0075 0075 0075 0074 0075 0072

2.5002 23.9765 39.8776 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 39.8776 39.8776 2.4590 1.3362 0.8224 17.0160 1.6115 17.0160 1.6115 17.0160 1.6115 17.0160 22.7191 22.7191 17.0160 17.0160 22.7191 22.7191 22.7191 22.7191 22.7191 22.7191 22.7191 22.7191 22.7191 22.7191 17.0160 22.7191 1.6115

119.43 1,145.36 1,904.95 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1,904.95 1,904.95 117.47 63.83 39.29 812.85 76.98 812.85 76.98 812.85 76.98 812.85 1,085.29 1,085.29 812.85 812.85 1,085.29 1,085.29 1,085.29 1,085.29 1,085.29 1,085.29 1,085.29 1,085.29 1,085.29 1,085.29 812.85 1,085.29 76.98

272.32 2,611.52 4,343.47 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 4,343.47 4,343.47 267.83 145.54 89.58 1,853.38 175.52 1,853.38 175.52 1,853.38 175.52 1,853.38 2,474.56 2,474.56 1,853.38 1,853.38 2,474.56 2,474.56 2,474.56 2,474.56 2,474.56 2,474.56 2,474.56 2,474.56 2,474.56 2,474.56 1,853.38 2,474.56 175.52

312.12 2,993.23 4,978.32 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 4,978.32 4,978.32 306.98 166.81 102.67 2,124.28 201.18 2,124.28 201.18 2,124.28 201.18 2,124.28 2,836.25 2,836.25 2,124.28 2,124.28 2,836.25 2,836.25 2,836.25 2,836.25 2,836.25 2,836.25 2,836.25 2,836.25 2,836.25 2,836.25 2,124.28 2,836.25 201.18

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

X

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

15 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only T T T T T T C C T T T T T T T T T C C T T T

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 1,085.29 190.79 1,085.29 190.79 1,904.95 1,904.95 0.00 0.00 1,904.95 1,904.95 1,904.95

Children's Hospital Outpatient Fee 2,474.56 435.03 2,474.56 435.03 4,343.47 4,343.47 0.00 0.00 4,343.47 4,343.47 4,343.47

Critical PDD Access Update to Hospital ACS Outpatient Fee 2,836.25 498.61 2,836.25 498.61 4,978.32 4,978.32 0.00 0.00 4,978.32 4,978.32 4,978.32

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

31576 31577 31578 31579 31580 31582 31584 31587 31588 31590 31595

Laryngoscopy with biopsy Remove foreign body, larynx Removal of larynx lesion Diagnostic laryngoscopy Revision of larynx Revision of larynx Treat larynx fracture Revision of larynx Revision of larynx Reinnervate larynx Larynx nerve surgery

0075 0073 0075 0073 0256 0256 0000 0000 0256 0256 0256

22.7191 3.9940 22.7191 3.9940 39.8776 39.8776 0.0000 0.0000 39.8776 39.8776 39.8776

31599 31600 31601 31603 31605 31610 31611 31612 31613 31614 31615 31620 31622 31623 31624 31625 31628 31629 31630 31631 31632 31633 31635 31636 31637 31638 31640 31641 31643 31645 31646 31656 31715 31717 31720 31725 31730 31750 31755 31760 31766 31770 31775 31780 31781 31785 31786 31800 31805 31820 31825 31830

Larynx surgery procedure Incision of windpipe Incision of windpipe Incision of windpipe Incision of windpipe Incision of windpipe Surgery/speech prosthesis Puncture/clear windpipe Repair windpipe opening Repair windpipe opening Visualization of windpipe Endobronchial us add-on Dx bronchoscope/wash Dx bronchoscope/brush Dx bronchoscope/lavage Bronchoscopy w/biopsy(s) Bronchoscopy/lung bx, each Bronchoscopy/needle bx, each Bronchoscopy dilate/fx repr Bronchoscopy, dilate w/stent Bronchoscopy/lung bx, add’l Bronchoscopy/needle bx add’l Bronchoscopy w/fb removal Bronchoscopy, bronch stents Bronchoscopy, stent add-on Bronchoscopy, revise stent Bronchoscopy w/tumor excise Bronchoscopy, treat blockage Diag bronchoscope/catheter Bronchoscopy, clear airways Bronchoscopy, reclear airway Bronchoscopy, inj for x-ray Injection for bronchus x-ray Bronchial brush biopsy Clearance of airways Clearance of airways Intro, windpipe wire/tube Repair of windpipe Repair of windpipe Repair of windpipe Reconstruction of windpipe Repair/graft of bronchus Reconstruct bronchus Reconstruct windpipe Reconstruct windpipe Remove windpipe lesion Remove windpipe lesion Repair of windpipe injury Repair of windpipe injury Closure of windpipe lesion Repair of windpipe defect Revise windpipe scar

T T T T T T T T T T T N T T T T T T T T T T T T T T T T T T T T N T S C T T T C C C C C C T C C C T T T

T T T T T T T T T T T N T T T T T T T T T T T T T T T T T T T T N T S C T T T C C C C C C T C C C T T T

0251 0254 0254 0252 0252 0254 0254 0254 0254 0256 0076 0000 0076 0076 0076 0076 0076 0076 0415 0415 0076 0076 0076 0415 0076 0415 0415 0415 0076 0076 0076 0076 0000 0073 0077 0000 0073 0256 0256 0000 0000 0000 0000 0000 0000 0254 0000 0000 0000 0253 0254 0254

2.5002 23.9765 23.9765 7.4474 7.4474 23.9765 23.9765 23.9765 23.9765 39.8776 9.9575 0.0000 9.9575 9.9575 9.9575 9.9575 9.9575 9.9575 24.0654 24.0654 9.9575 9.9575 9.9575 24.0654 9.9575 24.0654 24.0654 24.0654 9.9575 9.9575 9.9575 9.9575 0.0000 3.9940 0.3877 0.0000 3.9940 39.8776 39.8776 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 23.9765 0.0000 0.0000 0.0000 16.3288 23.9765 23.9765

119.43 1,145.36 1,145.36 355.76 355.76 1,145.36 1,145.36 1,145.36 1,145.36 1,904.95 475.67 0.00 475.67 475.67 475.67 475.67 475.67 475.67 1,149.60 1,149.60 475.67 475.67 475.67 1,149.60 475.67 1,149.60 1,149.60 1,149.60 475.67 475.67 475.67 475.67 0.00 190.79 18.52 0.00 190.79 1,904.95 1,904.95 0.00 0.00 0.00 0.00 0.00 0.00 1,145.36 0.00 0.00 0.00 780.03 1,145.36 1,145.36

272.32 2,611.52 2,611.52 811.17 811.17 2,611.52 2,611.52 2,611.52 2,611.52 4,343.47 1,084.57 0.00 1,084.57 1,084.57 1,084.57 1,084.57 1,084.57 1,084.57 2,621.20 2,621.20 1,084.57 1,084.57 1,084.57 2,621.20 1,084.57 2,621.20 2,621.20 2,621.20 1,084.57 1,084.57 1,084.57 1,084.57 0.00 435.03 42.23 0.00 435.03 4,343.47 4,343.47 0.00 0.00 0.00 0.00 0.00 0.00 2,611.52 0.00 0.00 0.00 1,778.53 2,611.52 2,611.52

312.12 2,993.23 2,993.23 929.73 929.73 2,993.23 2,993.23 2,993.23 2,993.23 4,978.32 1,243.09 0.00 1,243.09 1,243.09 1,243.09 1,243.09 1,243.09 1,243.09 3,004.32 3,004.32 1,243.09 1,243.09 1,243.09 3,004.32 1,243.09 3,004.32 3,004.32 3,004.32 1,243.09 1,243.09 1,243.09 1,243.09 0.00 498.61 48.40 0.00 498.61 4,978.32 4,978.32 0.00 0.00 0.00 0.00 0.00 0.00 2,993.23 0.00 0.00 0.00 2,038.49 2,993.23 2,993.23

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

X

X

31899

Airways surgical procedure

T

T

0076

9.9575

475.67

1,084.57

1,243.09

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

32035 32036 32095 32100 32110 32120 32124 32140 32141 32150 32151 32160 32200 32201 32215 32220 32225 32310 32320 32400 32402 32405 32420 32421 32422 32440 32442 32445 32480 32482 32484 32486 32488 32491 32500 32501 32503 32504 32540 32550 32551 32560 32601 32602 32603 32604 32605 32606 32650 32651 32652 32653 32654 32655 32656 32657 32658 32659 32660 32661 32662 32663 32664 32665 32800 32810 32815 32820 32850 32851 32852 32853 32854 32855 32856 32900 32905 32906 32940 32960 32997 32998

Exploration of chest Exploration of chest Biopsy through chest wall Exploration/biopsy of chest Explore/repair chest Re-exploration of chest Explore chest free adhesions Removal of lung lesion(s) Remove/treat lung lesions Removal of lung lesion(s) Remove lung foreign body Open chest heart massage Drain, open, lung lesion Drain, percut, lung lesion Treat chest lining Release of lung Partial release of lung Removal of chest lining Free/remove chest lining Needle biopsy chest lining Open biopsy chest lining Biopsy, lung or mediastinum Puncture/clear lung Thoracentesis for aspiration Thoracentesis w/tube insert Removal of lung Sleeve pneumonectomy Removal of lung Partial removal of lung Bilobectomy Segmentectomy Sleeve lobectomy Completion pneumonectomy Lung volume reduction Partial removal of lung Repair bronchus add-on Resect apical lung tumor Resect apical lung tum/chest Removal of lung lesion Insert pleural cath Insertion of chest tube Treat lung lining chemically Thoracoscopy, diagnostic Thoracoscopy, diagnostic Thoracoscopy, diagnostic Thoracoscopy, diagnostic Thoracoscopy, diagnostic Thoracoscopy, diagnostic Thoracoscopy, surgical Thoracoscopy, surgical Thoracoscopy, surgical Thoracoscopy, surgical Thoracoscopy, surgical Thoracoscopy, surgical Thoracoscopy, surgical Thoracoscopy, surgical Thoracoscopy, surgical Thoracoscopy, surgical Thoracoscopy, surgical Thoracoscopy, surgical Thoracoscopy, surgical Thoracoscopy, surgical Thoracoscopy, surgical Thoracoscopy, surgical Repair lung hernia Close chest after drainage Close bronchial fistula Reconstruct injured chest Donor pneumonectomy Lung transplant, single Lung transplant with bypass Lung transplant, double Lung transplant with bypass Prepare donor lung, single Prepare donor lung, double Removal of rib(s) Revise & repair chest wall Revise & repair chest wall Revision of lung Therapeutic pneumothorax Total lung lavage Perq rf ablate tx, pul tumor

C C C C C C C C C C C C C T C C C C C T C T T T T C C C C C C C C C C C C C C T T T T T T T T T C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C T C T

C C C C C C C C C C C C C T C C C C C T C T T T T C C C C C C C C C C C C C C T T T T T T T T T C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C T C T

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0070 0000 0000 0000 0000 0000 0685 0000 0685 0070 0070 0070 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0652 0070 0070 0069 0069 0069 0069 0069 0069 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0070 0000 0423

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 5.2024 0.0000 0.0000 0.0000 0.0000 0.0000 9.3354 0.0000 9.3354 5.2024 5.2024 5.2024 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 30.7096 5.2024 5.2024 32.5666 32.5666 32.5666 32.5666 32.5666 32.5666 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 5.2024 0.0000 42.9980

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 248.52 0.00 0.00 0.00 0.00 0.00 445.95 0.00 445.95 248.52 248.52 248.52 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1,467.00 248.52 248.52 1,555.71 1,555.71 1,555.71 1,555.71 1,555.71 1,555.71 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 248.52 0.00 2,054.01

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 566.65 0.00 0.00 0.00 0.00 0.00 1,016.81 0.00 1,016.81 566.65 566.65 566.65 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3,344.89 566.65 566.65 3,547.15 3,547.15 3,547.15 3,547.15 3,547.15 3,547.15 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 566.65 0.00 4,683.34

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 649.47 0.00 0.00 0.00 0.00 0.00 1,165.43 0.00 1,165.43 649.47 649.47 649.47 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3,833.79 649.47 649.47 4,065.61 4,065.61 4,065.61 4,065.61 4,065.61 4,065.61 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 649.47 0.00 5,367.87

X X

X X X

Added 1/1/07 to book SI= T, effect. 05/01/06 If needed add 282N Taxonomy

32999 33010 33011 33015 33020 33025

Chest surgery procedure Drainage of heart sac Repeat drainage of heart sac Incision of heart sac Incision of heart sac Incision of heart sac

T T T C C C

T T T C C C

0070 0070 0070 0000 0000 0000

5.2024 5.2024 5.2024 0.0000 0.0000 0.0000

248.52 248.52 248.52 0.00 0.00 0.00

566.65 566.65 566.65 0.00 0.00 0.00

649.47 649.47 649.47 0.00 0.00 0.00

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

16 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only C C C C C C C C C T T T T T T T T T T T T T T T T T T T T T C C C T T C T T C C C C C C C C C C C S T C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C N C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C T T T T T T T T T T T T T T T T T T T T T C C C T T C T T C C C C C C C C C C C S T C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C N C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 5,811.26 5,811.26 6,689.31 3,321.05 3,321.05 4,816.84 5,220.55 6,689.31 1,145.53 3,321.05 3,321.05 1,145.53 1,145.53 718.74 718.74 12,408.19 12,408.19 1,145.53 1,145.53 1,145.53 1,145.53 0.00 0.00 0.00 15,946.08 1,145.53 0.00 1,145.53 19,339.89 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3,372.91 414.88 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Children's Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 13,250.21 13,250.21 15,252.25 7,572.30 7,572.30 10,982.85 11,903.33 15,252.25 2,611.92 7,572.30 7,572.30 2,611.92 2,611.92 1,638.79 1,638.79 28,291.82 28,291.82 2,611.92 2,611.92 2,611.92 2,611.92 0.00 0.00 0.00 36,358.54 2,611.92 0.00 2,611.92 44,096.73 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 7,690.55 945.97 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Critical PDD Access Update to Hospital ACS Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 15,186.89 15,186.89 17,481.56 8,679.09 8,679.09 12,588.13 13,643.15 17,481.56 2,993.69 8,679.09 8,679.09 2,993.69 2,993.69 1,878.32 1,878.32 32,427.02 32,427.02 2,993.69 2,993.69 2,993.69 2,993.69 0.00 0.00 0.00 41,672.79 2,993.69 0.00 2,993.69 50,542.01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8,814.62 1,084.24 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

33030 33031 33050 33120 33130 33140 33141 33202 33203 33206 33207 33208 33210 33211 33212 33213 33214 33215 33216 33217 33218 33220 33222 33223 33224 33225 33226 33233 33234 33235 33236 33237 33238 33240 33241 33243 33244 33249 33250 33251 33254 33255 33256 33257 33258 33259 33261 33265 33266 33282 33284 33300 33305 33310 33315 33320 33321 33322 33330 33332 33335 33400 33401 33403 33404 33405 33406 33410 33411 33412 33413 33414 33415 33416 33417 33420 33422 33425 33426 33427 33430 33460 33463 33464 33465 33468 33470 33471 33472 33474 33475 33476 33478 33496 33500 33501 33502 33503 33504 33505 33506 33507 33508 33510 33511 33512 33513 33514 33516 33517 33518 33519 33521 33522 33523 33530 33533 33534 33535 33536 33542 33545 33548 33572 33600 33602 33606 33608 33610 33611 33612 33615 33617 33619 33641 33645 33647 33660 33665 33670 33675 33676 33677 33681 33684 33688 33690 33692 33694 33697 33702 33710 33720 33722 33724 33726 33730 33732 33735 33736 33737

Partial removal of heart sac Partial removal of heart sac Removal of heart sac lesion Removal of heart lesion Removal of heart lesion Heart revascularize (tmr) Heart tmr w/other procedure Insert epicard eltrd, open Insert epicard eltrd, endo Insertion of heart pacemaker Insertion of heart pacemaker Insertion of heart pacemaker Insertion of heart electrode Insertion of heart electrode Insertion of pulse generator Insertion of pulse generator Upgrade of pacemaker system Reposition pacing-defib lead Insert lead pace-defib, one Insert lead pace-defib, dual Repair lead pace-defib, one Repair lead pace-defib, dual Revise pocket, pacemaker Revise pocket, pacing-defib Insert pacing lead & connect L ventric pacing lead add-on Reposition l ventric lead Removal of pacemaker system Removal of pacemaker system Removal pacemaker electrode Remove electrode/thoracotomy Remove electrode/thoracotomy Remove electrode/thoracotomy Insert pulse generator Remove pulse generator Remove eltrd/thoracotomy Remove eltrd, transven Eltrd/insert pace-defib Ablate heart dysrhythm focus Ablate heart dysrhythm focus Ablate atria, lmtd Ablate atria w/o bypass, ext Ablate atria w/bypass, exten Ablate atria, lmtd, add-on Ablate atria, x10sv, add-on Ablate atria w/bypass add-on Ablate heart dysrhythm focus Ablate atria, lmtd, endo Ablate atria, x10sv, endo Implant pat-active ht record Remove pat-active ht record Repair of heart wound Repair of heart wound Exploratory heart surgery Exploratory heart surgery Repair major blood vessel(s) Repair major vessel Repair major blood vessel(s) Insert major vessel graft Insert major vessel graft Insert major vessel graft Repair of aortic valve Valvuloplasty, open Valvuloplasty, w/cp bypass Prepare heart-aorta conduit Replacement of aortic valve Replacement of aortic valve Replacement of aortic valve Replacement of aortic valve Replacement of aortic valve Replacement of aortic valve Repair of aortic valve Revision, subvalvular tissue Revise ventricle muscle Repair of aortic valve Revision of mitral valve Revision of mitral valve Repair of mitral valve Repair of mitral valve Repair of mitral valve Replacement of mitral valve Revision of tricuspid valve Valvuloplasty, tricuspid Valvuloplasty, tricuspid Replace tricuspid valve Revision of tricuspid valve Revision of pulmonary valve Valvotomy, pulmonary valve Revision of pulmonary valve Revision of pulmonary valve Replacement, pulmonary valve Revision of heart chamber Revision of heart chamber Repair, prosth valve clot Repair heart vessel fistula Repair heart vessel fistula Coronary artery correction Coronary artery graft Coronary artery graft Repair artery w/tunnel Repair artery, translocation Repair art, intramural Endoscopic vein harvest CABG, vein, single CABG, vein, two CABG, vein, three CABG, vein, four CABG, vein, five Cabg, vein, six or more CABG, artery-vein, single CABG, artery-vein, two CABG, artery-vein, three CABG, artery-vein, four CABG, artery-vein, five Cabg, art-vein, six or more Coronary artery, bypass/reop CABG, arterial, single CABG, arterial, two CABG, arterial, three Cabg, arterial, four or more Removal of heart lesion Repair of heart damage Restore/remodel, ventricle Open coronary endarterectomy Closure of valve Closure of valve Anastomosis/artery-aorta Repair anomaly w/conduit Repair by enlargement Repair double ventricle Repair double ventricle Repair, modified fontan Repair single ventricle Repair single ventricle Repair heart septum defect Revision of heart veins Repair heart septum defects Repair of heart defects Repair of heart defects Repair of heart chambers Close mult vsd Close mult vsd w/resection Cl mult vsd w/rem pul band Repair heart septum defect Repair heart septum defect Repair heart septum defect Reinforce pulmonary artery Repair of heart defects Repair of heart defects Repair of heart defects Repair of heart defects Repair of heart defects Repair of heart defect Repair of heart defect Repair venous anomaly Repair pul venous stenosis Repair heart-vein defect(s) Repair heart-vein defect Revision of heart chamber Revision of heart chamber Revision of heart chamber

0000 0000 0000 0000 0000 0000 0000 0000 0000 0089 0089 0655 0106 0106 0090 0654 0655 0105 0106 0106 0105 0105 0136 0136 0418 0418 0105 0105 0105 0105 0000 0000 0000 0107 0105 0000 0105 0108 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0680 0020 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 121.6508 121.6508 140.0317 69.5217 69.5217 100.8341 109.2851 140.0317 23.9802 69.5217 69.5217 23.9802 23.9802 15.0458 15.0458 259.7486 259.7486 23.9802 23.9802 23.9802 23.9802 0.0000 0.0000 0.0000 333.8096 23.9802 0.0000 23.9802 404.8543 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 70.6073 8.6850 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

Added 1/1/07 to book Added 1/1/07 to book

X

X

Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book X X X Added 1/1/07 to book description change Added 1/1/07 to book description change

x x

Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book

Added 1/1/07 to book Added 1/1/07 to book

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

17 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Children's Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Critical PDD Access Update to Hospital ACS Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

33750 33755 33762 33764 33766 33767 33768 33770 33771 33774 33775 33776 33777 33778 33779 33780 33781 33786 33788 33800 33802 33803 33813 33814 33820 33822 33824 33840 33845 33851 33852 33853 33860 33861 33863 33864 33870 33875 33877 33880 33881 33883 33884 33886 33889 33891 33910 33915 33916 33917 33920 33922 33924 33925 33926 33930 33933 33935 33940 33944 33945 33960 33961 33967 33968 33970 33971 33973 33974 33975 33976 33977 33978 33979 33980

Major vessel shunt Major vessel shunt Major vessel shunt Major vessel shunt & graft Major vessel shunt Major vessel shunt Cavopulmonary shunting Repair great vessels defect Repair great vessels defect Repair great vessels defect Repair great vessels defect Repair great vessels defect Repair great vessels defect Repair great vessels defect Repair great vessels defect Repair great vessels defect Repair great vessels defect Repair arterial trunk Revision of pulmonary artery Aortic suspension Repair vessel defect Repair vessel defect Repair septal defect Repair septal defect Revise major vessel Revise major vessel Revise major vessel Remove aorta constriction Remove aorta constriction Remove aorta constriction Repair septal defect Repair septal defect Ascending aortic graft Ascending aortic graft Ascending aortic graft Ascending aortic graft Transverse aortic arch graft Thoracic aortic graft Thoracoabdominal graft Endovasc taa repr incl subcl Endovasc taa repr w/o subcl Insert endovasc prosth, taa Endovasc prosth, taa, add-on Endovasc prosth, delayed Artery transpose/endovas taa Car-car bp grft/endovas taa Remove lung artery emboli Remove lung artery emboli Surgery of great vessel Repair pulmonary artery Repair pulmonary atresia Transect pulmonary artery Remove pulmonary shunt Rpr pul art unifocal w/o cpb Repr pul art, unifocal w/cpb Removal of donor heart/lung Prepare donor heart/lung Transplantation, heart/lung Removal of donor heart Prepare donor heart Transplantation of heart External circulation assist External circulation assist Insert ia percut device Remove aortic assist device Aortic circulation assist Aortic circulation assist Insert balloon device Remove intra-aortic balloon Implant ventricular device Implant ventricular device Remove ventricular device Remove ventricular device Insert intracorporeal device Remove intracorporeal device

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

X

33999 34001 34051 34101 34111 34151 34201 34203 34401 34421 34451 34471 34490 34501 34502 34510 34520 34530 34800 34802 34803 34804 34805 34806 34808 34812 34813 34820 34825 34826 34830 34831 34832 34833 34834 34900 35001 35002 35005 35011 35013 35021 35022 35045 35081 35082 35091 35092 35102 35103 35111 35112 35121 35122 35131 35132 35141 35142 35151 35152 35180 35182 35184 35188 35189 35190 35201 35206 35207 35211 35216 35221 35226 35231 35236 35241 35246 35251 35256 35261 35266 35271 35276 35281 35286 35301

Cardiac surgery procedure Removal of artery clot Removal of artery clot Removal of artery clot Removal of arm artery clot Removal of artery clot Removal of artery clot Removal of leg artery clot Removal of vein clot Removal of vein clot Removal of vein clot Removal of vein clot Removal of vein clot Repair valve, femoral vein Reconstruct vena cava Transposition of vein valve Cross-over vein graft Leg vein fusion Endovas aaa repr w/sm tube Endovas aaa repr w/2-p part Endovas aaa repr w/3-p part Endovas aaa repr w/1-p part Endovas aaa repr w/long tube Aneurysm press sensor add-on Endovas iliac a device addon Xpose for endoprosth, femorl Femoral endovas graft add-on Xpose for endoprosth, iliac Endovasc extend prosth, init Endovasc exten prosth, add’l Open aortic tube prosth repr Open aortoiliac prosth repr Open aortofemor prosth repr Xpose for endoprosth, iliac Xpose, endoprosth, brachial Endovasc iliac repr w/graft Repair defect of artery Repair artery rupture, neck Repair defect of artery Repair defect of artery Repair artery rupture, arm Repair defect of artery Repair artery rupture, chest Repair defect of arm artery Repair defect of artery Repair artery rupture, aorta Repair defect of artery Repair artery rupture, aorta Repair defect of artery Repair artery rupture, groin Repair defect of artery Repair artery rupture,spleen Repair defect of artery Repair artery rupture, belly Repair defect of artery Repair artery rupture, groin Repair defect of artery Repair artery rupture, thigh Repair defect of artery Repair artery rupture, knee Repair blood vessel lesion Repair blood vessel lesion Repair blood vessel lesion Repair blood vessel lesion Repair blood vessel lesion Repair blood vessel lesion Repair blood vessel lesion Repair blood vessel lesion Repair blood vessel lesion Repair blood vessel lesion Repair blood vessel lesion Repair blood vessel lesion Repair blood vessel lesion Repair blood vessel lesion Repair blood vessel lesion Repair blood vessel lesion Repair blood vessel lesion Repair blood vessel lesion Repair blood vessel lesion Repair blood vessel lesion Repair blood vessel lesion Repair blood vessel lesion Repair blood vessel lesion Repair blood vessel lesion Repair blood vessel lesion Rechanneling of artery

T C C T T C T T C T C T T T C T T T C C C C C C C C C C C C C C C C C C C C C T C C C C C C C C C C C C C C C C C C C C T C T T C T T T T C C C T T T C C C T T T C C C T C

T C C T T C T T C T C T T T C T T T C C C C C C C C C C C C C C C C C C C C C T C C C C C C C C C C C C C C C C C C C C T C T T C T T T T C C C T T T C C C T T T C C C T C

0070 0000 0000 0088 0088 0000 0088 0088 0000 0088 0000 0088 0088 0088 0000 0088 0088 0088 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0653 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0093 0000 0093 0088 0000 0093 0093 0093 0088 0000 0000 0000 0093 0093 0093 0000 0000 0000 0093 0653 0653 0000 0000 0000 0653 0000

5.2024 0.0000 0.0000 38.7673 38.7673 0.0000 38.7673 38.7673 0.0000 38.7673 0.0000 38.7673 38.7673 38.7673 0.0000 38.7673 38.7673 38.7673 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 40.4667 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 30.1294 0.0000 30.1294 38.7673 0.0000 30.1294 30.1294 30.1294 38.7673 0.0000 0.0000 0.0000 30.1294 30.1294 30.1294 0.0000 0.0000 0.0000 30.1294 40.4667 40.4667 0.0000 0.0000 0.0000 40.4667 0.0000

248.52 0.00 0.00 1,851.91 1,851.91 0.00 1,851.91 1,851.91 0.00 1,851.91 0.00 1,851.91 1,851.91 1,851.91 0.00 1,851.91 1,851.91 1,851.91 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1,933.09 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1,439.28 0.00 1,439.28 1,851.91 0.00 1,439.28 1,439.28 1,439.28 1,851.91 0.00 0.00 0.00 1,439.28 1,439.28 1,439.28 0.00 0.00 0.00 1,439.28 1,933.09 1,933.09 0.00 0.00 0.00 1,933.09 0.00

566.65 0.00 0.00 4,222.53 4,222.53 0.00 4,222.53 4,222.53 0.00 4,222.53 0.00 4,222.53 4,222.53 4,222.53 0.00 4,222.53 4,222.53 4,222.53 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 4,407.63 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3,281.69 0.00 3,281.69 4,222.53 0.00 3,281.69 3,281.69 3,281.69 4,222.53 0.00 0.00 0.00 3,281.69 3,281.69 3,281.69 0.00 0.00 0.00 3,281.69 4,407.63 4,407.63 0.00 0.00 0.00 4,407.63 0.00

649.47 0.00 0.00 4,839.71 4,839.71 0.00 4,839.71 4,839.71 0.00 4,839.71 0.00 4,839.71 4,839.71 4,839.71 0.00 4,839.71 4,839.71 4,839.71 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 5,051.86 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3,761.35 0.00 3,761.35 4,839.71 0.00 3,761.35 3,761.35 3,761.35 4,839.71 0.00 0.00 0.00 3,761.35 3,761.35 3,761.35 0.00 0.00 0.00 3,761.35 5,051.86 5,051.86 0.00 0.00 0.00 5,051.86 0.00

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

X

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

18 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only C C C C C C T C C C C C C C C C C C C C C T T T T T T T T T T C C C C T T T T T T T T T C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C N C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C T T C C C C C C C C C T C C C T C T T T T T T C T C C N S N N N N N N N N N N N N N N N N N N N N N T T T C C C C C C T C C C C C C C C C C C C C C T T T T T T T T T T C C C C T T T T T T T T T C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C N C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C T T C C C C C C C C C T C C C T C T T T T T T C T C C N S N N N N N N N N N N N N N N N N N N N N N T T T

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 1,439.28 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2,168.02 2,168.02 2,168.02 2,168.02 2,168.02 2,168.02 2,168.02 2,168.02 2,168.02 2,168.02 0.00 0.00 0.00 0.00 4,180.53 4,180.53 4,180.53 4,180.53 4,180.53 4,180.53 4,180.53 4,180.53 700.19 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1,439.28 1,439.28 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1,418.60 0.00 0.00 0.00 1,439.28 0.00 1,851.91 1,851.91 1,851.91 1,851.91 1,851.91 1,851.91 0.00 1,418.60 0.00 0.00 0.00 113.65 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1,379.33 1,145.53 1,145.53

Children's Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 3,281.69 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 4,943.28 4,943.28 4,943.28 4,943.28 4,943.28 4,943.28 4,943.28 4,943.28 4,943.28 4,943.28 0.00 0.00 0.00 0.00 9,531.99 9,531.99 9,531.99 9,531.99 9,531.99 9,531.99 9,531.99 9,531.99 1,596.51 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3,281.69 3,281.69 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3,234.54 0.00 0.00 0.00 3,281.69 0.00 4,222.53 4,222.53 4,222.53 4,222.53 4,222.53 4,222.53 0.00 3,234.54 0.00 0.00 0.00 259.14 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3,144.99 2,611.92 2,611.92

Critical PDD Access Update to Hospital ACS Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 3,761.35 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 5,665.80 5,665.80 5,665.80 5,665.80 5,665.80 5,665.80 5,665.80 5,665.80 5,665.80 5,665.80 0.00 0.00 0.00 0.00 10,925.21 10,925.21 10,925.21 10,925.21 10,925.21 10,925.21 10,925.21 10,925.21 1,829.85 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3,761.35 3,761.35 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3,707.31 0.00 0.00 0.00 3,761.35 0.00 4,839.71 4,839.71 4,839.71 4,839.71 4,839.71 4,839.71 0.00 3,707.31 0.00 0.00 0.00 297.02 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3,604.67 2,993.69 2,993.69

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

35302 35303 35304 35305 35306 35311 35321 35331 35341 35351 35355 35361 35363 35371 35372 35390 35400 35450 35452 35454 35456 35458 35459 35460 35470 35471 35472 35473 35474 35475 35476 35480 35481 35482 35483 35484 35485 35490 35491 35492 35493 35494 35495 35500 35501 35506 35508 35509 35510 35511 35512 35515 35516 35518 35521 35522 35523 35525 35526 35531 35533 35536 35537 35538 35539 35540 35548 35549 35551 35556 35558 35560 35563 35565 35566 35571 35572 35583 35585 35587 35600 35601 35606 35612 35616 35621 35623 35626 35631 35636 35637 35638 35642 35645 35646 35647 35650 35651 35654 35656 35661 35663 35665 35666 35671 35681 35682 35683 35685 35686 35691 35693 35694 35695 35697 35700 35701 35721 35741 35761 35800 35820 35840 35860 35870 35875 35876 35879 35881 35883 35884 35901 35903 35905 35907 36000 36002 36005 36010 36011 36012 36013 36014 36015 36100 36120 36140 36145 36160 36200 36215 36216 36217 36218 36245 36246 36247 36248 36260 36261 36262

Rechanneling of artery Rechanneling of artery Rechanneling of artery Rechanneling of artery Rechanneling of artery Rechanneling of artery Rechanneling of artery Rechanneling of artery Rechanneling of artery Rechanneling of artery Rechanneling of artery Rechanneling of artery Rechanneling of artery Rechanneling of artery Rechanneling of artery Reoperation, carotid add-on Angioscopy Repair arterial blockage Repair arterial blockage Repair arterial blockage Repair arterial blockage Repair arterial blockage Repair arterial blockage Repair venous blockage Repair arterial blockage Repair arterial blockage Repair arterial blockage Repair arterial blockage Repair arterial blockage Repair arterial blockage Repair venous blockage Atherectomy, open Atherectomy, open Atherectomy, open Atherectomy, open Atherectomy, open Atherectomy, open Atherectomy, percutaneous Atherectomy, percutaneous Atherectomy, percutaneous Atherectomy, percutaneous Atherectomy, percutaneous Atherectomy, percutaneous Harvest vein for bypass Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Harvest femoropopliteal vein Vein bypass graft Vein bypass graft Vein bypass graft Harvest art for cabg add-on Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Bypass graft, not vein Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Artery bypass graft Composite bypass graft Composite bypass graft Composite bypass graft Bypass graft patency/patch Bypass graft/av fist patency Arterial transposition Arterial transposition Arterial transposition Arterial transposition Reimplant artery each Reoperation, bypass graft Exploration, carotid artery Exploration, femoral artery Exploration popliteal artery Exploration of artery/vein Explore neck vessels Explore chest vessels Explore abdominal vessels Explore limb vessels Repair vessel graft defect Removal of clot in graft Removal of clot in graft Revise graft w/vein Revise graft w/vein Revise graft w/nonauto graft Revise graft w/vein Excision, graft, neck Excision, graft, extremity Excision, graft, thorax Excision, graft, abdomen Place needle in vein Pseudoaneurysm injection trt Injection ext venography Place catheter in vein Place catheter in vein Place catheter in vein Place catheter in artery Place catheter in artery Place catheter in artery Establish access to artery Establish access to artery Establish access to artery Artery to vein shunt Establish access to aorta Place catheter in aorta Place catheter in artery Place catheter in artery Place catheter in artery Place catheter in artery Place catheter in artery Place catheter in artery Place catheter in artery Place catheter in artery Insertion of infusion pump Revision of infusion pump Removal of infusion pump

0000 0000 0000 0000 0000 0000 0093 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0083 0083 0083 0083 0083 0083 0083 0083 0083 0083 0000 0000 0000 0000 0082 0082 0082 0082 0082 0082 0082 0082 0103 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0093 0093 0000 0000 0000 0000 0000 0000 0000 0000 0000 0115 0000 0000 0000 0093 0000 0088 0088 0088 0088 0088 0088 0000 0115 0000 0000 0000 0267 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0623 0105 0105

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 30.1294 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 45.3845 45.3845 45.3845 45.3845 45.3845 45.3845 45.3845 45.3845 45.3845 45.3845 0.0000 0.0000 0.0000 0.0000 87.5137 87.5137 87.5137 87.5137 87.5137 87.5137 87.5137 87.5137 14.6576 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 30.1294 30.1294 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 29.6965 0.0000 0.0000 0.0000 30.1294 0.0000 38.7673 38.7673 38.7673 38.7673 38.7673 38.7673 0.0000 29.6965 0.0000 0.0000 0.0000 2.3792 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 28.8743 23.9802 23.9802

Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book

X

Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book

Description Change

x

Added 1/1/07 to book Added 1/1/07 to book

Added 1/1/07 to book Added 1/1/07 to book

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

19 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee

Children's Hospital Outpatient Fee

Critical PDD Access Update to Hospital ACS Outpatient Fee

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

36299 36400 36405 36406 36410 36415 36416 36420 36425 36430 36440 36450 36455 36460 36468 36469 36470 36471 36475 36476 36478 36479 36481 36500 36510 36511 36512 36513 36514 36515 36516 36522

Vessel injection procedure Bl draw < 3 yrs fem/jugular Bl draw < 3 yrs scalp vein Bl draw < 3 yrs other vein Non-routine bl draw > 3 yrs Routine venipuncture Capillary blood draw Vein access cutdown < 1 yr Vein access cutdown > 1 yr Blood transfusion service Bl push transfuse, 2 yr or < Bl exchange/transfuse, nb Bl exchange/transfuse non-nb Transfusion service, fetal Injection(s), spider veins Injection(s), spider veins Injection therapy of vein Injection therapy of veins Endovenous rf, 1st vein Endovenous rf, vein add-on Endovenous laser, 1st vein Endovenous laser vein addon Insertion of catheter, vein Insertion of catheter, vein Insertion of catheter, vein Apheresis wbc Apheresis rbc Apheresis platelets Apheresis plasma Apheresis, adsorp/reinfuse Apheresis, selective Photopheresis

N N N N N A N T T S S S S S T T T T T T T T N N N S S S S S S S

N N N N N 3 N T T S S S S S 1 1 1 1 T T T T N N N S S S S S S S

0000 0000 0000 0000 0000 0000 0000 0035 0035 0110 0110 0110 0110 0110 0013 0013 0013 0013 0091 0092 0092 0092 0000 0000 0000 0111 0111 0111 0111 0112 0112 0112

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.2143 0.2143 3.3967 3.3967 3.3967 3.3967 3.3967 0.7930 0.7930 0.7930 0.7930 42.6114 25.8410 25.8410 25.8410 0.0000 0.0000 0.0000 11.5058 11.5058 11.5058 11.5058 30.6035 30.6035 30.6035

0.00 0.00 0.00 0.00 0.00 M01 0.00 10.24 10.24 162.26 162.26 162.26 162.26 162.26 0.00 0.00 0.00 0.00 2,035.55 1,234.42 1,234.42 1,234.42 0.00 0.00 0.00 549.63 549.63 549.63 549.63 1,461.93 1,461.93 1,461.93

0.00 0.00 0.00 0.00 0.00 M01 0.00 23.34 23.34 369.97 369.97 369.97 369.97 369.97 0.00 0.00 0.00 0.00 4,641.23 2,814.60 2,814.60 2,814.60 0.00 0.00 0.00 1,253.21 1,253.21 1,253.21 1,253.21 3,333.33 3,333.33 3,333.33

0.00 0.00 0.00 0.00 0.00 M01 0.00 26.75 26.75 424.04 424.04 424.04 424.04 424.04 0.00 0.00 0.00 0.00 5,319.61 3,225.99 3,225.99 3,225.99 0.00 0.00 0.00 1,436.38 1,436.38 1,436.38 1,436.38 3,820.54 3,820.54 3,820.54

SI= N, effect. 05/01/06 If needed add 282N Taxonomy

Change Valid Sex to F

x

36555 36556 36557 36558 36560 36561 36563 36565 36566 36568 36569 36570 36571 36575 36576 36578 36580 36581 36582 36583 36584 36585 36589 36590 36591 36592 36593 36595 36596 36597 36598 36600 36620 36625 36640 36660 36680 36800 36810 36815 36818 36819 36820 36821 36822 36823 36825 36830 36831 36832 36833 36834 36835 36838 36860 36861 36870 37140 37145 37160 37180 37181 37182 37183 37184 37185 37186 37187 37188 37195 37200 37201 37202 37203 37204 37205 37206 37207 37208 37209 37210 37215 37216 37250 37251 37500

Insert non-tunnel cv cath Insert non-tunnel cv cath Insert tunneled cv cath Insert tunneled cv cath Insert tunneled cv cath Insert tunneled cv cath Insert tunneled cv cath Insert tunneled cv cath Insert tunneled cv cath Insert picc cath Insert picc cath Insert picvad cath Insert picvad cath Repair tunneled cv cath Repair tunneled cv cath Replace tunneled cv cath Replace cvad cath Replace tunneled cv cath Replace tunneled cv cath Replace tunneled cv cath Replace picc cath Replace picvad cath Removal tunneled cv cath Removal tunneled cv cath Draw blood off venous device Collect blood from picc Declot vascular device Mech remov tunneled cv cath Mech remov tunneled cv cath Reposition venous catheter Inj w/fluor, eval cv device Withdrawal of arterial blood Insertion catheter, artery Insertion catheter, artery Insertion catheter, artery Insertion catheter, artery Insert needle, bone cavity Insertion of cannula Insertion of cannula Insertion of cannula Av fuse, uppr arm, cephalic Av fuse, uppr arm, basilic Av fusion/forearm vein Av fusion direct any site Insertion of cannula(s) Insertion of cannula(s) Artery-vein autograft Artery-vein nonautograft Open thrombect av fistula Av fistula revision, open Av fistula revision Repair A-V aneurysm Artery to vein shunt Dist revas ligation, hemo External cannula declotting Cannula declotting Percut thrombect av fistula Revision of circulation Revision of circulation Revision of circulation Revision of circulation Splice spleen/kidney veins Insert hepatic shunt (tips) Remove hepatic shunt (tips) Prim art mech thrombectomy Prim art m-thrombect add-on Sec art m-thrombect add-on Venous mech thrombectomy Venous m-thrombectomy add-on Thrombolytic therapy, stroke Transcatheter biopsy Transcatheter therapy infuse Transcatheter therapy infuse Transcatheter retrieval Transcatheter occlusion Transcath iv stent, percut Transcath iv stent/perc addl Transcath iv stent, open Transcath iv stent/open addl Exchange arterial catheter Embolization uterine fibroid Transcath stent, cca w/eps Transcath stent, cca w/o eps Iv us first vessel add-on Iv us each add vessel add-on Endoscopy ligate perf veins

T T T T T T T T T T T T T T T T T T T T T T T T Q N T T T T T Q N N T C T T T T T T T T C C T T T T T T T T T T T C C C C C C T T T T T T T T T T T T T T T T T T C E N N T

T T T T T T T T T T T T T T T T T T T T T T T T Q N T T T T T Q N N T C T T T T T T T T C C T T T T T T T T T T T C C C C C C T T T T T T T T T T T T T T T T T T C 3 N N T

0621 0621 0622 0622 0623 0623 0623 0623 0625 0621 0621 0622 0622 0109 0621 0622 0621 0622 0623 0623 0621 0622 0109 0621 0624 0000 0676 0622 0621 0621 0676 0035 0000 0000 0623 0000 0002 0115 0115 0115 0088 0088 0088 0088 0000 0000 0088 0088 0088 0088 0088 0088 0115 0088 0676 0115 0653 0000 0000 0000 0000 0000 0000 0229 0088 0088 0088 0088 0088 0676 0623 0103 0103 0623 0082 0229 0229 0229 0229 0623 0229 0000 0000 0000 0000 0091

10.9092 10.9092 24.1069 24.1069 28.8743 28.8743 28.8743 28.8743 81.7482 10.9092 10.9092 24.1069 24.1069 5.6614 10.9092 24.1069 10.9092 24.1069 28.8743 28.8743 10.9092 24.1069 5.6614 10.9092 0.5689 0.0000 2.4824 24.1069 10.9092 10.9092 2.4824 0.2143 0.0000 0.0000 28.8743 0.0000 1.1097 29.6965 29.6965 29.6965 38.7673 38.7673 38.7673 38.7673 0.0000 0.0000 38.7673 38.7673 38.7673 38.7673 38.7673 38.7673 29.6965 38.7673 2.4824 29.6965 40.4667 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 88.5367 38.7673 38.7673 38.7673 38.7673 38.7673 2.4824 28.8743 14.6576 14.6576 28.8743 87.5137 88.5367 88.5367 88.5367 88.5367 28.8743 88.5367 0.0000 0.0000 0.0000 0.0000 42.6114

521.13 521.13 1,151.59 1,151.59 1,379.33 1,379.33 1,379.33 1,379.33 3,905.11 521.13 521.13 1,151.59 1,151.59 270.45 521.13 1,151.59 521.13 1,151.59 1,379.33 1,379.33 521.13 1,151.59 270.45 521.13 27.18 0.00 118.58 1,151.59 521.13 521.13 118.58 10.24 0.00 0.00 1,379.33 0.00 53.01 1,418.60 1,418.60 1,418.60 1,851.91 1,851.91 1,851.91 1,851.91 0.00 0.00 1,851.91 1,851.91 1,851.91 1,851.91 1,851.91 1,851.91 1,418.60 1,851.91 118.58 1,418.60 1,933.09 0.00 0.00 0.00 0.00 0.00 0.00 4,229.40 1,851.91 1,851.91 1,851.91 1,851.91 1,851.91 118.58 1,379.33 700.19 700.19 1,379.33 4,180.53 4,229.40 4,229.40 4,229.40 4,229.40 1,379.33 4,229.40 0.00 M01 0.00 0.00 2,035.55

1,188.23 1,188.23 2,625.72 2,625.72 3,144.99 3,144.99 3,144.99 3,144.99 8,904.01 1,188.23 1,188.23 2,625.72 2,625.72 616.64 1,188.23 2,625.72 1,188.23 2,625.72 3,144.99 3,144.99 1,188.23 2,625.72 616.64 1,188.23 61.96 0.00 270.38 2,625.72 1,188.23 1,188.23 270.38 23.34 0.00 0.00 3,144.99 0.00 120.87 3,234.54 3,234.54 3,234.54 4,222.53 4,222.53 4,222.53 4,222.53 0.00 0.00 4,222.53 4,222.53 4,222.53 4,222.53 4,222.53 4,222.53 3,234.54 4,222.53 270.38 3,234.54 4,407.63 0.00 0.00 0.00 0.00 0.00 0.00 9,643.42 4,222.53 4,222.53 4,222.53 4,222.53 4,222.53 270.38 3,144.99 1,596.51 1,596.51 3,144.99 9,531.99 9,643.42 9,643.42 9,643.42 9,643.42 3,144.99 9,643.42 0.00 M01 0.00 0.00 4,641.23

1,361.90 1,361.90 3,009.51 3,009.51 3,604.67 3,604.67 3,604.67 3,604.67 10,205.45 1,361.90 1,361.90 3,009.51 3,009.51 706.77 1,361.90 3,009.51 1,361.90 3,009.51 3,604.67 3,604.67 1,361.90 3,009.51 706.77 1,361.90 71.02 0.00 309.90 3,009.51 1,361.90 1,361.90 309.90 26.75 0.00 0.00 3,604.67 0.00 138.53 3,707.31 3,707.31 3,707.31 4,839.71 4,839.71 4,839.71 4,839.71 0.00 0.00 4,839.71 4,839.71 4,839.71 4,839.71 4,839.71 4,839.71 3,707.31 4,839.71 309.90 3,707.31 5,051.86 0.00 0.00 0.00 0.00 0.00 0.00 11,052.92 4,839.71 4,839.71 4,839.71 4,839.71 4,839.71 309.90 3,604.67 1,829.85 1,829.85 3,604.67 10,925.21 11,052.92 11,052.92 11,052.92 11,052.92 3,604.67 11,052.92 0.00 M01 0.00 0.00 5,319.61

X X X

X SI change 1/1/07 (TR 1155)

Added 1/1/07 to book SI change 1/1/07 (Addendum B) X X

37501 37565 37600 37605 37606 37607 37609 37615 37616 37617 37618 37620 37650 37660 37700 37718 37722 37735 37760 37765 37766 37780 37785 37788 37790

Vascular endoscopy procedure Ligation of neck vein Ligation of neck artery Ligation of neck artery Ligation of neck artery Ligation of a-v fistula Temporal artery procedure Ligation of neck artery Ligation of chest artery Ligation of abdomen artery Ligation of extremity artery Revision of major vein Revision of major vein Revision of major vein Revise leg vein Ligate/strip short leg vein Ligate/strip long leg vein Removal of leg veins/lesion Ligation, leg veins, open Phleb veins extrem 10-20 Phleb veins extrem 20+ Revision of leg vein Ligate/divide/excise vein Revascularization, penis Penile venous occlusion

T T T T T T T T C C C T T C T T T T T T T T T C T

T T T T T T T T C C C T T C T T T T T T T T T C T

0092 0093 0093 0091 0092 0092 0021 0092 0000 0000 0000 0091 0092 0000 0092 0092 0091 0091 0092 0092 0092 0092 0092 0000 0181

25.8410 30.1294 30.1294 42.6114 25.8410 25.8410 16.1001 25.8410 0.0000 0.0000 0.0000 42.6114 25.8410 0.0000 25.8410 25.8410 42.6114 42.6114 25.8410 25.8410 25.8410 25.8410 25.8410 0.0000 33.9306

1,234.42 1,439.28 1,439.28 2,035.55 1,234.42 1,234.42 769.10 1,234.42 0.00 0.00 0.00 2,035.55 1,234.42 0.00 1,234.42 1,234.42 2,035.55 2,035.55 1,234.42 1,234.42 1,234.42 1,234.42 1,234.42 0.00 1,620.86

2,814.60 3,281.69 3,281.69 4,641.23 2,814.60 2,814.60 1,753.62 2,814.60 0.00 0.00 0.00 4,641.23 2,814.60 0.00 2,814.60 2,814.60 4,641.23 4,641.23 2,814.60 2,814.60 2,814.60 2,814.60 2,814.60 0.00 3,695.72

3,225.99 3,761.35 3,761.35 5,319.61 3,225.99 3,225.99 2,009.94 3,225.99 0.00 0.00 0.00 5,319.61 3,225.99 0.00 3,225.99 3,225.99 5,319.61 5,319.61 3,225.99 3,225.99 3,225.99 3,225.99 3,225.99 0.00 4,235.90

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

Description Change

x

37799 38100 38101 38102 38115 38120

Vascular surgery procedure Removal of spleen, total Removal of spleen, partial Removal of spleen, total Repair of ruptured spleen Laparoscopy, splenectomy

T C C C C T

T C C C C T

0103 0000 0000 0000 0000 0131

14.6576 0.0000 0.0000 0.0000 0.0000 45.5317

700.19 0.00 0.00 0.00 0.00 2,175.05

1,596.51 0.00 0.00 0.00 0.00 4,959.31

1,829.85 0.00 0.00 0.00 0.00 5,684.18

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

38129 38200 38204

Laparoscope proc, spleen Injection for spleen x-ray Bl donor search management

T N N

T N N

0130 0000 0000

34.3958 0.0000 0.0000

1,643.09 0.00 0.00

3,746.39 0.00 0.00

4,293.97 0.00 0.00

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

20 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only S S S S S S S S S S S T T S S S S T T T C C C T T T T T T T T T C C T T T S S S S S S S S S S S T T S S S S T T T C C C T T T T T T T T T C C T T T

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 549.63 549.63 162.26 162.26 162.26 271.91 271.91 271.91 271.91 271.91 271.91 148.13 148.13 1,461.93 1,461.93 1,461.93 549.63 552.19 875.13 1,096.72 0.00 0.00 0.00 1,096.72 339.87 1,096.72 1,096.72 1,096.72 1,096.72 2,117.36 1,096.72 1,096.72 0.00 0.00 2,175.05 3,327.91 2,175.05

Children's Hospital Outpatient Fee 1,253.21 1,253.21 369.97 369.97 369.97 619.98 619.98 619.98 619.98 619.98 619.98 337.74 337.74 3,333.33 3,333.33 3,333.33 1,253.21 1,259.05 1,995.38 2,500.63 0.00 0.00 0.00 2,500.63 774.93 2,500.63 2,500.63 2,500.63 2,500.63 4,827.77 2,500.63 2,500.63 0.00 0.00 4,959.31 7,587.93 4,959.31

Critical PDD Access Update to Hospital ACS Outpatient Fee 1,436.38 1,436.38 424.04 424.04 424.04 710.60 710.60 710.60 710.60 710.60 710.60 387.10 387.10 3,820.54 3,820.54 3,820.54 1,436.38 1,443.08 2,287.03 2,866.13 0.00 0.00 0.00 2,866.13 888.20 2,866.13 2,866.13 2,866.13 2,866.13 5,533.41 2,866.13 2,866.13 0.00 0.00 5,684.18 8,697.00 5,684.18

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

38205 38206 38207 38208 38209 38210 38211 38212 38213 38214 38215 38220 38221 38230 38240 38241 38242 38300 38305 38308 38380 38381 38382 38500 38505 38510 38520 38525 38530 38542 38550 38555 38562 38564 38570 38571 38572

Harvest allogenic stem cells Harvest auto stem cells Cryopreserve stem cells Thaw preserved stem cells Wash harvest stem cells T-cell depletion of harvest Tumor cell deplete of harvst Rbc depletion of harvest Platelet deplete of harvest Volume deplete of harvest Harvest stem cell concentrte Bone marrow aspiration Bone marrow biopsy Bone marrow collection Bone marrow/stem transplant Bone marrow/stem transplant Lymphocyte infuse transplant Drainage, lymph node lesion Drainage, lymph node lesion Incision of lymph channels Thoracic duct procedure Thoracic duct procedure Thoracic duct procedure Biopsy/removal, lymph nodes Needle biopsy, lymph nodes Biopsy/removal, lymph nodes Biopsy/removal, lymph nodes Biopsy/removal, lymph nodes Biopsy/removal, lymph nodes Explore deep node(s), neck Removal, neck/armpit lesion Removal, neck/armpit lesion Removal, pelvic lymph nodes Removal, abdomen lymph nodes Laparoscopy, lymph node biop Laparoscopy, lymphadenectomy Laparoscopy, lymphadenectomy

0111 0111 0110 0110 0110 0393 0393 0393 0393 0393 0393 0003 0003 0112 0112 0112 0111 0007 0008 0113 0000 0000 0000 0113 0005 0113 0113 0113 0113 0114 0113 0113 0000 0000 0131 0132 0131

11.5058 11.5058 3.3967 3.3967 3.3967 5.6921 5.6921 5.6921 5.6921 5.6921 5.6921 3.1008 3.1008 30.6035 30.6035 30.6035 11.5058 11.5594 18.3197 22.9584 0.0000 0.0000 0.0000 22.9584 7.1147 22.9584 22.9584 22.9584 22.9584 44.3240 22.9584 22.9584 0.0000 0.0000 45.5317 69.6652 45.5317

SI =S effective 01/01/08 add tax 282N if necessary SI =S effective 01/01/08 add tax 282N if necessary SI =S effective 01/01/08 add tax 282N if necessary SI =S effective 01/01/08 add tax 282N if necessary SI =S effective 01/01/08 add tax 282N if necessary SI =S effective 01/01/08 add tax 282N if necessary SI =S effective 01/01/08 add tax 282N if necessary SI =S effective 01/01/08 add tax 282N if necessary SI =S effective 01/01/08 add tax 282N if necessary

X X X X X X X X X

38589 38700 38720 38724 38740 38745 38746 38747 38760 38765 38770 38780 38790 38792 38794

Laparoscope proc, lymphatic Removal of lymph nodes, neck Removal of lymph nodes, neck Removal of lymph nodes, neck Remove armpit lymph nodes Remove armpit lymph nodes Remove thoracic lymph nodes Remove abdominal lymph nodes Remove groin lymph nodes Remove groin lymph nodes Remove pelvis lymph nodes Remove abdomen lymph nodes Inject for lymphatic x-ray Identify sentinel node Access thoracic lymph duct

T T T C T T C C T C C C N Q N

T T T C T T C C T C C C N Q N

0130 0113 0113 0000 0114 0114 0000 0000 0113 0000 0000 0000 0000 0392 0000

34.3958 22.9584 22.9584 0.0000 44.3240 44.3240 0.0000 0.0000 22.9584 0.0000 0.0000 0.0000 0.0000 2.9022 0.0000

1,643.09 1,096.72 1,096.72 0.00 2,117.36 2,117.36 0.00 0.00 1,096.72 0.00 0.00 0.00 0.00 138.64 0.00

3,746.39 2,500.63 2,500.63 0.00 4,827.77 4,827.77 0.00 0.00 2,500.63 0.00 0.00 0.00 0.00 316.11 0.00

4,293.97 2,866.13 2,866.13 0.00 5,533.41 5,533.41 0.00 0.00 2,866.13 0.00 0.00 0.00 0.00 362.31 0.00

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

SI change 1/1/07 (TR 1155)

38999 39000 39010 39200 39220 39400

Blood/lymph system procedure Exploration of chest Exploration of chest Removal chest lesion Removal chest lesion Visualization of chest

S C C C C T

S C C C C T

0110 0000 0000 0000 0000 0069

3.3967 0.0000 0.0000 0.0000 0.0000 32.5666

162.26 0.00 0.00 0.00 0.00 1,555.71

369.97 0.00 0.00 0.00 0.00 3,547.15

424.04 0.00 0.00 0.00 0.00 4,065.61

SI= S, effect. 05/01/06 If needed add 282N Taxonomy

39499 39501 39502 39503 39520 39530 39531 39540 39541 39545 39560 39561

Chest procedure Repair diaphragm laceration Repair paraesophageal hernia Repair of diaphragm hernia Repair of diaphragm hernia Repair of diaphragm hernia Repair of diaphragm hernia Repair of diaphragm hernia Repair of diaphragm hernia Revision of diaphragm Resect diaphragm, simple Resect diaphragm, complex

C C C C C C C C C C C C

C C C C C C C C C C C C

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

SI= C, effect. 05/01/06 If needed add 282N Taxonomy

39599 40490 40500 40510 40520 40525 40527 40530 40650 40652 40654 40700 40701 40702 40720 40761

Diaphragm surgery procedure Biopsy of lip Partial excision of lip Partial excision of lip Partial excision of lip Reconstruct lip with flap Reconstruct lip with flap Partial removal of lip Repair lip Repair lip Repair lip Repair cleft lip/nasal Repair cleft lip/nasal Repair cleft lip/nasal Repair cleft lip/nasal Repair cleft lip/nasal

C T T T T T T T T T T T T T T T

C T T T T T T T T T T T T T T T

0000 0251 0253 0254 0253 0254 0254 0254 0252 0252 0252 0256 0256 0256 0256 0256

0.0000 2.5002 16.3288 23.9765 16.3288 23.9765 23.9765 23.9765 7.4474 7.4474 7.4474 39.8776 39.8776 39.8776 39.8776 39.8776

0.00 119.43 780.03 1,145.36 780.03 1,145.36 1,145.36 1,145.36 355.76 355.76 355.76 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95

0.00 272.32 1,778.53 2,611.52 1,778.53 2,611.52 2,611.52 2,611.52 811.17 811.17 811.17 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47

0.00 312.12 2,038.49 2,993.23 2,038.49 2,993.23 2,993.23 2,993.23 929.73 929.73 929.73 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32

SI= C, effect. 05/01/06 If needed add 282N Taxonomy

40799 40800 40801 40804 40805 40806 40808 40810 40812 40814 40816 40818 40819 40820 40830 40831 40840 40842 40843 40844 40845

Lip surgery procedure Drainage of mouth lesion Drainage of mouth lesion Removal, foreign body, mouth Removal, foreign body, mouth Incision of lip fold Biopsy of mouth lesion Excision of mouth lesion Excise/repair mouth lesion Excise/repair mouth lesion Excision of mouth lesion Excise oral mucosa for graft Excise lip or cheek fold Treatment of mouth lesion Repair mouth laceration Repair mouth laceration Reconstruction of mouth Reconstruction of mouth Reconstruction of mouth Reconstruction of mouth Reconstruction of mouth

T T T X T T T T T T T T T T T T T T T T T

T T T X T T T T T T T T T T T T T T T T T

0251 0006 0252 0340 0252 0251 0251 0253 0253 0253 0254 0251 0252 0253 0251 0252 0254 0254 0254 0256 0256

2.5002 1.4066 7.4474 0.6310 7.4474 2.5002 2.5002 16.3288 16.3288 16.3288 23.9765 2.5002 7.4474 16.3288 2.5002 7.4474 23.9765 23.9765 23.9765 39.8776 39.8776

119.43 67.19 355.76 30.14 355.76 119.43 119.43 780.03 780.03 780.03 1,145.36 119.43 355.76 780.03 119.43 355.76 1,145.36 1,145.36 1,145.36 1,904.95 1,904.95

272.32 153.21 811.17 68.73 811.17 272.32 272.32 1,778.53 1,778.53 1,778.53 2,611.52 272.32 811.17 1,778.53 272.32 811.17 2,611.52 2,611.52 2,611.52 4,343.47 4,343.47

312.12 175.60 929.73 78.77 929.73 312.12 312.12 2,038.49 2,038.49 2,038.49 2,993.23 312.12 929.73 2,038.49 312.12 929.73 2,993.23 2,993.23 2,993.23 4,978.32 4,978.32

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

40899 41000 41005 41006 41007 41008 41009 41010 41015 41016 41017 41018 41019 41100 41105 41108 41110 41112 41113 41114 41115 41116 41120 41130 41135 41140 41145 41150 41153 41155 41250 41251 41252 41500

Mouth surgery procedure Drainage of mouth lesion Drainage of mouth lesion Drainage of mouth lesion Drainage of mouth lesion Drainage of mouth lesion Drainage of mouth lesion Incision of tongue fold Drainage of mouth lesion Drainage of mouth lesion Drainage of mouth lesion Drainage of mouth lesion Place needles h&n for rt Biopsy of tongue Biopsy of tongue Biopsy of floor of mouth Excision of tongue lesion Excision of tongue lesion Excision of tongue lesion Excision of tongue lesion Excision of tongue fold Excision of mouth lesion Partial removal of tongue Partial removal of tongue Tongue and neck surgery Removal of tongue Tongue removal, neck surgery Tongue, mouth, jaw surgery Tongue, mouth, neck surgery Tongue, jaw, & neck surgery Repair tongue laceration Repair tongue laceration Repair tongue laceration Fixation of tongue

T T T T T T T T T T T T T T T T T T T T T T T C C C C C C C T T T T

T T T T T T T T T T T T T T T T T T T T T T T C C C C C C C T T T T

0251 0253 0251 0254 0253 0253 0251 0252 0251 0252 0252 0252 0254 0252 0253 0252 0253 0253 0253 0254 0252 0253 0254 0000 0000 0000 0000 0000 0000 0000 0251 0251 0252 0254

2.5002 16.3288 2.5002 23.9765 16.3288 16.3288 2.5002 7.4474 2.5002 7.4474 7.4474 7.4474 23.9765 7.4474 16.3288 7.4474 16.3288 16.3288 16.3288 23.9765 7.4474 16.3288 23.9765 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 2.5002 2.5002 7.4474 23.9765

119.43 780.03 119.43 1,145.36 780.03 780.03 119.43 355.76 119.43 355.76 355.76 355.76 1,145.36 355.76 780.03 355.76 780.03 780.03 780.03 1,145.36 355.76 780.03 1,145.36 0.00 0.00 0.00 0.00 0.00 0.00 0.00 119.43 119.43 355.76 1,145.36

272.32 1,778.53 272.32 2,611.52 1,778.53 1,778.53 272.32 811.17 272.32 811.17 811.17 811.17 2,611.52 811.17 1,778.53 811.17 1,778.53 1,778.53 1,778.53 2,611.52 811.17 1,778.53 2,611.52 0.00 0.00 0.00 0.00 0.00 0.00 0.00 272.32 272.32 811.17 2,611.52

312.12 2,038.49 312.12 2,993.23 2,038.49 2,038.49 312.12 929.73 312.12 929.73 929.73 929.73 2,993.23 929.73 2,038.49 929.73 2,038.49 2,038.49 2,038.49 2,993.23 929.73 2,038.49 2,993.23 0.00 0.00 0.00 0.00 0.00 0.00 0.00 312.12 312.12 929.73 2,993.23

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

X

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

21 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only T T T T

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 780.03 355.76

Children's Hospital Outpatient Fee 1,778.53 811.17

Critical PDD Access Update to Hospital ACS Outpatient Fee 2,038.49 929.73

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

41510 41520

Tongue to lip surgery Reconstruction, tongue fold

0253 0252

16.3288 7.4474

41599 41800 41805 41806 41820 41821 41822 41823 41825 41826 41827 41828 41830 41850 41870 41872 41874 41899 42000 42100 42104 42106 42107 42120 42140 42145 42160 42180 42182 42200 42205 42210 42215 42220 42225 42226 42227 42235 42260 42280 42281

Tongue and mouth surgery Drainage of gum lesion Removal foreign body, gum Removal foreign body,jawbone Excision, gum, each quadrant Excision of gum flap Excision of gum lesion Excision of gum lesion Excision of gum lesion Excision of gum lesion Excision of gum lesion Excision of gum lesion Removal of gum tissue Treatment of gum lesion Gum graft Repair gum Repair tooth socket Dental surgery procedure Drainage mouth roof lesion Biopsy roof of mouth Excision lesion, mouth roof Excision lesion, mouth roof Excision lesion, mouth roof Remove palate/lesion Excision of uvula Repair palate, pharynx/uvula Treatment mouth roof lesion Repair palate Repair palate Reconstruct cleft palate Reconstruct cleft palate Reconstruct cleft palate Reconstruct cleft palate Reconstruct cleft palate Reconstruct cleft palate Lengthening of palate Lengthening of palate Repair palate Repair nose to lip fistula Preparation, palate mold Insertion, palate prosthesis

T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T

T T T T T T T T T T T T T T T T T 2 T T T T T T T T T T T T T T T T T T T T T T T

0251 0006 0254 0253 0252 0252 0253 0254 0253 0253 0254 0253 0253 0253 0254 0253 0254 0251 0251 0252 0253 0253 0254 0256 0252 0254 0253 0251 0256 0256 0256 0256 0256 0256 0256 0256 0256 0253 0254 0251 0253

2.5002 1.4066 23.9765 16.3288 7.4474 7.4474 16.3288 23.9765 16.3288 16.3288 23.9765 16.3288 16.3288 16.3288 23.9765 16.3288 23.9765 2.5002 2.5002 7.4474 16.3288 16.3288 23.9765 39.8776 7.4474 23.9765 16.3288 2.5002 39.8776 39.8776 39.8776 39.8776 39.8776 39.8776 39.8776 39.8776 39.8776 16.3288 23.9765 2.5002 16.3288

119.43 67.19 1,145.36 780.03 355.76 355.76 780.03 1,145.36 780.03 780.03 1,145.36 780.03 780.03 780.03 1,145.36 780.03 1,145.36

272.32 153.21 2,611.52 1,778.53 811.17 811.17 1,778.53 2,611.52 1,778.53 1,778.53 2,611.52 1,778.53 1,778.53 1,778.53 2,611.52 1,778.53 2,611.52

312.12 175.60 2,993.23 2,038.49 929.73 929.73 2,038.49 2,993.23 2,038.49 2,038.49 2,993.23 2,038.49 2,038.49 2,038.49 2,993.23 2,038.49 2,993.23

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

APC by Report APC by Report APC by Report 119.43 272.32 312.12 355.76 811.17 929.73 780.03 1,778.53 2,038.49 780.03 1,778.53 2,038.49 1,145.36 2,611.52 2,993.23 1,904.95 4,343.47 4,978.32 355.76 811.17 929.73 1,145.36 2,611.52 2,993.23 780.03 1,778.53 2,038.49 119.43 272.32 312.12 1,904.95 4,343.47 4,978.32 1,904.95 4,343.47 4,978.32 1,904.95 4,343.47 4,978.32 1,904.95 4,343.47 4,978.32 1,904.95 4,343.47 4,978.32 1,904.95 4,343.47 4,978.32 1,904.95 4,343.47 4,978.32 1,904.95 4,343.47 4,978.32 1,904.95 4,343.47 4,978.32 780.03 1,778.53 2,038.49 1,145.36 2,611.52 2,993.23 119.43 272.32 312.12 780.03 1,778.53 2,038.49 SI= T, effect. 05/01/06 If needed add 282N Taxonomy

42299 42300 42305 42310 42320 42330 42335 42340 42400 42405 42408 42409 42410 42415 42420 42425 42426 42440 42450 42500 42505 42507 42508 42509 42510 42550 42600 42650 42660 42665

Palate/uvula surgery Drainage of salivary gland Drainage of salivary gland Drainage of salivary gland Drainage of salivary gland Removal of salivary stone Removal of salivary stone Removal of salivary stone Biopsy of salivary gland Biopsy of salivary gland Excision of salivary cyst Drainage of salivary cyst Excise parotid gland/lesion Excise parotid gland/lesion Excise parotid gland/lesion Excise parotid gland/lesion Excise parotid gland/lesion Excise submaxillary gland Excise sublingual gland Repair salivary duct Repair salivary duct Parotid duct diversion Parotid duct diversion Parotid duct diversion Parotid duct diversion Injection for salivary x-ray Closure of salivary fistula Dilation of salivary duct Dilation of salivary duct Ligation of salivary duct

T T T T T T T T T T T T T T T T C T T T T T T T T N T T T T

T T T T T T T T T T T T T T T T C T T T T T T T T N T T T T

0251 0253 0253 0251 0251 0253 0253 0253 0005 0253 0253 0253 0256 0256 0256 0256 0000 0256 0254 0254 0256 0256 0256 0256 0256 0000 0253 0252 0251 0254

2.5002 16.3288 16.3288 2.5002 2.5002 16.3288 16.3288 16.3288 7.1147 16.3288 16.3288 16.3288 39.8776 39.8776 39.8776 39.8776 0.0000 39.8776 23.9765 23.9765 39.8776 39.8776 39.8776 39.8776 39.8776 0.0000 16.3288 7.4474 2.5002 23.9765

119.43 780.03 780.03 119.43 119.43 780.03 780.03 780.03 339.87 780.03 780.03 780.03 1,904.95 1,904.95 1,904.95 1,904.95 0.00 1,904.95 1,145.36 1,145.36 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95 0.00 780.03 355.76 119.43 1,145.36

272.32 1,778.53 1,778.53 272.32 272.32 1,778.53 1,778.53 1,778.53 774.93 1,778.53 1,778.53 1,778.53 4,343.47 4,343.47 4,343.47 4,343.47 0.00 4,343.47 2,611.52 2,611.52 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47 0.00 1,778.53 811.17 272.32 2,611.52

312.12 2,038.49 2,038.49 312.12 312.12 2,038.49 2,038.49 2,038.49 888.20 2,038.49 2,038.49 2,038.49 4,978.32 4,978.32 4,978.32 4,978.32 0.00 4,978.32 2,993.23 2,993.23 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32 0.00 2,038.49 929.73 312.12 2,993.23

42699 42700 42720 42725 42800 42802 42804 42806 42808 42809 42810 42815 42820 42821 42825 42826 42830 42831 42835 42836 42842 42844 42845 42860 42870 42890 42892 42894 42900 42950 42953 42955 42960 42961 42962 42970 42971 42972

Salivary surgery procedure Drainage of tonsil abscess Drainage of throat abscess Drainage of throat abscess Biopsy of throat Biopsy of throat Biopsy of upper nose/throat Biopsy of upper nose/throat Excise pharynx lesion Remove pharynx foreign body Excision of neck cyst Excision of neck cyst Remove tonsils and adenoids Remove tonsils and adenoids Removal of tonsils Removal of tonsils Removal of adenoids Removal of adenoids Removal of adenoids Removal of adenoids Extensive surgery of throat Extensive surgery of throat Extensive surgery of throat Excision of tonsil tags Excision of lingual tonsil Partial removal of pharynx Revision of pharyngeal walls Revision of pharyngeal walls Repair throat wound Reconstruction of throat Repair throat, esophagus Surgical opening of throat Control throat bleeding Control throat bleeding Control throat bleeding Control nose/throat bleeding Control nose/throat bleeding Control nose/throat bleeding

T T T T T T T T T X T T T T T T T T T T T T C T T T T C T T C T T C T T C T

T T T T T T T T T X T T T T T T T T T T T T C T T T T C T T C T T C T T C T

0251 0251 0253 0256 0252 0253 0253 0254 0253 0340 0254 0256 0258 0258 0258 0258 0258 0258 0258 0258 0254 0256 0000 0258 0258 0256 0256 0000 0252 0254 0000 0254 0250 0000 0256 0250 0000 0253

2.5002 2.5002 16.3288 39.8776 7.4474 16.3288 16.3288 23.9765 16.3288 0.6310 23.9765 39.8776 22.2557 22.2557 22.2557 22.2557 22.2557 22.2557 22.2557 22.2557 23.9765 39.8776 0.0000 22.2557 22.2557 39.8776 39.8776 0.0000 7.4474 23.9765 0.0000 23.9765 1.1251 0.0000 39.8776 1.1251 0.0000 16.3288

119.43 119.43 780.03 1,904.95 355.76 780.03 780.03 1,145.36 780.03 30.14 1,145.36 1,904.95 1,063.15 1,063.15 1,063.15 1,063.15 1,063.15 1,063.15 1,063.15 1,063.15 1,145.36 1,904.95 0.00 1,063.15 1,063.15 1,904.95 1,904.95 0.00 355.76 1,145.36 0.00 1,145.36 53.75 0.00 1,904.95 53.75 0.00 780.03

272.32 272.32 1,778.53 4,343.47 811.17 1,778.53 1,778.53 2,611.52 1,778.53 68.73 2,611.52 4,343.47 2,424.09 2,424.09 2,424.09 2,424.09 2,424.09 2,424.09 2,424.09 2,424.09 2,611.52 4,343.47 0.00 2,424.09 2,424.09 4,343.47 4,343.47 0.00 811.17 2,611.52 0.00 2,611.52 122.55 0.00 4,343.47 122.55 0.00 1,778.53

312.12 312.12 2,038.49 4,978.32 929.73 2,038.49 2,038.49 2,993.23 2,038.49 78.77 2,993.23 4,978.32 2,778.40 2,778.40 2,778.40 2,778.40 2,778.40 2,778.40 2,778.40 2,778.40 2,993.23 4,978.32 0.00 2,778.40 2,778.40 4,978.32 4,978.32 0.00 929.73 2,993.23 0.00 2,993.23 140.46 0.00 4,978.32 140.46 0.00 2,038.49

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

42999 43020 43030 43045 43100 43101 43107 43108 43112 43113 43116 43117 43118 43121 43122 43123 43124 43130 43135 43200 43201 43202 43204 43205 43215 43216 43217 43219 43220 43226 43227 43228 43231 43232 43234 43235 43236 43237 43238 43239 43240 43241 43242

Throat surgery procedure Incision of esophagus Throat muscle surgery Incision of esophagus Excision of esophagus lesion Excision of esophagus lesion Removal of esophagus Removal of esophagus Removal of esophagus Removal of esophagus Partial removal of esophagus Partial removal of esophagus Partial removal of esophagus Partial removal of esophagus Partial removal of esophagus Partial removal of esophagus Removal of esophagus Removal of esophagus pouch Removal of esophagus pouch Esophagus endoscopy Esoph scope w/submucous inj Esophagus endoscopy, biopsy Esoph scope w/sclerosis inj Esophagus endoscopy/ligation Esophagus endoscopy Esophagus endoscopy/lesion Esophagus endoscopy Esophagus endoscopy Esoph endoscopy, dilation Esoph endoscopy, dilation Esoph endoscopy, repair Esoph endoscopy, ablation Esoph endoscopy w/us exam Esoph endoscopy w/us fn bx Upper GI endoscopy, exam Uppr gi endoscopy, diagnosis Uppr gi scope w/submuc inj Endoscopic us exam, esoph Uppr gi endoscopy w/us fn bx Upper GI endoscopy, biopsy Esoph endoscope w/drain cyst Upper GI endoscopy with tube Uppr gi endoscopy w/us fn bx

T T T C C C C C C C C C C C C C C T C T T T T T T T T T T T T T T T T T T T T T T T T

T T T C C C C C C C C C C C C C C T C T T T T T T T T T T T T T T T T T T T T T T T T

0251 0252 0253 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0256 0000 0141 0141 0141 0141 0141 0141 0141 0141 0384 0141 0141 0141 0422 0141 0141 0141 0141 0141 0141 0141 0141 0141 0141 0141

2.5002 7.4474 16.3288 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 39.8776 0.0000 8.5030 8.5030 8.5030 8.5030 8.5030 8.5030 8.5030 8.5030 24.9814 8.5030 8.5030 8.5030 25.3233 8.5030 8.5030 8.5030 8.5030 8.5030 8.5030 8.5030 8.5030 8.5030 8.5030 8.5030

119.43 355.76 780.03 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1,904.95 0.00 406.19 406.19 406.19 406.19 406.19 406.19 406.19 406.19 1,193.36 406.19 406.19 406.19 1,209.69 406.19 406.19 406.19 406.19 406.19 406.19 406.19 406.19 406.19 406.19 406.19

272.32 811.17 1,778.53 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 4,343.47 0.00 926.15 926.15 926.15 926.15 926.15 926.15 926.15 926.15 2,720.97 926.15 926.15 926.15 2,758.21 926.15 926.15 926.15 926.15 926.15 926.15 926.15 926.15 926.15 926.15 926.15

312.12 929.73 2,038.49 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 4,978.32 0.00 1,061.51 1,061.51 1,061.51 1,061.51 1,061.51 1,061.51 1,061.51 1,061.51 3,118.68 1,061.51 1,061.51 1,061.51 3,161.36 1,061.51 1,061.51 1,061.51 1,061.51 1,061.51 1,061.51 1,061.51 1,061.51 1,061.51 1,061.51 1,061.51

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

22 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 406.19 406.19 406.19 406.19 406.19 406.19 406.19 406.19 406.19 406.19 1,193.36 1,209.69 406.19 406.19 1,000.83 1,000.83 1,000.83 1,000.83 1,000.83 1,000.83 1,000.83 1,193.36 1,193.36 1,000.83 1,000.83 3,327.91

Children's Hospital Outpatient Fee 926.15 926.15 926.15 926.15 926.15 926.15 926.15 926.15 926.15 926.15 2,720.97 2,758.21 926.15 926.15 2,281.98 2,281.98 2,281.98 2,281.98 2,281.98 2,281.98 2,281.98 2,720.97 2,720.97 2,281.98 2,281.98 7,587.93

Critical PDD Access Update to Hospital ACS Outpatient Fee 1,061.51 1,061.51 1,061.51 1,061.51 1,061.51 1,061.51 1,061.51 1,061.51 1,061.51 1,061.51 3,118.68 3,161.36 1,061.51 1,061.51 2,615.52 2,615.52 2,615.52 2,615.52 2,615.52 2,615.52 2,615.52 3,118.68 3,118.68 2,615.52 2,615.52 8,697.00

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

43243 43244 43245 43246 43247 43248 43249 43250 43251 43255 43256 43257 43258 43259 43260 43261 43262 43263 43264 43265 43267 43268 43269 43271 43272 43280

Upper gi endoscopy & inject Upper GI endoscopy/ligation Uppr gi scope dilate strictr Place gastrostomy tube Operative upper GI endoscopy Uppr gi endoscopy/guide wire Esoph endoscopy, dilation Upper GI endoscopy/tumor Operative upper GI endoscopy Operative upper GI endoscopy Uppr gi endoscopy w/stent Uppr gi scope w/thrml txmnt Operative upper GI endoscopy Endoscopic ultrasound exam Endo cholangiopancreatograph Endo cholangiopancreatograph Endo cholangiopancreatograph Endo cholangiopancreatograph Endo cholangiopancreatograph Endo cholangiopancreatograph Endo cholangiopancreatograph Endo cholangiopancreatograph Endo cholangiopancreatograph Endo cholangiopancreatograph Endo cholangiopancreatograph Laparoscopy, fundoplasty

0141 0141 0141 0141 0141 0141 0141 0141 0141 0141 0384 0422 0141 0141 0151 0151 0151 0151 0151 0151 0151 0384 0384 0151 0151 0132

8.5030 8.5030 8.5030 8.5030 8.5030 8.5030 8.5030 8.5030 8.5030 8.5030 24.9814 25.3233 8.5030 8.5030 20.9510 20.9510 20.9510 20.9510 20.9510 20.9510 20.9510 24.9814 24.9814 20.9510 20.9510 69.6652

43289 43300 43305 43310 43312 43313 43314 43320 43324 43325 43326 43330 43331 43340 43341 43350 43351 43352 43360 43361 43400 43401 43405 43410 43415 43420 43425 43450 43453 43456 43458 43460 43496

Laparoscope proc, esoph Repair of esophagus Repair esophagus and fistula Repair of esophagus Repair esophagus and fistula Esophagoplasty congenital Tracheo-esophagoplasty cong Fuse esophagus & stomach Revise esophagus & stomach Revise esophagus & stomach Revise esophagus & stomach Repair of esophagus Repair of esophagus Fuse esophagus & intestine Fuse esophagus & intestine Surgical opening, esophagus Surgical opening, esophagus Surgical opening, esophagus Gastrointestinal repair Gastrointestinal repair Ligate esophagus veins Esophagus surgery for veins Ligate/staple esophagus Repair esophagus wound Repair esophagus wound Repair esophagus opening Repair esophagus opening Dilate esophagus Dilate esophagus Dilate esophagus Dilate esophagus Pressure treatment esophagus Free jejunum flap, microvasc

T C C C C C C C C C C C C C C C C C C C C C C C C C C T T T T C C

T C C C C C C C C C C C C C C C C C C C C C C C C C C T T T T C C

0130 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0140 0140 0140 0141 0000 0000

34.3958 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 5.8431 5.8431 5.8431 8.5030 0.0000 0.0000

1,643.09 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 279.12 279.12 279.12 406.19 0.00 0.00

3,746.39 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 636.43 636.43 636.43 926.15 0.00 0.00

4,293.97 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 729.45 729.45 729.45 1,061.51 0.00 0.00

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

43499 43500 43501 43502 43510 43520 43600 43605 43610 43611 43620 43621 43622 43631 43632 43633 43634 43635 43640 43641 43644 43645 43647 43648 43651 43652 43653

Esophagus surgery procedure Surgical opening of stomach Surgical repair of stomach Surgical repair of stomach Surgical opening of stomach Incision of pyloric muscle Biopsy of stomach Biopsy of stomach Excision of stomach lesion Excision of stomach lesion Removal of stomach Removal of stomach Removal of stomach Removal of stomach, partial Removal of stomach, partial Removal of stomach, partial Removal of stomach, partial Removal of stomach, partial Vagotomy & pylorus repair Vagotomy & pylorus repair Lap gastric bypass/roux-en-y Lap gastr bypass incl smll i Lap impl electrode, antrum Lap revise/remv eltrd antrum Laparoscopy, vagus nerve Laparoscopy, vagus nerve Laparoscopy, gastrostomy

T C C C T C T C C C C C C C C C C C C C C C S T T T T

T C C C T C T C C C C C C C C C C C C C C C S T T T T

0141 0000 0000 0000 0141 0000 0141 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0061 0130 0132 0132 0131

8.5030 0.0000 0.0000 0.0000 8.5030 0.0000 8.5030 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 82.8597 34.3958 69.6652 69.6652 45.5317

406.19 0.00 0.00 0.00 406.19 0.00 406.19 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3,958.21 1,643.09 3,327.91 3,327.91 2,175.05

926.15 0.00 0.00 0.00 926.15 0.00 926.15 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 9,025.08 3,746.39 7,587.93 7,587.93 4,959.31

1,061.51 0.00 0.00 0.00 1,061.51 0.00 1,061.51 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 10,344.20 4,293.97 8,697.00 8,697.00 5,684.18

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

Added 1/1/07 to book Added 1/1/07 to book

X

43659 43752 43760 43761 43770 43771 43772 43773 43774 43800 43810 43820 43825 43830 43831 43832 43840 43842 43843 43845 43846 43847 43848 43850 43855 43860 43865 43870 43880 43881 43882 43886 43887 43888

Laparoscope proc, stom Nasal/orogastric w/stent Change gastrostomy tube Reposition gastrostomy tube Lap place gastr adj device Lap revise gastr adj device Lap rmvl gastr adj device Lap replace gastr adj device Lap rmvl gastr adj all parts Reconstruction of pylorus Fusion of stomach and bowel Fusion of stomach and bowel Fusion of stomach and bowel Place gastrostomy tube Place gastrostomy tube Place gastrostomy tube Repair of stomach lesion V-band gastroplasty Gastroplasty w/o v-band Gastroplasty duodenal switch Gastric bypass for obesity Gastric bypass incl small i Revision gastroplasty Revise stomach-bowel fusion Revise stomach-bowel fusion Revise stomach-bowel fusion Revise stomach-bowel fusion Repair stomach opening Repair stomach-bowel fistula Impl/redo electrd, antrum Revise/remove electrd antrum Revise gastric port, open Remove gastric port, open Change gastric port, open

T X T T C C C C C C C C C T T C C E C C C C C C C C C T C C C T T T

T X T T C C C C C C C C C T T C C C C C C C C C C C C T C C C T T T

0130 0272 0121 0141 0000 0000 0000 0000 0000 0000 0000 0000 0000 0422 0141 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0141 0000 0000 0000 0137 0135 0137

34.3958 1.3271 3.2383 8.5030 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 25.3233 8.5030 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 8.5030 0.0000 0.0000 0.0000 20.2069 4.5263 20.2069

1,643.09 63.40 154.69 406.19 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1,209.69 406.19 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 406.19 0.00 0.00 0.00 965.28 216.22 965.28

3,746.39 144.55 352.72 926.15 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2,758.21 926.15 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 926.15 0.00 0.00 0.00 2,200.94 493.00 2,200.94

4,293.97 165.68 404.27 1,061.51 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3,161.36 1,061.51 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1,061.51 0.00 0.00 0.00 2,522.63 565.06 2,522.63

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

Description Change Description Change Description Change Description Change Description Change

x x x x x

Added 1/1/07 to book Added 1/1/07 to book

43999 44005 44010 44015 44020 44021 44025 44050 44055 44100 44110 44111 44120 44121 44125 44126 44127 44128 44130 44132 44133 44135 44136 44137 44139 44140 44141 44143 44144 44145 44146 44147 44150 44151

Stomach surgery procedure Freeing of bowel adhesion Incision of small bowel Insert needle cath bowel Explore small intestine Decompress small bowel Incision of large bowel Reduce bowel obstruction Correct malrotation of bowel Biopsy of bowel Excise intestine lesion(s) Excision of bowel lesion(s) Removal of small intestine Removal of small intestine Removal of small intestine Enterectomy w/o taper, cong Enterectomy w/taper, cong Enterectomy cong, add-on Bowel to bowel fusion Enterectomy, cadaver donor Enterectomy, live donor Intestine transplnt, cadaver Intestine transplant, live Remove intestinal allograft Mobilization of colon Partial removal of colon Partial removal of colon Partial removal of colon Partial removal of colon Partial removal of colon Partial removal of colon Partial removal of colon Removal of colon Removal of colon/ileostomy

T C C C C C C C C T C C C C C C C C C C C C C C C C C C C C C C C C

T C C C C C C C C T C C C C C C C C C 1 1 1 1 1 C C C C C C C C C C

0141 0000 0000 0000 0000 0000 0000 0000 0000 0141 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

8.5030 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 8.5030 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

406.19 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 406.19 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

926.15 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 926.15 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

1,061.51 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1,061.51 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

23 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only C C C C C T T C C C C C C T T T C C C T C C C C C C T T C C C C C C T T T C C C T C

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 2,175.05 2,175.05 0.00 0.00 0.00 0.00 0.00 0.00 3,327.91 3,327.91 3,327.91 0.00 0.00 0.00 1,643.09 0.00

Children's Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 4,959.31 4,959.31 0.00 0.00 0.00 0.00 0.00 0.00 7,587.93 7,587.93 7,587.93 0.00 0.00 0.00 3,746.39 0.00

Critical PDD Access Update to Hospital ACS Outpatient Fee 0.00 0.00 0.00 0.00 0.00 5,684.18 5,684.18 0.00 0.00 0.00 0.00 0.00 0.00 8,697.00 8,697.00 8,697.00 0.00 0.00 0.00 4,293.97 0.00

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

44155 44156 44157 44158 44160 44180 44186 44187 44188 44202 44203 44204 44205 44206 44207 44208 44210 44211 44212 44213 44227

Removal of colon/ileostomy Removal of colon/ileostomy Colectomy w/ileoanal anast Colectomy w/neo-rectum pouch Removal of colon Lap, enterolysis Lap, jejunostomy Lap, ileo/jejuno-stomy Lap, colostomy Lap resect s/intestine singl Lap resect s/intestine, addl Laparo partial colectomy Lap colectomy part w/ileum Lap part colectomy w/stoma L colectomy/coloproctostomy L colectomy/coloproctostomy Laparo total proctocolectomy Laparo total proctocolectomy Laparo total proctocolectomy Lap, mobil splenic fl add-on Lap, close enterostomy

0000 0000 0000 0000 0000 0131 0131 0000 0000 0000 0000 0000 0000 0132 0132 0132 0000 0000 0000 0130 0000

0.0000 0.0000 0.0000 0.0000 0.0000 45.5317 45.5317 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 69.6652 69.6652 69.6652 0.0000 0.0000 0.0000 34.3958 0.0000

Added 1/1/07 to book Added 1/1/07 to book

44238 44300 44310 44312 44314 44316 44320 44322 44340 44345 44346 44360 44361 44363 44364 44365 44366 44369 44370 44372 44373 44376 44377 44378 44379 44380 44382 44383 44385 44386 44388 44389 44390 44391 44392 44393 44394 44397 44500 44602 44603 44604 44605 44615 44620 44625 44626 44640 44650 44660 44661 44680 44700 44701 44715 44720 44721

Laparoscope proc, intestine Open bowel to skin Ileostomy/jejunostomy Revision of ileostomy Revision of ileostomy Devise bowel pouch Colostomy Colostomy with biopsies Revision of colostomy Revision of colostomy Revision of colostomy Small bowel endoscopy Small bowel endoscopy/biopsy Small bowel endoscopy Small bowel endoscopy Small bowel endoscopy Small bowel endoscopy Small bowel endoscopy Small bowel endoscopy/stent Small bowel endoscopy Small bowel endoscopy Small bowel endoscopy Small bowel endoscopy/biopsy Small bowel endoscopy S bowel endoscope w/stent Small bowel endoscopy Small bowel endoscopy Ileoscopy w/stent Endoscopy of bowel pouch Endoscopy, bowel pouch/biop Colonoscopy Colonoscopy with biopsy Colonoscopy for foreign body Colonoscopy for bleeding Colonoscopy & polypectomy Colonoscopy, lesion removal Colonoscopy w/snare Colonoscopy w/stent Intro, gastrointestinal tube Suture, small intestine Suture, small intestine Suture, large intestine Repair of bowel lesion Intestinal stricturoplasty Repair bowel opening Repair bowel opening Repair bowel opening Repair bowel-skin fistula Repair bowel fistula Repair bowel-bladder fistula Repair bowel-bladder fistula Surgical revision, intestine Suspend bowel w/prosthesis Intraop colon lavage add-on Prepare donor intestine Prep donor intestine/venous Prep donor intestine/artery

T C C T C C C C T C C T T T T T T T T T T T T T T T T T T T T T T T T T T T T C C C C C C C C C C C C C C N C C C

T C C T C C C C T C C T T T T T T T T T T T T T T T T T T T T T T T T T T T T C C C C C C C C C C C C C C N 1 1 1

0130 0000 0000 0137 0000 0000 0000 0000 0137 0000 0000 0142 0142 0142 0142 0142 0142 0142 0384 0142 0142 0142 0142 0142 0384 0142 0142 0384 0143 0143 0143 0143 0143 0143 0143 0143 0143 0384 0121 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

34.3958 0.0000 0.0000 20.2069 0.0000 0.0000 0.0000 0.0000 20.2069 0.0000 0.0000 9.5292 9.5292 9.5292 9.5292 9.5292 9.5292 9.5292 24.9814 9.5292 9.5292 9.5292 9.5292 9.5292 24.9814 9.5292 9.5292 24.9814 8.8486 8.8486 8.8486 8.8486 8.8486 8.8486 8.8486 8.8486 8.8486 24.9814 3.2383 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

1,643.09 0.00 0.00 965.28 0.00 0.00 0.00 0.00 965.28 0.00 0.00 455.21 455.21 455.21 455.21 455.21 455.21 455.21 1,193.36 455.21 455.21 455.21 455.21 455.21 1,193.36 455.21 455.21 1,193.36 422.70 422.70 422.70 422.70 422.70 422.70 422.70 422.70 422.70 1,193.36 154.69 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

3,746.39 0.00 0.00 2,200.94 0.00 0.00 0.00 0.00 2,200.94 0.00 0.00 1,037.92 1,037.92 1,037.92 1,037.92 1,037.92 1,037.92 1,037.92 2,720.97 1,037.92 1,037.92 1,037.92 1,037.92 1,037.92 2,720.97 1,037.92 1,037.92 2,720.97 963.79 963.79 963.79 963.79 963.79 963.79 963.79 963.79 963.79 2,720.97 352.72 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

4,293.97 0.00 0.00 2,522.63 0.00 0.00 0.00 0.00 2,522.63 0.00 0.00 1,189.63 1,189.63 1,189.63 1,189.63 1,189.63 1,189.63 1,189.63 3,118.68 1,189.63 1,189.63 1,189.63 1,189.63 1,189.63 3,118.68 1,189.63 1,189.63 3,118.68 1,104.66 1,104.66 1,104.66 1,104.66 1,104.66 1,104.66 1,104.66 1,104.66 1,104.66 3,118.68 404.27 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

44799 44800 44820 44850

Unlisted procedure intestine Excision of bowel pouch Excision of mesentery lesion Repair of mesentery

T C C C

T C C C

0153 0000 0000 0000

25.6947 0.0000 0.0000 0.0000

1,227.44 0.00 0.00 0.00

2,798.67 0.00 0.00 0.00

3,207.73 0.00 0.00 0.00

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

44899 44900 44901 44950 44955 44960 44970

Bowel surgery procedure Drain app abscess, open Drain app abscess, percut Appendectomy Appendectomy add-on Appendectomy Laparoscopy, appendectomy

C C T C C C T

C C T C C C T

0000 0000 0037 0000 0000 0000 0131

0.0000 0.0000 13.5764 0.0000 0.0000 0.0000 45.5317

0.00 0.00 648.54 0.00 0.00 0.00 2,175.05

0.00 0.00 1,478.74 0.00 0.00 0.00 4,959.31

0.00 0.00 1,694.88 0.00 0.00 0.00 5,684.18

SI= C, effect. 05/01/06 If needed add 282N Taxonomy

44979 45000 45005 45020 45100 45108 45110 45111 45112 45113 45114 45116 45119 45120 45121 45123 45126 45130 45135 45136 45150 45160 45170 45190 45300 45303 45305 45307 45308 45309 45315 45317 45320 45321 45327 45330 45331 45332 45333 45334 45335 45337 45338 45339 45340 45341 45342 45345 45355 45378 45379 45380 45381 45382 45383 45384 45385 45386 45387 45391 45392 45395 45397 45400 45402

Laparoscope proc, app Drainage of pelvic abscess Drainage of rectal abscess Drainage of rectal abscess Biopsy of rectum Removal of anorectal lesion Removal of rectum Partial removal of rectum Removal of rectum Partial proctectomy Partial removal of rectum Partial removal of rectum Remove rectum w/reservoir Removal of rectum Removal of rectum and colon Partial proctectomy Pelvic exenteration Excision of rectal prolapse Excision of rectal prolapse Excise ileoanal reservior Excision of rectal stricture Excision of rectal lesion Excision of rectal lesion Destruction, rectal tumor Proctosigmoidoscopy dx Proctosigmoidoscopy dilate Proctosigmoidoscopy w/bx Proctosigmoidoscopy fb Proctosigmoidoscopy removal Proctosigmoidoscopy removal Proctosigmoidoscopy removal Proctosigmoidoscopy bleed Proctosigmoidoscopy ablate Proctosigmoidoscopy volvul Proctosigmoidoscopy w/stent Diagnostic sigmoidoscopy Sigmoidoscopy and biopsy Sigmoidoscopy w/fb removal Sigmoidoscopy & polypectomy Sigmoidoscopy for bleeding Sigmoidoscopy w/submuc inj Sigmoidoscopy & decompress Sigmoidoscopy w/tumr remove Sigmoidoscopy w/ablate tumr Sig w/balloon dilation Sigmoidoscopy w/ultrasound Sigmoidoscopy w/us guide bx Sigmoidoscopy w/stent Surgical colonoscopy Diagnostic colonoscopy Colonoscopy w/fb removal Colonoscopy and biopsy Colonoscopy, submucous inj Colonoscopy/control bleeding Lesion removal colonoscopy Lesion remove colonoscopy Lesion removal colonoscopy Colonoscopy dilate stricture Colonoscopy w/stent Colonoscopy w/endoscope us Colonoscopy w/endoscopic fnb Lap, removal of rectum Lap, remove rectum w/pouch Laparoscopic proctopexy Lap proctopexy w/sig resect

T T T T T T C C C C C C C C C C C C C C T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T C C C C

T T T T T T C C C C C C C C C C C C C C T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T C C C C

0130 0155 0155 0155 0149 0149 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0149 0149 0149 0149 0146 0147 0147 0428 0147 0147 0147 0147 0428 0428 0384 0146 0146 0146 0147 0147 0146 0146 0147 0147 0147 0147 0147 0384 0143 0143 0143 0143 0143 0143 0143 0143 0143 0143 0384 0143 0143 0000 0000 0000 0000

34.3958 10.9132 10.9132 10.9132 22.7451 22.7451 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 22.7451 22.7451 22.7451 22.7451 5.0972 8.7031 8.7031 21.4632 8.7031 8.7031 8.7031 8.7031 21.4632 21.4632 24.9814 5.0972 5.0972 5.0972 8.7031 8.7031 5.0972 5.0972 8.7031 8.7031 8.7031 8.7031 8.7031 24.9814 8.8486 8.8486 8.8486 8.8486 8.8486 8.8486 8.8486 8.8486 8.8486 8.8486 24.9814 8.8486 8.8486 0.0000 0.0000 0.0000 0.0000

1,643.09 521.32 521.32 521.32 1,086.53 1,086.53 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1,086.53 1,086.53 1,086.53 1,086.53 243.49 415.75 415.75 1,025.30 415.75 415.75 415.75 415.75 1,025.30 1,025.30 1,193.36 243.49 243.49 243.49 415.75 415.75 243.49 243.49 415.75 415.75 415.75 415.75 415.75 1,193.36 422.70 422.70 422.70 422.70 422.70 422.70 422.70 422.70 422.70 422.70 1,193.36 422.70 422.70 0.00 0.00 0.00 0.00

3,746.39 1,188.67 1,188.67 1,188.67 2,477.40 2,477.40 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2,477.40 2,477.40 2,477.40 2,477.40 555.19 947.94 947.94 2,337.77 947.94 947.94 947.94 947.94 2,337.77 2,337.77 2,720.97 555.19 555.19 555.19 947.94 947.94 555.19 555.19 947.94 947.94 947.94 947.94 947.94 2,720.97 963.79 963.79 963.79 963.79 963.79 963.79 963.79 963.79 963.79 963.79 2,720.97 963.79 963.79 0.00 0.00 0.00 0.00

4,293.97 1,362.40 1,362.40 1,362.40 2,839.50 2,839.50 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2,839.50 2,839.50 2,839.50 2,839.50 636.33 1,086.50 1,086.50 2,679.47 1,086.50 1,086.50 1,086.50 1,086.50 2,679.47 2,679.47 3,118.68 636.33 636.33 636.33 1,086.50 1,086.50 636.33 636.33 1,086.50 1,086.50 1,086.50 1,086.50 1,086.50 3,118.68 1,104.66 1,104.66 1,104.66 1,104.66 1,104.66 1,104.66 1,104.66 1,104.66 1,104.66 1,104.66 3,118.68 1,104.66 1,104.66 0.00 0.00 0.00 0.00

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

24 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee

Children's Hospital Outpatient Fee

Critical PDD Access Update to Hospital ACS Outpatient Fee

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

45499 45500 45505 45520 45540 45541 45550 45560 45562 45563 45800 45805 45820 45825 45900 45905 45910 45915 45990

Laparoscope proc, rectum Repair of rectum Repair of rectum Treatment of rectal prolapse Correct rectal prolapse Correct rectal prolapse Repair rectum/remove sigmoid Repair of rectocele Exploration/repair of rectum Exploration/repair of rectum Repair rect/bladder fistula Repair fistula w/colostomy Repair rectourethral fistula Repair fistula w/colostomy Reduction of rectal prolapse Dilation of anal sphincter Dilation of rectal narrowing Remove rectal obstruction Surg dx exam, anorectal

T T T T C T C T C C C C C C T T T T T

T T T T C T C T C C C C C C T T T T T

0130 0149 0150 0013 0000 0150 0000 0150 0000 0000 0000 0000 0000 0000 0148 0149 0149 0155 0149

34.3958 22.7451 30.1606 0.7930 0.0000 30.1606 0.0000 30.1606 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 4.7935 22.7451 22.7451 10.9132 22.7451

1,643.09 1,086.53 1,440.77 37.88 0.00 1,440.77 0.00 1,440.77 0.00 0.00 0.00 0.00 0.00 0.00 228.99 1,086.53 1,086.53 521.32 1,086.53

3,746.39 2,477.40 3,285.09 86.37 0.00 3,285.09 0.00 3,285.09 0.00 0.00 0.00 0.00 0.00 0.00 522.11 2,477.40 2,477.40 1,188.67 2,477.40

4,293.97 2,839.50 3,765.25 99.00 0.00 3,765.25 0.00 3,765.25 0.00 0.00 0.00 0.00 0.00 0.00 598.42 2,839.50 2,839.50 1,362.40 2,839.50

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

45999 46020 46030 46040 46045 46050 46060 46070 46080 46083 46200 46210 46211 46220 46221 46230 46250 46255 46257 46258 46260 46261 46262 46270 46275 46280 46285 46288 46320 46500 46505 46600 46604 46606 46608 46610 46611 46612 46614 46615 46700 46705 46706 46710 46712 46715 46716 46730 46735 46740 46742 46744 46746 46748 46750 46751 46753 46754 46760 46761 46762 46900 46910 46916 46917 46922 46924 46934 46935 46936 46937 46938 46940 46942 46945 46946 46947

Rectum surgery procedure Placement of seton Removal of rectal marker Incision of rectal abscess Incision of rectal abscess Incision of anal abscess Incision of rectal abscess Incision of anal septum Incision of anal sphincter Incise external hemorrhoid Removal of anal fissure Removal of anal crypt Removal of anal crypts Removal of anal tag Ligation of hemorrhoid(s) Removal of anal tags Hemorrhoidectomy Hemorrhoidectomy Remove hemorrhoids & fissure Remove hemorrhoids & fistula Hemorrhoidectomy Remove hemorrhoids & fissure Remove hemorrhoids & fistula Removal of anal fistula Removal of anal fistula Removal of anal fistula Removal of anal fistula Repair anal fistula Removal of hemorrhoid clot Injection into hemorrhoid(s) Chemodenervation anal musc Diagnostic anoscopy Anoscopy and dilation Anoscopy and biopsy Anoscopy, remove for body Anoscopy, remove lesion Anoscopy Anoscopy, remove lesions Anoscopy, control bleeding Anoscopy Repair of anal stricture Repair of anal stricture Repr of anal fistula w/glue Repr per/vag pouch sngl proc Repr per/vag pouch dbl proc Rep perf anoper fistu Rep perf anoper/vestib fistu Construction of absent anus Construction of absent anus Construction of absent anus Repair of imperforated anus Repair of cloacal anomaly Repair of cloacal anomaly Repair of cloacal anomaly Repair of anal sphincter Repair of anal sphincter Reconstruction of anus Removal of suture from anus Repair of anal sphincter Repair of anal sphincter Implant artificial sphincter Destruction, anal lesion(s) Destruction, anal lesion(s) Cryosurgery, anal lesion(s) Laser surgery, anal lesions Excision of anal lesion(s) Destruction, anal lesion(s) Destruction of hemorrhoids Destruction of hemorrhoids Destruction of hemorrhoids Cryotherapy of rectal lesion Cryotherapy of rectal lesion Treatment of anal fissure Treatment of anal fissure Ligation of hemorrhoids Ligation of hemorrhoids Hemorrhoidopexy by stapling

T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T X T T T T T T T T T C T C C C C C C C C C C C T C T T T T T T T T T T T T T T T T T T T T T

T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T X T T T T T T T T T C T C C C C C C C C C C C T C T T T T T T T T T T T T T T T T T T T T T

0148 0149 0148 0149 0149 0155 0149 0155 0149 0164 0149 0149 0149 0149 0148 0149 0149 0149 0149 0149 0149 0149 0149 0149 0149 0149 0149 0149 0149 0155 0148 0340 0147 0146 0147 0428 0147 0428 0146 0428 0149 0000 0150 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0150 0000 0149 0149 0150 0150 0150 0016 0017 0015 0017 0017 0017 0155 0155 0149 0149 0150 0149 0148 0155 0155 0150

4.7935 22.7451 4.7935 22.7451 22.7451 10.9132 22.7451 10.9132 22.7451 2.0077 22.7451 22.7451 22.7451 22.7451 4.7935 22.7451 22.7451 22.7451 22.7451 22.7451 22.7451 22.7451 22.7451 22.7451 22.7451 22.7451 22.7451 22.7451 22.7451 10.9132 4.7935 0.6310 8.7031 5.0972 8.7031 21.4632 8.7031 21.4632 5.0972 21.4632 22.7451 0.0000 30.1606 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 30.1606 0.0000 22.7451 22.7451 30.1606 30.1606 30.1606 2.6604 19.9041 1.4595 19.9041 19.9041 19.9041 10.9132 10.9132 22.7451 22.7451 30.1606 22.7451 4.7935 10.9132 10.9132 30.1606

228.99 1,086.53 228.99 1,086.53 1,086.53 521.32 1,086.53 521.32 1,086.53 95.91 1,086.53 1,086.53 1,086.53 1,086.53 228.99 1,086.53 1,086.53 1,086.53 1,086.53 1,086.53 1,086.53 1,086.53 1,086.53 1,086.53 1,086.53 1,086.53 1,086.53 1,086.53 1,086.53 521.32 228.99 30.14 415.75 243.49 415.75 1,025.30 415.75 1,025.30 243.49 1,025.30 1,086.53 0.00 1,440.77 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1,440.77 0.00 1,086.53 1,086.53 1,440.77 1,440.77 1,440.77 127.09 950.82 69.72 950.82 950.82 950.82 521.32 521.32 1,086.53 1,086.53 1,440.77 1,086.53 228.99 521.32 521.32 1,440.77

522.11 2,477.40 522.11 2,477.40 2,477.40 1,188.67 2,477.40 1,188.67 2,477.40 218.68 2,477.40 2,477.40 2,477.40 2,477.40 522.11 2,477.40 2,477.40 2,477.40 2,477.40 2,477.40 2,477.40 2,477.40 2,477.40 2,477.40 2,477.40 2,477.40 2,477.40 2,477.40 2,477.40 1,188.67 522.11 68.73 947.94 555.19 947.94 2,337.77 947.94 2,337.77 555.19 2,337.77 2,477.40 0.00 3,285.09 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3,285.09 0.00 2,477.40 2,477.40 3,285.09 3,285.09 3,285.09 289.77 2,167.95 158.97 2,167.95 2,167.95 2,167.95 1,188.67 1,188.67 2,477.40 2,477.40 3,285.09 2,477.40 522.11 1,188.67 1,188.67 3,285.09

598.42 2,839.50 598.42 2,839.50 2,839.50 1,362.40 2,839.50 1,362.40 2,839.50 250.64 2,839.50 2,839.50 2,839.50 2,839.50 598.42 2,839.50 2,839.50 2,839.50 2,839.50 2,839.50 2,839.50 2,839.50 2,839.50 2,839.50 2,839.50 2,839.50 2,839.50 2,839.50 2,839.50 1,362.40 598.42 78.77 1,086.50 636.33 1,086.50 2,679.47 1,086.50 2,679.47 636.33 2,679.47 2,839.50 0.00 3,765.25 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3,765.25 0.00 2,839.50 2,839.50 3,765.25 3,765.25 3,765.25 332.12 2,484.83 182.20 2,484.83 2,484.83 2,484.83 1,362.40 1,362.40 2,839.50 2,839.50 3,765.25 2,839.50 598.42 1,362.40 1,362.40 3,765.25

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

46999 47000 47001 47010 47011 47015 47100 47120 47122 47125 47130 47133 47135 47136 47140 47141 47142 47143 47144 47145 47146 47147 47300 47350 47360 47361 47362 47370 47371

Anus surgery procedure Needle biopsy of liver Needle biopsy, liver add-on Open drainage, liver lesion Percut drain, liver lesion Inject/aspirate liver cyst Wedge biopsy of liver Partial removal of liver Extensive removal of liver Partial removal of liver Partial removal of liver Removal of donor liver Transplantation of liver Transplantation of liver Partial removal, donor liver Partial removal, donor liver Partial removal, donor liver Prep donor liver, whole Prep donor liver, 3-segment Prep donor liver, lobe split Prep donor liver/venous Prep donor liver/arterial Surgery for liver lesion Repair liver wound Repair liver wound Repair liver wound Repair liver wound Laparo ablate liver tumor rf Laparo ablate liver cryosurg

T T N C T C C C C C C C C C C C C C C C C C C C C C C T T

T T N C T C C C C C C C C C C C C C C C C C C C C C C T T

0148 0685 0000 0000 0037 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0132 0131

4.7935 9.3354 0.0000 0.0000 13.5764 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 69.6652 45.5317

228.99 445.95 0.00 0.00 648.54 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3,327.91 2,175.05

522.11 1,016.81 0.00 0.00 1,478.74 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 7,587.93 4,959.31

598.42 1,165.43 0.00 0.00 1,694.88 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8,697.00 5,684.18

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

47379 47380 47381 47382

Laparoscope procedure, liver Open ablate liver tumor rf Open ablate liver tumor cryo Percut ablate liver rf

T C C T

T C C T

0130 0000 0000 0423

34.3958 0.0000 0.0000 42.9980

1,643.09 0.00 0.00 2,054.01

3,746.39 0.00 0.00 4,683.34

4,293.97 0.00 0.00 5,367.87

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

47399 47400 47420 47425 47460 47480 47490 47500 47505 47510 47511 47525 47530 47550 47552 47553 47554 47555 47556 47560 47561 47562 47563 47564

Liver surgery procedure Incision of liver duct Incision of bile duct Incision of bile duct Incise bile duct sphincter Incision of gallbladder Incision of gallbladder Injection for liver x-rays Injection for liver x-rays Insert catheter, bile duct Insert bile duct drain Change bile duct catheter Revise/reinsert bile tube Bile duct endoscopy add-on Biliary endoscopy thru skin Biliary endoscopy thru skin Biliary endoscopy thru skin Biliary endoscopy thru skin Biliary endoscopy thru skin Laparoscopy w/cholangio Laparo w/cholangio/biopsy Laparoscopic cholecystectomy Laparo cholecystectomy/graph Laparo cholecystectomy/explr

T C C C C C T N N T T T T C T T T T T T T T T T

T C C C C C T N N T T T T C T T T T T T T T T T

0004 0000 0000 0000 0000 0000 0152 0000 0000 0152 0152 0427 0427 0000 0152 0152 0152 0152 0152 0130 0130 0131 0131 0131

4.3270 0.0000 0.0000 0.0000 0.0000 0.0000 28.6884 0.0000 0.0000 28.6884 28.6884 15.3545 15.3545 0.0000 28.6884 28.6884 28.6884 28.6884 28.6884 34.3958 34.3958 45.5317 45.5317 45.5317

206.70 0.00 0.00 0.00 0.00 0.00 1,370.44 0.00 0.00 1,370.44 1,370.44 733.48 733.48 0.00 1,370.44 1,370.44 1,370.44 1,370.44 1,370.44 1,643.09 1,643.09 2,175.05 2,175.05 2,175.05

471.30 0.00 0.00 0.00 0.00 0.00 3,124.74 0.00 0.00 3,124.74 3,124.74 1,672.41 1,672.41 0.00 3,124.74 3,124.74 3,124.74 3,124.74 3,124.74 3,746.39 3,746.39 4,959.31 4,959.31 4,959.31

540.18 0.00 0.00 0.00 0.00 0.00 3,581.46 0.00 0.00 3,581.46 3,581.46 1,916.86 1,916.86 0.00 3,581.46 3,581.46 3,581.46 3,581.46 3,581.46 4,293.97 4,293.97 5,684.18 5,684.18 5,684.18

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

25 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only C C

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 0.00

Children's Hospital Outpatient Fee 0.00

Critical PDD Access Update to Hospital ACS Outpatient Fee 0.00

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

47570

Laparo cholecystoenterostomy

0000

0.0000

47579 47600 47605 47610 47612 47620 47630 47700 47701 47711 47712 47715 47720 47721 47740 47741 47760 47765 47780 47785 47800 47801 47802 47900

Laparoscope proc, biliary Removal of gallbladder Removal of gallbladder Removal of gallbladder Removal of gallbladder Removal of gallbladder Remove bile duct stone Exploration of bile ducts Bile duct revision Excision of bile duct tumor Excision of bile duct tumor Excision of bile duct cyst Fuse gallbladder & bowel Fuse upper gi structures Fuse gallbladder & bowel Fuse gallbladder & bowel Fuse bile ducts and bowel Fuse liver ducts & bowel Fuse bile ducts and bowel Fuse bile ducts and bowel Reconstruction of bile ducts Placement, bile duct support Fuse liver duct & intestine Suture bile duct injury

T C C C C C T C C C C C C C C C C C C C C C C C

T C C C C C T C C C C C C C C C C C C C C C C C

0130 0000 0000 0000 0000 0000 0152 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

34.3958 0.0000 0.0000 0.0000 0.0000 0.0000 28.6884 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

1,643.09 0.00 0.00 0.00 0.00 0.00 1,370.44 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

3,746.39 0.00 0.00 0.00 0.00 0.00 3,124.74 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

4,293.97 0.00 0.00 0.00 0.00 0.00 3,581.46 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

47999 48000 48001 48020 48100 48102 48105 48120 48140 48145 48146 48148 48150 48152 48153 48154 48155 48160 48400 48500 48510 48511 48520 48540 48545 48547 48548 48550 48551 48552 48554 48556

Bile tract surgery procedure Drainage of abdomen Placement of drain, pancreas Removal of pancreatic stone Biopsy of pancreas, open Needle biopsy, pancreas Resect/debride pancreas Removal of pancreas lesion Partial removal of pancreas Partial removal of pancreas Pancreatectomy Removal of pancreatic duct Partial removal of pancreas Pancreatectomy Pancreatectomy Pancreatectomy Removal of pancreas Pancreas removal/transplant Injection, intraop add-on Surgery of pancreatic cyst Drain pancreatic pseudocyst Drain pancreatic pseudocyst Fuse pancreas cyst and bowel Fuse pancreas cyst and bowel Pancreatorrhaphy Duodenal exclusion Fuse pancreas and bowel Donor pancreatectomy Prep donor pancreas Prep donor pancreas/venous Transpl allograft pancreas Removal, allograft pancreas

T C C C C T C C C C C C C C C C C E C C C T C C C C C E C C C C

T C C C C T C C C C C C C C C C C 3 C C C T C C C C C 3 C C C C

0152 0000 0000 0000 0000 0685 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0037 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

28.6884 0.0000 0.0000 0.0000 0.0000 9.3354 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 13.5764 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

1,370.44 0.00 0.00 0.00 0.00 445.95 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 648.54 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00

3,124.74 0.00 0.00 0.00 0.00 1,016.81 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 1,478.74 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00

3,581.46 0.00 0.00 0.00 0.00 1,165.43 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 1,694.88 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

Added 1/1/07 to book

Added 1/1/07 to book

48999 49000 49002 49010 49020 49021 49040 49041 49060 49061 49062 49080 49081 49180

Pancreas surgery procedure Exploration of abdomen Reopening of abdomen Exploration behind abdomen Drain abdominal abscess Drain abdominal abscess Drain, open, abdom abscess Drain, percut, abdom abscess Drain, open, retrop abscess Drain, percut, retroper absc Drain to peritoneal cavity Puncture, peritoneal cavity Removal of abdominal fluid Biopsy, abdominal mass

T C C C C T C T C T C T T T

T C C C C T C T C T C T T T

0004 0000 0000 0000 0000 0037 0000 0037 0000 0037 0000 0070 0070 0685

4.3270 0.0000 0.0000 0.0000 0.0000 13.5764 0.0000 13.5764 0.0000 13.5764 0.0000 5.2024 5.2024 9.3354

206.70 0.00 0.00 0.00 0.00 648.54 0.00 648.54 0.00 648.54 0.00 248.52 248.52 445.95

471.30 0.00 0.00 0.00 0.00 1,478.74 0.00 1,478.74 0.00 1,478.74 0.00 566.65 566.65 1,016.81

540.18 0.00 0.00 0.00 0.00 1,694.88 0.00 1,694.88 0.00 1,694.88 0.00 649.47 649.47 1,165.43

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

49203 49204 49205 49215 49220 49250 49255 49320 49321 49322 49323 49324 49325 49326

Exc abd tum 5 cm or less Exc abd tum over 5 cm Exc abd tum over 10 cm Excise sacral spine tumor Multiple surgery, abdomen Excision of umbilicus Removal of omentum Diag laparo separate proc Laparoscopy, biopsy Laparoscopy, aspiration Laparo drain lymphocele Lap insertion perm ip cath Lap revision perm ip cath Lap w/omentopexy add-on

C C C C C T C T T T T T T T

C C C C C T C T T T T T T T

0000 0000 0000 0000 0000 0153 0000 0130 0130 0130 0130 0130 0130 0130

0.0000 0.0000 0.0000 0.0000 0.0000 25.6947 0.0000 34.3958 34.3958 34.3958 34.3958 34.3958 34.3958 34.3958

0.00 0.00 0.00 0.00 0.00 1,227.44 0.00 1,643.09 1,643.09 1,643.09 1,643.09 1,643.09 1,643.09 1,643.09

0.00 0.00 0.00 0.00 0.00 2,798.67 0.00 3,746.39 3,746.39 3,746.39 3,746.39 3,746.39 3,746.39 3,746.39

0.00 0.00 0.00 0.00 0.00 3,207.73 0.00 4,293.97 4,293.97 4,293.97 4,293.97 4,293.97 4,293.97 4,293.97

X X X

Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book SI= T, effect. 05/01/06 If needed add 282N Taxonomy Added 1/1/07 to book

49329 49400 49402 49419 49420 49421 49422 49423 49424 49425 49426 49427 49428 49429 49435 49436 49440 49441 49442 49446 49450 49451 49452 49460 49465 49491 49492 49495 49496 49500 49501 49505 49507 49520 49521 49525 49540 49550 49553 49555 49557 49560 49561 49565 49566 49568 49570 49572 49580 49582 49585 49587 49590 49600 49605 49606 49610 49611 49650 49651

Laparo proc, abdm/per/oment Air injection into abdomen Remove foreign body, adbomen Insrt abdom cath for chemotx Insert abdom drain, temp Insert abdom drain, perm Remove perm cannula/catheter Exchange drainage catheter Assess cyst, contrast inject Insert abdomen-venous drain Revise abdomen-venous shunt Injection, abdominal shunt Ligation of shunt Removal of shunt Insert subq exten to ip cath Embedded ip cath exit-site Place gastrostomy tube perc Place duod/jej tube perc Place cecostomy tube perc Change g-tube to g-j perc Replace g/c tube perc Replace duod/jej tube perc Replace g-j tube perc Fix g/colon tube w/device Fluoro exam of g/colon tube Rpr hern preemie reduc Rpr ing hern premie, blocked Rpr ing hernia baby, reduc Rpr ing hernia baby, blocked Rpr ing hernia, init, reduce Rpr ing hernia, init blocked Prp i/hern init reduc >5 yr Prp i/hern init block >5 yr Rerepair ing hernia, reduce Rerepair ing hernia, blocked Repair ing hernia, sliding Repair lumbar hernia Rpr rem hernia, init, reduce Rpr fem hernia, init blocked Rerepair fem hernia, reduce Rerepair fem hernia, blocked Rpr ventral hern init, reduc Rpr ventral hern init, block Rerepair ventrl hern, reduce Rerepair ventrl hern, block Hernia repair w/mesh Rpr epigastric hern, reduce Rpr epigastric hern, blocked Rpr umbil hern, reduc < 5 yr Rpr umbil hern, block < 5 yr Rpr umbil hern, reduc > 5 yr Rpr umbil hern, block > 5 yr Repair spigelian hernia Repair umbilical lesion Repair umbilical lesion Repair umbilical lesion Repair umbilical lesion Repair umbilical lesion Laparo hernia repair initial Laparo hernia repair recur

T N T T T T T T N C T N C T T T T T T T T T T T Q T T T T T T T T T T T T T T T T T T T T T T T T T T T T T C C C C T T

T N T T T T T T N C T N C T 1 T T T T T T T T T Q T T T T T T T T T T T T T T T T T T T T T T T T T T T T T C C C C T T

0130 0000 0153 0115 0652 0652 0105 0427 0000 0000 0153 0000 0000 0105 0427 0427 0141 0141 0155 0141 0121 0121 0121 0121 0276 0154 0154 0154 0154 0154 0154 0154 0154 0154 0154 0154 0154 0154 0154 0154 0154 0154 0154 0154 0154 0154 0154 0154 0154 0154 0154 0154 0154 0154 0000 0000 0000 0000 0131 0131

34.3958 0.0000 25.6947 29.6965 30.7096 30.7096 23.9802 15.3545 0.0000 0.0000 25.6947 0.0000 0.0000 23.9802 15.3545 15.3545 8.5030 8.5030 10.9132 8.5030 3.2383 3.2383 3.2383 3.2383 1.3834 30.6788 30.6788 30.6788 30.6788 30.6788 30.6788 30.6788 30.6788 30.6788 30.6788 30.6788 30.6788 30.6788 30.6788 30.6788 30.6788 30.6788 30.6788 30.6788 30.6788 30.6788 30.6788 30.6788 30.6788 30.6788 30.6788 30.6788 30.6788 30.6788 0.0000 0.0000 0.0000 0.0000 45.5317 45.5317

1,643.09 0.00 1,227.44 1,418.60 1,467.00 1,467.00 1,145.53 733.48 0.00 0.00 1,227.44 0.00 0.00 1,145.53 0.00 733.48 406.19 406.19 521.32 406.19 154.69 154.69 154.69 154.69 66.09 1,465.53 1,465.53 1,465.53 1,465.53 1,465.53 1,465.53 1,465.53 1,465.53 1,465.53 1,465.53 1,465.53 1,465.53 1,465.53 1,465.53 1,465.53 1,465.53 1,465.53 1,465.53 1,465.53 1,465.53 1,465.53 1,465.53 1,465.53 1,465.53 1,465.53 1,465.53 1,465.53 1,465.53 1,465.53 0.00 0.00 0.00 0.00 2,175.05 2,175.05

3,746.39 0.00 2,798.67 3,234.54 3,344.89 3,344.89 2,611.92 1,672.41 0.00 0.00 2,798.67 0.00 0.00 2,611.92 0.00 1,672.41 926.15 926.15 1,188.67 926.15 352.72 352.72 352.72 352.72 150.68 3,341.53 3,341.53 3,341.53 3,341.53 3,341.53 3,341.53 3,341.53 3,341.53 3,341.53 3,341.53 3,341.53 3,341.53 3,341.53 3,341.53 3,341.53 3,341.53 3,341.53 3,341.53 3,341.53 3,341.53 3,341.53 3,341.53 3,341.53 3,341.53 3,341.53 3,341.53 3,341.53 3,341.53 3,341.53 0.00 0.00 0.00 0.00 4,959.31 4,959.31

4,293.97 0.00 3,207.73 3,707.31 3,833.79 3,833.79 2,993.69 1,916.86 0.00 0.00 3,207.73 0.00 0.00 2,993.69 0.00 1,916.86 1,061.51 1,061.51 1,362.40 1,061.51 404.27 404.27 404.27 404.27 172.70 3,829.94 3,829.94 3,829.94 3,829.94 3,829.94 3,829.94 3,829.94 3,829.94 3,829.94 3,829.94 3,829.94 3,829.94 3,829.94 3,829.94 3,829.94 3,829.94 3,829.94 3,829.94 3,829.94 3,829.94 3,829.94 3,829.94 3,829.94 3,829.94 3,829.94 3,829.94 3,829.94 3,829.94 3,829.94 0.00 0.00 0.00 0.00 5,684.18 5,684.18

Added 1/1/07 to book Added 1/1/07 to book X X X X X X X X X

49659 49900 49904 49905 49906

Laparo proc, hernia repair Repair of abdominal wall Omental flap, extra-abdom Omental flap, intra-abdom Free omental flap, microvasc

T C C C C

T C C C C

0130 0000 0000 0000 0000

34.3958 0.0000 0.0000 0.0000 0.0000

1,643.09 0.00 0.00 0.00 0.00

3,746.39 0.00 0.00 0.00 0.00

4,293.97 0.00 0.00 0.00 0.00

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

26 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee

Children's Hospital Outpatient Fee

Critical PDD Access Update to Hospital ACS Outpatient Fee

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

49999 50010 50020 50021 50040 50045 50060 50065 50070 50075 50080 50081 50100 50120 50125 50130 50135 50200 50205 50220 50225 50230 50234 50236 50240 50250 50280 50290 50300 50320 50323 50325 50327 50328 50329 50340 50360 50365 50370 50380 50382 50384 50385 50386 50387 50389 50390 50391 50392 50393 50394 50395 50396 50398 50400 50405 50500 50520 50525 50526 50540 50541 50542 50543 50544 50545 50546 50547 50548

Abdomen surgery procedure Exploration of kidney Renal abscess, open drain Renal abscess, percut drain Drainage of kidney Exploration of kidney Removal of kidney stone Incision of kidney Incision of kidney Removal of kidney stone Removal of kidney stone Removal of kidney stone Revise kidney blood vessels Exploration of kidney Explore and drain kidney Removal of kidney stone Exploration of kidney Biopsy of kidney Biopsy of kidney Remove kidney, open Removal kidney open, complex Removal kidney open, radical Removal of kidney & ureter Removal of kidney & ureter Partial removal of kidney Cryoablate renal mass open Removal of kidney lesion Removal of kidney lesion Remove cadaver donor kidney Remove kidney, living donor Prep cadaver renal allograft Prep donor renal graft Prep renal graft/venous Prep renal graft/arterial Prep renal graft/ureteral Removal of kidney Transplantation of kidney Transplantation of kidney Remove transplanted kidney Reimplantation of kidney Change ureter stent, percut Remove ureter stent, percut Change stent via transureth Remove stent via transureth Change ext/int ureter stent Remove renal tube w/fluoro Drainage of kidney lesion Instll rx agnt into rnal tub Insert kidney drain Insert ureteral tube Injection for kidney x-ray Create passage to kidney Measure kidney pressure Change kidney tube Revision of kidney/ureter Revision of kidney/ureter Repair of kidney wound Close kidney-skin fistula Repair renal-abdomen fistula Repair renal-abdomen fistula Revision of horseshoe kidney Laparo ablate renal cyst Laparo ablate renal mass Laparo partial nephrectomy Laparoscopy, pyeloplasty Laparo radical nephrectomy Laparoscopic nephrectomy Laparo removal donor kidney Laparo remove w/ureter

T C T T C C C C C C T T C C C C C T C C C C C C C C C C C C C C C C C C C C C C T T T T T T T T T T N T T T C C C C C C C T T T T C C C C

T C T T C C C C C C T T C C C C C T C C C C C C C C C C C C C C C C C C C C C C T T T T T T T T T T N T T T C C C C C C C T T T T C C C C

0153 0000 0162 0037 0000 0000 0000 0000 0000 0000 0429 0429 0000 0000 0000 0000 0000 0685 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0162 0161 0161 0160 0427 0160 0685 0126 0161 0162 0000 0161 0164 0427 0000 0000 0000 0000 0000 0000 0000 0130 0132 0131 0130 0000 0000 0000 0000

25.6947 0.0000 24.7749 13.5764 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 45.2042 45.2042 0.0000 0.0000 0.0000 0.0000 0.0000 9.3354 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 24.7749 17.9420 17.9420 5.9735 15.3545 5.9735 9.3354 1.0356 17.9420 24.7749 0.0000 17.9420 2.0077 15.3545 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 34.3958 69.6652 45.5317 34.3958 0.0000 0.0000 0.0000 0.0000

1,227.44 0.00 1,183.50 648.54 0.00 0.00 0.00 0.00 0.00 0.00 2,159.40 2,159.40 0.00 0.00 0.00 0.00 0.00 445.95 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1,183.50 857.09 857.09 285.35 733.48 285.35 445.95 49.47 857.09 1,183.50 0.00 857.09 95.91 733.48 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1,643.09 3,327.91 2,175.05 1,643.09 0.00 0.00 0.00 0.00

2,798.67 0.00 2,698.48 1,478.74 0.00 0.00 0.00 0.00 0.00 0.00 4,923.64 4,923.64 0.00 0.00 0.00 0.00 0.00 1,016.81 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2,698.48 1,954.24 1,954.24 650.63 1,672.41 650.63 1,016.81 112.80 1,954.24 2,698.48 0.00 1,954.24 218.68 1,672.41 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3,746.39 7,587.93 4,959.31 3,746.39 0.00 0.00 0.00 0.00

3,207.73 0.00 3,092.90 1,694.88 0.00 0.00 0.00 0.00 0.00 0.00 5,643.29 5,643.29 0.00 0.00 0.00 0.00 0.00 1,165.43 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3,092.90 2,239.88 2,239.88 745.73 1,916.86 745.73 1,165.43 129.28 2,239.88 3,092.90 0.00 2,239.88 250.64 1,916.86 0.00 0.00 0.00 0.00 0.00 0.00 0.00 4,293.97 8,697.00 5,684.18 4,293.97 0.00 0.00 0.00 0.00

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

X X

50549 50551 50553 50555 50557 50561 50562 50570 50572 50574 50575 50576 50580 50590 50592 50593 50600 50605 50610 50620 50630 50650 50660 50684 50686 50688 50690 50700 50715 50722 50725 50727 50728 50740 50750 50760 50770 50780 50782 50783 50785 50800 50810 50815 50820 50825 50830 50840 50845 50860 50900 50920 50930 50940 50945 50947 50948

Laparoscope proc, renal Kidney endoscopy Kidney endoscopy Kidney endoscopy & biopsy Kidney endoscopy & treatment Kidney endoscopy & treatment Renal scope w/tumor resect Kidney endoscopy Kidney endoscopy Kidney endoscopy & biopsy Kidney endoscopy Kidney endoscopy & treatment Kidney endoscopy & treatment Fragmenting of kidney stone Perc rf ablate renal tumor Perc cryo ablate renal tum Exploration of ureter Insert ureteral support Removal of ureter stone Removal of ureter stone Removal of ureter stone Removal of ureter Removal of ureter Injection for ureter x-ray Measure ureter pressure Change of ureter tube Injection for ureter x-ray Revision of ureter Release of ureter Release of ureter Release/revise ureter Revise ureter Revise ureter Fusion of ureter & kidney Fusion of ureter & kidney Fusion of ureters Splicing of ureters Reimplant ureter in bladder Reimplant ureter in bladder Reimplant ureter in bladder Reimplant ureter in bladder Implant ureter in bowel Fusion of ureter & bowel Urine shunt to intestine Construct bowel bladder Construct bowel bladder Revise urine flow Replace ureter by bowel Appendico-vesicostomy Transplant ureter to skin Repair of ureter Closure ureter/skin fistula Closure ureter/bowel fistula Release of ureter Laparoscopy ureterolithotomy Laparo new ureter/bladder Laparo new ureter/bladder

T T T T T T T T T T T T T T T T C C C C C C C N T T N C C C C C C C C C C C C C C C C C C C C C C C C C C C T T T

T T T T T T T T T T T T T T T T C C C C C C C N T T N C C C C C C C C C C C C C C C C C C C C C C C C C C C T T T

0130 0160 0162 0160 0162 0162 0160 0160 0160 0160 0163 0161 0161 0169 0423 0423 0000 0000 0000 0000 0000 0000 0000 0000 0126 0427 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0131 0131 0131

34.3958 5.9735 24.7749 5.9735 24.7749 24.7749 5.9735 5.9735 5.9735 5.9735 36.0774 17.9420 17.9420 41.5299 42.9980 42.9980 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 1.0356 15.3545 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 45.5317 45.5317 45.5317

1,643.09 285.35 1,183.50 285.35 1,183.50 1,183.50 285.35 285.35 285.35 285.35 1,723.42 857.09 857.09 1,983.88 2,054.01 2,054.01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 49.47 733.48 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2,175.05 2,175.05 2,175.05

3,746.39 650.63 2,698.48 650.63 2,698.48 2,698.48 650.63 650.63 650.63 650.63 3,929.55 1,954.24 1,954.24 4,523.44 4,683.34 4,683.34 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 112.80 1,672.41 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 4,959.31 4,959.31 4,959.31

4,293.97 745.73 3,092.90 745.73 3,092.90 3,092.90 745.73 745.73 745.73 745.73 4,503.90 2,239.88 2,239.88 5,184.59 5,367.87 5,367.87 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 129.28 1,916.86 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 5,684.18 5,684.18 5,684.18

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

X

X

50949 50951 50953 50955 50957 50961 50970 50972 50974 50976 50980

Laparoscope proc, ureter Endoscopy of ureter Endoscopy of ureter Ureter endoscopy & biopsy Ureter endoscopy & treatment Ureter endoscopy & treatment Ureter endoscopy Ureter endoscopy & catheter Ureter endoscopy & biopsy Ureter endoscopy & treatment Ureter endoscopy & treatment

T T T T T T T T T T T

T T T T T T T T T T T

0130 0160 0160 0162 0162 0162 0160 0160 0161 0161 0162

34.3958 5.9735 5.9735 24.7749 24.7749 24.7749 5.9735 5.9735 17.9420 17.9420 24.7749

1,643.09 285.35 285.35 1,183.50 1,183.50 1,183.50 285.35 285.35 857.09 857.09 1,183.50

3,746.39 650.63 650.63 2,698.48 2,698.48 2,698.48 650.63 650.63 1,954.24 1,954.24 2,698.48

4,293.97 745.73 745.73 3,092.90 3,092.90 3,092.90 745.73 745.73 2,239.88 2,239.88 3,092.90

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

51020 51030 51040 51045 51050 51060 51065 51080 51100 51101 51102 51500 51520 51525 51530 51535 51550

Incise & treat bladder Incise & treat bladder Incise & drain bladder Incise bladder/drain ureter Removal of bladder stone Removal of ureter stone Remove ureter calculus Drainage of bladder abscess Drain bladder by needle Drain bladder by trocar/cath Drain bl w/cath insertion Removal of bladder cyst Removal of bladder lesion Removal of bladder lesion Removal of bladder lesion Repair of ureter lesion Partial removal of bladder

T T T T T C T T T T T T T C C T C

T T T T T C T T T T T T T C C T C

0162 0162 0162 0160 0162 0000 0162 0008 0164 0126 0165 0154 0162 0000 0000 0162 0000

24.7749 24.7749 24.7749 5.9735 24.7749 0.0000 24.7749 18.3197 2.0077 1.0356 19.3414 30.6788 24.7749 0.0000 0.0000 24.7749 0.0000

1,183.50 1,183.50 1,183.50 285.35 1,183.50 0.00 1,183.50 875.13 95.91 49.47 923.94 1,465.53 1,183.50 0.00 0.00 1,183.50 0.00

2,698.48 2,698.48 2,698.48 650.63 2,698.48 0.00 2,698.48 1,995.38 218.68 112.80 2,106.67 3,341.53 2,698.48 0.00 0.00 2,698.48 0.00

3,092.90 3,092.90 3,092.90 745.73 3,092.90 0.00 3,092.90 2,287.03 250.64 129.28 2,414.58 3,829.94 3,092.90 0.00 0.00 3,092.90 0.00

X X X

X

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

27 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only C C C C C C C C C C N N N T X X T T T T T T T T T T T T T T T X C C C C C C C T C C C C C C T T C C C C C C C C C C N N N T X X T T T T T T T T T T T T T T T X C C C C C C C T C C C C C C T T

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 95.91 30.14 30.14 49.47 95.91 733.48 1,422.90 95.91 145.55 145.55 49.47 49.47 95.91 49.47 95.91 49.47 95.91 95.91 30.14 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1,183.50 0.00 0.00 0.00 0.00 0.00 0.00 2,175.05 2,175.05

Children's Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 218.68 68.73 68.73 112.80 218.68 1,672.41 3,244.33 218.68 331.87 331.87 112.80 112.80 218.68 112.80 218.68 112.80 218.68 218.68 68.73 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2,698.48 0.00 0.00 0.00 0.00 0.00 0.00 4,959.31 4,959.31

Critical PDD Access Update to Hospital ACS Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 250.64 78.77 78.77 129.28 250.64 1,916.86 3,718.53 250.64 380.37 380.37 129.28 129.28 250.64 129.28 250.64 129.28 250.64 250.64 78.77 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3,092.90 0.00 0.00 0.00 0.00 0.00 0.00 5,684.18 5,684.18

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

51555 51565 51570 51575 51580 51585 51590 51595 51596 51597 51600 51605 51610 51700 51701 51702 51703 51705 51710 51715 51720 51725 51726 51736 51741 51772 51784 51785 51792 51795 51797 51798 51800 51820 51840 51841 51845 51860 51865 51880 51900 51920 51925 51940 51960 51980 51990 51992

Partial removal of bladder Revise bladder & ureter(s) Removal of bladder Removal of bladder & nodes Remove bladder/revise tract Removal of bladder & nodes Remove bladder/revise tract Remove bladder/revise tract Remove bladder/create pouch Removal of pelvic structures Injection for bladder x-ray Preparation for bladder xray Injection for bladder x-ray Irrigation of bladder Insert bladder catheter Insert temp bladder cath Insert bladder cath, complex Change of bladder tube Change of bladder tube Endoscopic injection/implant Treatment of bladder lesion Simple cystometrogram Complex cystometrogram Urine flow measurement Electro-uroflowmetry, first Urethra pressure profile Anal/urinary muscle study Anal/urinary muscle study Urinary reflex study Urine voiding pressure study Intraabdominal pressure test Us urine capacity measure Revision of bladder/urethra Revision of urinary tract Attach bladder/urethra Attach bladder/urethra Repair bladder neck Repair of bladder wound Repair of bladder wound Repair of bladder opening Repair bladder/vagina lesion Close bladder-uterus fistula Hysterectomy/bladder repair Correction of bladder defect Revision of bladder & bowel Construct bladder opening Laparo urethral suspension Laparo sling operation

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0164 0340 0340 0126 0164 0427 0168 0164 0156 0156 0126 0126 0164 0126 0164 0126 0164 0164 0340 0000 0000 0000 0000 0000 0000 0000 0162 0000 0000 0000 0000 0000 0000 0131 0131

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 2.0077 0.6310 0.6310 1.0356 2.0077 15.3545 29.7864 2.0077 3.0469 3.0469 1.0356 1.0356 2.0077 1.0356 2.0077 1.0356 2.0077 2.0077 0.6310 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 24.7749 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 45.5317 45.5317

51999 52000 52001 52005 52007 52010 52204 52214 52224 52234 52235 52240 52250 52260 52265 52270 52275 52276 52277 52281 52282 52283 52285 52290 52300 52301 52305 52310 52315 52317 52318 52320 52325 52327 52330 52332 52334 52341 52342 52343 52344 52345 52346 52351 52352 52353 52354 52355 52400 52402 52450 52500 52601 52606 52612 52614 52620 52630 52640 52647 52648 52649 52700 53000 53010 53020 53025 53040 53060 53080 53085 53200 53210 53215 53220 53230 53235 53240 53250 53260 53265 53270 53275 53400 53405 53410 53415 53420 53425 53430 53431 53440 53442 53444 53445 53446 53447 53448 53449 53450 53460 53500 53502 53505 53510 53515 53520 53600 53601 53605 53620 53621

Laparoscope proc, bladder Cystoscopy Cystoscopy, removal of clots Cystoscopy & ureter catheter Cystoscopy and biopsy Cystoscopy & duct catheter Cystoscopy Cystoscopy and treatment Cystoscopy and treatment Cystoscopy and treatment Cystoscopy and treatment Cystoscopy and treatment Cystoscopy and radiotracer Cystoscopy and treatment Cystoscopy and treatment Cystoscopy & revise urethra Cystoscopy & revise urethra Cystoscopy and treatment Cystoscopy and treatment Cystoscopy and treatment Cystoscopy, implant stent Cystoscopy and treatment Cystoscopy and treatment Cystoscopy and treatment Cystoscopy and treatment Cystoscopy and treatment Cystoscopy and treatment Cystoscopy and treatment Cystoscopy and treatment Remove bladder stone Remove bladder stone Cystoscopy and treatment Cystoscopy, stone removal Cystoscopy, inject material Cystoscopy and treatment Cystoscopy and treatment Create passage to kidney Cysto w/ureter stricture tx Cysto w/up stricture tx Cysto w/renal stricture tx Cysto/uretero, stricture tx Cysto/uretero w/up stricture Cystouretero w/renal strict Cystouretero & or pyeloscope Cystouretero w/stone remove Cystouretero w/lithotripsy Cystouretero w/biopsy Cystouretero w/excise tumor Cystouretero w/congen repr Cystourethro cut ejacul duct Incision of prostate Revision of bladder neck Prostatectomy (TURP) Control postop bleeding Prostatectomy, first stage Prostatectomy, second stage Remove residual prostate Remove prostate regrowth Relieve bladder contracture Laser surgery of prostate Laser surgery of prostate 2Prostate laser enucleation Drainage of prostate abscess Incision of urethra Incision of urethra Incision of urethra Incision of urethra Drainage of urethra abscess Drainage of urethra abscess Drainage of urinary leakage Drainage of urinary leakage Biopsy of urethra Removal of urethra Removal of urethra Treatment of urethra lesion Removal of urethra lesion Removal of urethra lesion Surgery for urethra pouch Removal of urethra gland Treatment of urethra lesion Treatment of urethra lesion Removal of urethra gland Repair of urethra defect Revise urethra, stage 1 Revise urethra, stage 2 Reconstruction of urethra Reconstruction of urethra Reconstruct urethra, stage 1 Reconstruct urethra, stage 2 Reconstruction of urethra Reconstruct urethra/bladder Male sling procedure Remove/revise male sling Insert tandem cuff Insert uro/ves nck sphincter Remove uro sphincter Remove/replace ur sphincter Remov/replc ur sphinctr comp Repair uro sphincter Revision of urethra Revision of urethra Urethrlys, transvag w/ scope Repair of urethra injury Repair of urethra injury Repair of urethra injury Repair of urethra injury Repair of urethra defect Dilate urethra stricture Dilate urethra stricture Dilate urethra stricture Dilate urethra stricture Dilate urethra stricture

T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T C T T T T S T S S T S C T T T T T T T T T T T T T T

T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T C T T T T S T S S T S C T T T T T T T T T T T T T T

0130 0160 0161 0161 0162 0160 0161 0162 0162 0162 0162 0162 0162 0161 0160 0161 0162 0162 0162 0161 0163 0162 0161 0161 0162 0162 0162 0161 0162 0162 0162 0162 0162 0162 0162 0162 0162 0162 0162 0162 0162 0162 0162 0162 0162 0163 0162 0162 0162 0162 0162 0162 0163 0162 0163 0163 0163 0163 0162 0429 0429 0429 0162 0166 0166 0166 0166 0166 0166 0166 0166 0166 0168 0166 0168 0168 0166 0168 0166 0166 0166 0166 0166 0168 0168 0168 0000 0168 0168 0168 0168 0385 0168 0385 0386 0168 0386 0000 0168 0168 0166 0168 0166 0168 0166 0168 0168 0156 0126 0161 0165 0164

34.3958 5.9735 17.9420 17.9420 24.7749 5.9735 17.9420 24.7749 24.7749 24.7749 24.7749 24.7749 24.7749 17.9420 5.9735 17.9420 24.7749 24.7749 24.7749 17.9420 36.0774 24.7749 17.9420 17.9420 24.7749 24.7749 24.7749 17.9420 24.7749 24.7749 24.7749 24.7749 24.7749 24.7749 24.7749 24.7749 24.7749 24.7749 24.7749 24.7749 24.7749 24.7749 24.7749 24.7749 24.7749 36.0774 24.7749 24.7749 24.7749 24.7749 24.7749 24.7749 36.0774 24.7749 36.0774 36.0774 36.0774 36.0774 24.7749 45.2042 45.2042 45.2042 24.7749 19.1505 19.1505 19.1505 19.1505 19.1505 19.1505 19.1505 19.1505 19.1505 29.7864 19.1505 29.7864 29.7864 19.1505 29.7864 19.1505 19.1505 19.1505 19.1505 19.1505 29.7864 29.7864 29.7864 0.0000 29.7864 29.7864 29.7864 29.7864 83.6366 29.7864 83.6366 144.1246 29.7864 144.1246 0.0000 29.7864 29.7864 19.1505 29.7864 19.1505 29.7864 19.1505 29.7864 29.7864 3.0469 1.0356 17.9420 19.3414 2.0077

1,643.09 285.35 857.09 857.09 1,183.50 285.35 857.09 1,183.50 1,183.50 1,183.50 1,183.50 1,183.50 1,183.50 857.09 285.35 857.09 1,183.50 1,183.50 1,183.50 857.09 1,723.42 1,183.50 857.09 857.09 1,183.50 1,183.50 1,183.50 857.09 1,183.50 1,183.50 1,183.50 1,183.50 1,183.50 1,183.50 1,183.50 1,183.50 1,183.50 1,183.50 1,183.50 1,183.50 1,183.50 1,183.50 1,183.50 1,183.50 1,183.50 1,723.42 1,183.50 1,183.50 1,183.50 1,183.50 1,183.50 1,183.50 1,723.42 1,183.50 1,723.42 1,723.42 1,723.42 1,723.42 1,183.50 2,159.40 2,159.40 2,159.40 1,183.50 914.82 914.82 914.82 914.82 914.82 914.82 914.82 914.82 914.82 1,422.90 914.82 1,422.90 1,422.90 914.82 1,422.90 914.82 914.82 914.82 914.82 914.82 1,422.90 1,422.90 1,422.90 0.00 1,422.90 1,422.90 1,422.90 1,422.90 3,995.32 1,422.90 3,995.32 6,884.83 1,422.90 6,884.83 0.00 1,422.90 1,422.90 914.82 1,422.90 914.82 1,422.90 914.82 1,422.90 1,422.90 145.55 49.47 857.09 923.94 95.91

3,746.39 650.63 1,954.24 1,954.24 2,698.48 650.63 1,954.24 2,698.48 2,698.48 2,698.48 2,698.48 2,698.48 2,698.48 1,954.24 650.63 1,954.24 2,698.48 2,698.48 2,698.48 1,954.24 3,929.55 2,698.48 1,954.24 1,954.24 2,698.48 2,698.48 2,698.48 1,954.24 2,698.48 2,698.48 2,698.48 2,698.48 2,698.48 2,698.48 2,698.48 2,698.48 2,698.48 2,698.48 2,698.48 2,698.48 2,698.48 2,698.48 2,698.48 2,698.48 2,698.48 3,929.55 2,698.48 2,698.48 2,698.48 2,698.48 2,698.48 2,698.48 3,929.55 2,698.48 3,929.55 3,929.55 3,929.55 3,929.55 2,698.48 4,923.64 4,923.64 4,923.64 2,698.48 2,085.87 2,085.87 2,085.87 2,085.87 2,085.87 2,085.87 2,085.87 2,085.87 2,085.87 3,244.33 2,085.87 3,244.33 3,244.33 2,085.87 3,244.33 2,085.87 2,085.87 2,085.87 2,085.87 2,085.87 3,244.33 3,244.33 3,244.33 0.00 3,244.33 3,244.33 3,244.33 3,244.33 9,109.70 3,244.33 9,109.70 15,698.05 3,244.33 15,698.05 0.00 3,244.33 3,244.33 2,085.87 3,244.33 2,085.87 3,244.33 2,085.87 3,244.33 3,244.33 331.87 112.80 1,954.24 2,106.67 218.68

4,293.97 745.73 2,239.88 2,239.88 3,092.90 745.73 2,239.88 3,092.90 3,092.90 3,092.90 3,092.90 3,092.90 3,092.90 2,239.88 745.73 2,239.88 3,092.90 3,092.90 3,092.90 2,239.88 4,503.90 3,092.90 2,239.88 2,239.88 3,092.90 3,092.90 3,092.90 2,239.88 3,092.90 3,092.90 3,092.90 3,092.90 3,092.90 3,092.90 3,092.90 3,092.90 3,092.90 3,092.90 3,092.90 3,092.90 3,092.90 3,092.90 3,092.90 3,092.90 3,092.90 4,503.90 3,092.90 3,092.90 3,092.90 3,092.90 3,092.90 3,092.90 4,503.90 3,092.90 4,503.90 4,503.90 4,503.90 4,503.90 3,092.90 5,643.29 5,643.29 5,643.29 3,092.90 2,390.75 2,390.75 2,390.75 2,390.75 2,390.75 2,390.75 2,390.75 2,390.75 2,390.75 3,718.53 2,390.75 3,718.53 3,718.53 2,390.75 3,718.53 2,390.75 2,390.75 2,390.75 2,390.75 2,390.75 3,718.53 3,718.53 3,718.53 0.00 3,718.53 3,718.53 3,718.53 3,718.53 10,441.19 3,718.53 10,441.19 17,992.52 3,718.53 17,992.52 0.00 3,718.53 3,718.53 2,390.75 3,718.53 2,390.75 3,718.53 2,390.75 3,718.53 3,718.53 380.37 129.28 2,239.88 2,414.58 250.64

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

X

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

28 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only T T T T T T T T T T T T

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 49.47 49.47 914.82 2,159.40 2,159.40 1,183.50

Children's Hospital Outpatient Fee 112.80 112.80 2,085.87 4,923.64 4,923.64 2,698.48

Critical PDD Access Update to Hospital ACS Outpatient Fee 129.28 129.28 2,390.75 5,643.29 5,643.29 3,092.90

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

53660 53661 53665 53850 53852 53853

Dilation of urethra Dilation of urethra Dilation of urethra Prostatic microwave thermotx Prostatic rf thermotx Prostatic water thermother

0126 0126 0166 0429 0429 0162

1.0356 1.0356 19.1505 45.2042 45.2042 24.7749

53899 54000 54001 54015 54050 54055 54056 54057 54060 54065 54100 54105 54110 54111 54112 54115 54120 54125 54130 54135 54150 54160 54161 54162 54163 54164 54200 54205 54220 54230 54231 54235 54240 54250 54300 54304 54308 54312 54316 54318 54322 54324 54326 54328 54332 54336 54340 54344 54348 54352 54360 54380 54385 54390 54400 54401 54405 54406 54408 54410 54411 54415 54416 54417 54420 54430 54435 54440 54450 54500 54505 54512 54520 54522 54530 54535 54550 54560 54600 54620 54640 54650 54660 54670 54680 54690 54692

Urology surgery procedure Slitting of prepuce Slitting of prepuce Drain penis lesion Destruction, penis lesion(s) Destruction, penis lesion(s) Cryosurgery, penis lesion(s) Laser surg, penis lesion(s) Excision of penis lesion(s) Destruction, penis lesion(s) Biopsy of penis Biopsy of penis Treatment of penis lesion Treat penis lesion, graft Treat penis lesion, graft Treatment of penis lesion Partial removal of penis Removal of penis Remove penis & nodes Remove penis & nodes Circumcision Circumcision Circumcision Lysis penil circumic lesion Repair of circumcision Frenulotomy of penis Treatment of penis lesion Treatment of penis lesion Treatment of penis lesion Prepare penis study Dynamic cavernosometry Penile injection Penis study Penis study Revision of penis Revision of penis Reconstruction of urethra Reconstruction of urethra Reconstruction of urethra Reconstruction of urethra Reconstruction of urethra Reconstruction of urethra Reconstruction of urethra Revise penis/urethra Revise penis/urethra Revise penis/urethra Secondary urethral surgery Secondary urethral surgery Secondary urethral surgery Reconstruct urethra/penis Penis plastic surgery Repair penis Repair penis Repair penis and bladder Insert semi-rigid prosthesis Insert self-contd prosthesis Insert multi-comp penis pros Remove muti-comp penis pros Repair multi-comp penis pros Remove/replace penis prosth Remov/replc penis pros, comp Remove self-contd penis pros Remv/repl penis contain pros Remv/replc penis pros, compl Revision of penis Revision of penis Revision of penis Repair of penis Preputial stretching Biopsy of testis Biopsy of testis Excise lesion testis Removal of testis Orchiectomy, partial Removal of testis Extensive testis surgery Exploration for testis Exploration for testis Reduce testis torsion Suspension of testis Suspension of testis Orchiopexy (Fowler-Stephens) Revision of testis Repair testis injury Relocation of testis(es) Laparoscopy, orchiectomy Laparoscopy, orchiopexy

T T T T T T T T T T T T T T T T T C C C T T T T T T T T T N T T T T T T T T T T T T T T C C T T T T T T T C S S S T T S C T S C T C T T T T T T T T T C T T T T T C T T T T T

T T T T T T T T T T T T T T T T T C C C T T T T T T T T T N T T 1 1 T T T T T T T T T T C C T T T T T T T C 1 1 1 1 1 1 1 1 1 1 T C T T T T T T T T T C T T T T T C 1 T T T T

0126 0166 0166 0008 0015 0017 0013 0017 0017 0017 0021 0022 0181 0181 0181 0008 0181 0000 0000 0000 0183 0183 0183 0183 0183 0183 0164 0181 0164 0000 0165 0164 0126 0164 0181 0181 0181 0181 0181 0181 0181 0181 0181 0181 0000 0000 0181 0181 0181 0181 0181 0181 0181 0000 0385 0386 0386 0181 0181 0386 0000 0181 0386 0000 0181 0000 0181 0181 0156 0037 0183 0183 0183 0183 0154 0000 0154 0183 0183 0183 0154 0000 0183 0183 0183 0131 0132

1.0356 19.1505 19.1505 18.3197 1.4595 19.9041 0.7930 19.9041 19.9041 19.9041 16.1001 21.1098 33.9306 33.9306 33.9306 18.3197 33.9306 0.0000 0.0000 0.0000 22.3251 22.3251 22.3251 22.3251 22.3251 22.3251 2.0077 33.9306 2.0077 0.0000 19.3414 2.0077 1.0356 2.0077 33.9306 33.9306 33.9306 33.9306 33.9306 33.9306 33.9306 33.9306 33.9306 33.9306 0.0000 0.0000 33.9306 33.9306 33.9306 33.9306 33.9306 33.9306 33.9306 0.0000 83.6366 144.1246 144.1246 33.9306 33.9306 144.1246 0.0000 33.9306 144.1246 0.0000 33.9306 0.0000 33.9306 33.9306 3.0469 13.5764 22.3251 22.3251 22.3251 22.3251 30.6788 0.0000 30.6788 22.3251 22.3251 22.3251 30.6788 0.0000 22.3251 22.3251 22.3251 45.5317 69.6652

49.47 914.82 914.82 875.13 69.72 950.82 37.88 950.82 950.82 950.82 769.10 1,008.42 1,620.86 1,620.86 1,620.86 875.13 1,620.86 0.00 0.00 0.00 1,066.47 1,066.47 1,066.47 1,066.47 1,066.47 1,066.47 95.91 1,620.86 95.91 0.00 923.94 95.91 0.00 0.00 1,620.86 1,620.86 1,620.86 1,620.86 1,620.86 1,620.86 1,620.86 1,620.86 1,620.86 1,620.86 0.00 0.00 1,620.86 1,620.86 1,620.86 1,620.86 1,620.86 1,620.86 1,620.86 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1,620.86 0.00 1,620.86 1,620.86 145.55 648.54 1,066.47 1,066.47 1,066.47 1,066.47 1,465.53 0.00 1,465.53 1,066.47 1,066.47 1,066.47 1,465.53 0.00 0.00 1,066.47 1,066.47 2,175.05 3,327.91

112.80 2,085.87 2,085.87 1,995.38 158.97 2,167.95 86.37 2,167.95 2,167.95 2,167.95 1,753.62 2,299.28 3,695.72 3,695.72 3,695.72 1,995.38 3,695.72 0.00 0.00 0.00 2,431.65 2,431.65 2,431.65 2,431.65 2,431.65 2,431.65 218.68 3,695.72 218.68 0.00 2,106.67 218.68 0.00 0.00 3,695.72 3,695.72 3,695.72 3,695.72 3,695.72 3,695.72 3,695.72 3,695.72 3,695.72 3,695.72 0.00 0.00 3,695.72 3,695.72 3,695.72 3,695.72 3,695.72 3,695.72 3,695.72 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3,695.72 0.00 3,695.72 3,695.72 331.87 1,478.74 2,431.65 2,431.65 2,431.65 2,431.65 3,341.53 0.00 3,341.53 2,431.65 2,431.65 2,431.65 3,341.53 0.00 0.00 2,431.65 2,431.65 4,959.31 7,587.93

129.28 2,390.75 2,390.75 2,287.03 182.20 2,484.83 99.00 2,484.83 2,484.83 2,484.83 2,009.94 2,635.35 4,235.90 4,235.90 4,235.90 2,287.03 4,235.90 0.00 0.00 0.00 2,787.07 2,787.07 2,787.07 2,787.07 2,787.07 2,787.07 250.64 4,235.90 250.64 0.00 2,414.58 250.64 0.00 0.00 4,235.90 4,235.90 4,235.90 4,235.90 4,235.90 4,235.90 4,235.90 4,235.90 4,235.90 4,235.90 0.00 0.00 4,235.90 4,235.90 4,235.90 4,235.90 4,235.90 4,235.90 4,235.90 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 4,235.90 0.00 4,235.90 4,235.90 380.37 1,694.88 2,787.07 2,787.07 2,787.07 2,787.07 3,829.94 0.00 3,829.94 2,787.07 2,787.07 2,787.07 3,829.94 0.00 0.00 2,787.07 2,787.07 5,684.18 8,697.00

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

54699 54700 54800 54830 54840 54860 54861 54865 54900 54901 55000 55040 55041 55060 55100 55110 55120 55150 55175 55180 55200 55250 55300 55400 55450 55500 55520 55530 55535 55540 55550

Laparoscope proc, testis Drainage of scrotum Biopsy of epididymis Remove epididymis lesion Remove epididymis lesion Removal of epididymis Removal of epididymis Explore epididymis Fusion of spermatic ducts Fusion of spermatic ducts Drainage of hydrocele Removal of hydrocele Removal of hydroceles Repair of hydrocele Drainage of scrotum abscess Explore scrotum Removal of scrotum lesion Removal of scrotum Revision of scrotum Revision of scrotum Incision of sperm duct Removal of sperm duct(s) Prepare, sperm duct x-ray Repair of sperm duct Ligation of sperm duct Removal of hydrocele Removal of sperm cord lesion Revise spermatic cord veins Revise spermatic cord veins Revise hernia & sperm veins Laparo ligate spermatic vein

T T T T T T T T T T T T T T T T T T T T T T N T T T T T T T T

T T T T T T T T T T T T T T T T T T T T T T N T T T T T T T T

0130 0183 0004 0183 0183 0183 0183 0183 0183 0183 0004 0154 0154 0183 0007 0183 0183 0183 0183 0183 0183 0183 0000 0183 0183 0183 0183 0183 0154 0154 0131

34.3958 22.3251 4.3270 22.3251 22.3251 22.3251 22.3251 22.3251 22.3251 22.3251 4.3270 30.6788 30.6788 22.3251 11.5594 22.3251 22.3251 22.3251 22.3251 22.3251 22.3251 22.3251 0.0000 22.3251 22.3251 22.3251 22.3251 22.3251 30.6788 30.6788 45.5317

1,643.09 1,066.47 206.70 1,066.47 1,066.47 1,066.47 1,066.47 1,066.47 1,066.47 1,066.47 206.70 1,465.53 1,465.53 1,066.47 552.19 1,066.47 1,066.47 1,066.47 1,066.47 1,066.47 1,066.47 1,066.47 0.00 1,066.47 1,066.47 1,066.47 1,066.47 1,066.47 1,465.53 1,465.53 2,175.05

3,746.39 2,431.65 471.30 2,431.65 2,431.65 2,431.65 2,431.65 2,431.65 2,431.65 2,431.65 471.30 3,341.53 3,341.53 2,431.65 1,259.05 2,431.65 2,431.65 2,431.65 2,431.65 2,431.65 2,431.65 2,431.65 0.00 2,431.65 2,431.65 2,431.65 2,431.65 2,431.65 3,341.53 3,341.53 4,959.31

4,293.97 2,787.07 540.18 2,787.07 2,787.07 2,787.07 2,787.07 2,787.07 2,787.07 2,787.07 540.18 3,829.94 3,829.94 2,787.07 1,443.08 2,787.07 2,787.07 2,787.07 2,787.07 2,787.07 2,787.07 2,787.07 0.00 2,787.07 2,787.07 2,787.07 2,787.07 2,787.07 3,829.94 3,829.94 5,684.18

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

Added 1/1/07 to book

55559 55600 55605 55650 55680 55700 55705 55720 55725 55801 55810 55812 55815 55821 55831 55840 55842 55845 55860 55862 55865 55866 55870 55873 55875 55876 55899 55920 55970 55980 56405 56420 56440

Laparo proc, spermatic cord Incise sperm duct pouch Incise sperm duct pouch Remove sperm duct pouch Remove sperm pouch lesion Biopsy of prostate Biopsy of prostate Drainage of prostate abscess Drainage of prostate abscess Removal of prostate Extensive prostate surgery Extensive prostate surgery Extensive prostate surgery Removal of prostate Removal of prostate Extensive prostate surgery Extensive prostate surgery Extensive prostate surgery Surgical exposure, prostate Extensive prostate surgery Extensive prostate surgery Laparo radical prostatectomy Electroejaculation Cryoablate prostate Transperi needle place, pros Place rtsurgery procedure Genital device/marker, pros Place needles pelvic for rt Sex transformation, M to F Sex transformation, F to M I & D of vulva/perineum Drainage of gland abscess Surgery for vulva lesion

T T C C T T T T T C C C C C C C C C T C C C T T Q T T E E T T T

T T C C T T T T T C C C C C C C C C T C C C 1 T Q T T 1 1 T T T

0130 0183 0000 0000 0183 0184 0184 0162 0162 0000 0000 0000 0000 0000 0000 0000 0000 0000 0165 0000 0000 0000 0189 0674 0163 0156 0126 0153 0000 0000 0189 0188 0193

34.3958 22.3251 0.0000 0.0000 22.3251 11.0338 11.0338 24.7749 24.7749 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 19.3414 0.0000 0.0000 0.0000 2.7584 122.7133 36.0774 3.0469 1.0356 25.6947 0.0000 0.0000 2.7584 1.3520 19.0203

1,643.09 1,066.47 0.00 0.00 1,066.47 527.08 527.08 1,183.50 1,183.50 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 923.94 0.00 0.00 0.00 0.00 5,862.01 1,723.42 145.55 49.47 1,227.44 0.00 0.00 131.77 64.59 908.60

3,746.39 2,431.65 0.00 0.00 2,431.65 1,201.80 1,201.80 2,698.48 2,698.48 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2,106.67 0.00 0.00 0.00 0.00 13,365.93 3,929.55 331.87 112.80 2,798.67 0.00 0.00 300.44 147.26 2,071.69

4,293.97 2,787.07 0.00 0.00 2,787.07 1,377.46 1,377.46 3,092.90 3,092.90 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2,414.58 0.00 0.00 0.00 0.00 15,319.53 4,503.90 380.37 129.28 3,207.73 0.00 0.00 344.36 168.78 2,374.49

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

SI= T, effect.

Added 1/1/07 to book Added 1/1/07 to book

X X

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

29 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only T T T T T T T T C C C C C C C T T T T T T T T T T T T T T T T T T T C C C T T T T T T T T T T T T T T T T T T C C T T T T T T T T T T C T C C C T C T T T T T T T T T T T T T T T T T T T T T T T T C C C T T T T T T T T N T C T C C C C C C C T T T C T C C C T T T C T E T T T T N T T T T T C C C C T T T T T T C T T T T T T T T T T T T T T T T C C C C C C C T T T T T T T T T T T T T T T T T T T C C C T T T T T T T T T T T T T T T T T T C C T T T T T T T 1 1 1 C T C C C T C T T T T T T T T T T T T T T T T T T T T T T T T C C C T T T T T T T T N T C T C C C C C C C T T T C T C C C T T T C T 3 T 1 1 1 1 1 1 1 T T C C C C T T T T T T C T T T T T T T T

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 908.60 908.60 950.82 950.82 131.77 64.59 908.60 908.60 0.00 0.00 0.00 0.00 0.00 0.00 0.00 908.60 908.60 908.60 908.60 908.60 64.59 64.59 908.60 908.60 290.36 552.19 875.13 908.60 908.60 290.36 908.60 908.60 1,548.88 1,548.88 0.00 0.00 0.00 1,548.88 908.60 908.60 64.59 290.36 64.59 6.25 64.59 908.60 908.60 2,040.25 1,548.88 1,548.88 1,548.88 1,548.88 2,040.25 1,548.88 1,548.88 0.00 0.00 2,040.25 2,040.25 2,040.25 1,548.88 1,548.88 2,040.25 1,548.88 0.00 0.00 0.00 0.00 1,548.88 0.00 0.00 0.00 2,040.25 0.00 1,548.88 1,548.88 1,548.88 908.60 908.60 908.60 131.77 131.77 2,040.25 1,643.09 131.77 131.77 131.77 131.77 908.60 908.60 290.36 290.36 908.60 64.59 908.60 908.60 908.60 1,548.88 0.00 0.00 0.00 1,548.88 1,548.88 2,040.25 908.60 908.60 908.60 908.60 64.59 0.00 908.60 0.00 1,548.88 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1,548.88 1,548.88 1,548.88 0.00 1,548.88 0.00 0.00 0.00 2,040.25 2,040.25 2,040.25 0.00 2,040.25 M01 64.59 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1,548.88 2,040.25 0.00 0.00 0.00 0.00 2,175.05 2,175.05 2,175.05 2,175.05 1,643.09 2,175.05 0.00 3,327.91 2,175.05 2,175.05 2,175.05 1,034.58 1,034.58 1,034.58 1,633.96

Children's Hospital Outpatient Fee 2,071.69 2,071.69 2,167.95 2,167.95 300.44 147.26 2,071.69 2,071.69 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2,071.69 2,071.69 2,071.69 2,071.69 2,071.69 147.26 147.26 2,071.69 2,071.69 662.05 1,259.05 1,995.38 2,071.69 2,071.69 662.05 2,071.69 2,071.69 3,531.59 3,531.59 0.00 0.00 0.00 3,531.59 2,071.69 2,071.69 147.26 662.05 147.26 14.26 147.26 2,071.69 2,071.69 4,651.96 3,531.59 3,531.59 3,531.59 3,531.59 4,651.96 3,531.59 3,531.59 0.00 0.00 4,651.96 4,651.96 4,651.96 3,531.59 3,531.59 4,651.96 3,531.59 0.00 0.00 0.00 0.00 3,531.59 0.00 0.00 0.00 4,651.96 0.00 3,531.59 3,531.59 3,531.59 2,071.69 2,071.69 2,071.69 300.44 300.44 4,651.96 3,746.39 300.44 300.44 300.44 300.44 2,071.69 2,071.69 662.05 662.05 2,071.69 147.26 2,071.69 2,071.69 2,071.69 3,531.59 0.00 0.00 0.00 3,531.59 3,531.59 4,651.96 2,071.69 2,071.69 2,071.69 2,071.69 147.26 0.00 2,071.69 0.00 3,531.59 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3,531.59 3,531.59 3,531.59 0.00 3,531.59 0.00 0.00 0.00 4,651.96 4,651.96 4,651.96 0.00 4,651.96 M01 147.26 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3,531.59 4,651.96 0.00 0.00 0.00 0.00 4,959.31 4,959.31 4,959.31 4,959.31 3,746.39 4,959.31 0.00 7,587.93 4,959.31 4,959.31 4,959.31 2,358.95 2,358.95 2,358.95 3,725.59

Critical PDD Access Update to Hospital ACS Outpatient Fee 2,374.49 2,374.49 2,484.83 2,484.83 344.36 168.78 2,374.49 2,374.49 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2,374.49 2,374.49 2,374.49 2,374.49 2,374.49 168.78 168.78 2,374.49 2,374.49 758.81 1,443.08 2,287.03 2,374.49 2,374.49 758.81 2,374.49 2,374.49 4,047.77 4,047.77 0.00 0.00 0.00 4,047.77 2,374.49 2,374.49 168.78 758.81 168.78 16.34 168.78 2,374.49 2,374.49 5,331.90 4,047.77 4,047.77 4,047.77 4,047.77 5,331.90 4,047.77 4,047.77 0.00 0.00 5,331.90 5,331.90 5,331.90 4,047.77 4,047.77 5,331.90 4,047.77 0.00 0.00 0.00 0.00 4,047.77 0.00 0.00 0.00 5,331.90 0.00 4,047.77 4,047.77 4,047.77 2,374.49 2,374.49 2,374.49 344.36 344.36 5,331.90 4,293.97 344.36 344.36 344.36 344.36 2,374.49 2,374.49 758.81 758.81 2,374.49 168.78 2,374.49 2,374.49 2,374.49 4,047.77 0.00 0.00 0.00 4,047.77 4,047.77 5,331.90 2,374.49 2,374.49 2,374.49 2,374.49 168.78 0.00 2,374.49 0.00 4,047.77 0.00 0.00 0.00 0.00 0.00 0.00 0.00 4,047.77 4,047.77 4,047.77 0.00 4,047.77 0.00 0.00 0.00 5,331.90 5,331.90 5,331.90 0.00 5,331.90 M01 168.78 0.00 0.00 0.00 0.00 0.00 0.00 0.00 4,047.77 5,331.90 0.00 0.00 0.00 0.00 5,684.18 5,684.18 5,684.18 5,684.18 4,293.97 5,684.18 0.00 8,697.00 5,684.18 5,684.18 5,684.18 2,703.73 2,703.73 2,703.73 4,270.13

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

56441 56442 56501 56515 56605 56606 56620 56625 56630 56631 56632 56633 56634 56637 56640 56700 56740 56800 56805 56810 56820 56821 57000 57010 57020 57022 57023 57061 57065 57100 57105 57106 57107 57109 57110 57111 57112 57120 57130 57135 57150 57155 57160 57170 57180 57200 57210 57220 57230 57240 57250 57260 57265 57267 57268 57270 57280 57282 57283 57284 57285 57287 57288 57289 57291 57292 57295 57296 57300 57305 57307 57308 57310 57311 57320 57330 57335 57400 57410 57415 57420 57421 57423 57425 57452 57454 57455 57456 57460 57461 57500 57505 57510 57511 57513 57520 57522 57530 57531 57540 57545 57550 57555 57556 57558 57700 57720 57800 58100 58110 58120 58140 58145 58146 58150 58152 58180 58200 58210 58240 58260 58262 58263 58267 58270 58275 58280 58285 58290 58291 58292 58293 58294 58300 58301 58321 58322 58323 58340 58345 58346 58350 58353 58356 58400 58410 58520 58540 58541 58542 58543 58544 58545 58546 58548 58550 58552 58553 58554 58555 58558 58559 58560

Lysis of labial lesion(s) Hymenotomy Destroy, vulva lesions, sim Destroy vulva lesion/s compl Biopsy of vulva/perineum Biopsy of vulva/perineum Partial removal of vulva Complete removal of vulva Extensive vulva surgery Extensive vulva surgery Extensive vulva surgery Extensive vulva surgery Extensive vulva surgery Extensive vulva surgery Extensive vulva surgery Partial removal of hymen Remove vagina gland lesion Repair of vagina Repair clitoris Repair of perineum Exam of vulva w/scope Exam/biopsy of vulva w/scope Exploration of vagina Drainage of pelvic abscess Drainage of pelvic fluid I & d vaginal hematoma, pp I & d vag hematoma, non-ob Destroy vag lesions, simple Destroy vag lesions, complex Biopsy of vagina Biopsy of vagina Remove vagina wall, partial Remove vagina tissue, part Vaginectomy partial w/nodes Remove vagina wall, complete Remove vagina tissue, compl Vaginectomy w/nodes, compl Closure of vagina Remove vagina lesion Remove vagina lesion Treat vagina infection Insert uteri tandems/ovoids Insert pessary/other device Fitting of diaphragm/cap Treat vaginal bleeding Repair of vagina Repair vagina/perineum Revision of urethra Repair of urethral lesion Repair bladder & vagina Repair rectum & vagina Repair of vagina Extensive repair of vagina Insert mesh/pelvic flr addon Repair of bowel bulge Repair of bowel pouch Suspension of vagina Colpopexy, extraperitoneal Colpopexy, intraperitoneal Repair paravaginal defect, open Repair paravag defect, vag Revise/remove sling repair Repair bladder defect Repair bladder & vagina Construction of vagina Construct vagina with graft Change vaginal graft Revise vag graft, open abd Repair rectum-vagina fistula Repair rectum-vagina fistula Fistula repair & colostomy Fistula repair, transperine Repair urethrovaginal lesion Repair urethrovaginal lesion Repair bladder-vagina lesion Repair bladder-vagina lesion Repair vagina Dilation of vagina Pelvic examination Remove vaginal foreign body Exam of vagina w/scope Exam/biopsy of vag w/scope Repair paravag defect, lap Laparoscopy, surg, colpopexy Exam of cervix w/scope Bx/curett of cervix w/scope Biopsy of cervix w/scope Endocerv curettage w/scope Bx of cervix w/scope, leep Conz of cervix w/scope, leep Biopsy of cervix Endocervical curettage Cauterization of cervix Cryocautery of cervix Laser surgery of cervix Conization of cervix Conization of cervix Removal of cervix Removal of cervix, radical Removal of residual cervix Remove cervix/repair pelvis Removal of residual cervix Remove cervix/repair vagina Remove cervix, repair bowel D&c of cervical stump Revision of cervix Revision of cervix Dilation of cervical canal Biopsy of uterus lining Bx done w/colposcopy add-on Dilation and curettage Myomectomy abdom method Myomectomy vag method Myomectomy abdom complex Total hysterectomy Total hysterectomy Partial hysterectomy Extensive hysterectomy Extensive hysterectomy Removal of pelvis contents Vaginal hysterectomy Vag hyst including t/o Vag hyst w/t/o & vag repair Vag hyst w/urinary repair Vag hyst w/enterocele repair Hysterectomy/revise vagina Hysterectomy/revise vagina Extensive hysterectomy Vag hyst complex Vag hyst incl t/o, complex Vag hyst t/o & repair, compl Vag hyst w/uro repair, compl Vag hyst w/enterocele, compl Insert intrauterine device Remove intrauterine device Artificial insemination Artificial insemination Sperm washing Catheter for hysterography Reopen fallopian tube Insert heyman uteri capsule Reopen fallopian tube Endometr ablate, thermal Endometrial cryoablation Suspension of uterus Suspension of uterus Repair of ruptured uterus Revision of uterus Lsh, uterus 250 g or less Lsh w/t/o ut 250 g or less Lsh uterus above 250 g Lsh w/t/o uterus above 250 g Laparoscopic myomectomy Laparo-myomectomy, complex Lap radical hyst Laparo-asst vag hysterectomy Laparo-vag hyst incl t/o Laparo-vag hyst, complex Laparo-vag hyst w/t/o, compl Hysteroscopy, dx, sep proc Hysteroscopy, biopsy Hysteroscopy, lysis Hysteroscopy, resect septum

0193 0193 0017 0017 0189 0188 0193 0193 0000 0000 0000 0000 0000 0000 0000 0193 0193 0193 0193 0193 0188 0188 0193 0193 0192 0007 0008 0193 0193 0192 0193 0193 0195 0195 0000 0000 0000 0195 0193 0193 0188 0192 0188 0191 0188 0193 0193 0202 0195 0195 0195 0195 0202 0195 0195 0000 0000 0202 0202 0202 0195 0195 0202 0195 0195 0195 0193 0000 0195 0000 0000 0000 0202 0000 0195 0195 0195 0193 0193 0193 0189 0189 0202 0130 0189 0189 0189 0189 0193 0193 0192 0192 0193 0188 0193 0193 0193 0195 0000 0000 0000 0195 0195 0202 0193 0193 0193 0193 0188 0000 0193 0000 0195 0000 0000 0000 0000 0000 0000 0000 0195 0195 0195 0000 0195 0000 0000 0000 0202 0202 0202 0000 0202 0000 0188 0189 0189 0189 0000 0193 0193 0195 0195 0202 0000 0000 0000 0000 0131 0131 0131 0131 0130 0131 0000 0132 0131 0131 0131 0190 0190 0190 0387

19.0203 19.0203 19.9041 19.9041 2.7584 1.3520 19.0203 19.0203 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 19.0203 19.0203 19.0203 19.0203 19.0203 1.3520 1.3520 19.0203 19.0203 6.0783 11.5594 18.3197 19.0203 19.0203 6.0783 19.0203 19.0203 32.4237 32.4237 0.0000 0.0000 0.0000 32.4237 19.0203 19.0203 1.3520 6.0783 1.3520 0.1309 1.3520 19.0203 19.0203 42.7099 32.4237 32.4237 32.4237 32.4237 42.7099 32.4237 32.4237 0.0000 0.0000 42.7099 42.7099 42.7099 32.4237 32.4237 42.7099 32.4237 32.4237 32.4237 19.0203 0.0000 32.4237 0.0000 0.0000 0.0000 42.7099 0.0000 32.4237 32.4237 32.4237 19.0203 19.0203 19.0203 2.7584 2.7584 42.7099 34.3958 2.7584 2.7584 2.7584 2.7584 19.0203 19.0203 6.0783 6.0783 19.0203 1.3520 19.0203 19.0203 19.0203 32.4237 0.0000 0.0000 0.0000 32.4237 32.4237 42.7099 19.0203 19.0203 19.0203 19.0203 1.3520 0.0000 19.0203 0.0000 32.4237 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 32.4237 32.4237 32.4237 0.0000 32.4237 0.0000 0.0000 0.0000 42.7099 42.7099 42.7099 0.0000 42.7099 0.0000 1.3520 2.7584 2.7584 2.7584 0.0000 19.0203 19.0203 32.4237 32.4237 42.7099 0.0000 0.0000 0.0000 0.0000 45.5317 45.5317 45.5317 45.5317 34.3958 45.5317 0.0000 69.6652 45.5317 45.5317 45.5317 21.6576 21.6576 21.6576 34.2048

Added 1/1/07 to book

SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) Description Change Change Valid Sex to F

x X

SI change 1/1/07 (TR 1155) Added 1/1/07 to book

SI change 1/1/07 (TR 1155)

Change Valid Sex to F

X

Added 1/1/07 to book

X

SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155)

SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155)

Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book

Added 1/1/07 to book

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

30 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only T T T T T T T T T T T T T T T T

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 1,633.96 1,034.58 1,633.96 2,040.25 2,175.05 2,175.05 2,175.05 2,175.05

Children's Hospital Outpatient Fee 3,725.59 2,358.95 3,725.59 4,651.96 4,959.31 4,959.31 4,959.31 4,959.31

Critical PDD Access Update to Hospital ACS Outpatient Fee 4,270.13 2,703.73 4,270.13 5,331.90 5,684.18 5,684.18 5,684.18 5,684.18

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

58561 58562 58563 58565 58570 58571 58572 58573

Hysteroscopy, remove myoma Hysteroscopy, remove fb Hysteroscopy, ablation Hysteroscopy, sterilization Tlh, uterus 250 g or less Tlh w/t/o 250 g or less Tlh, uterus over 250 g Tlh w/t/o uterus over 250 g

0387 0190 0387 0202 0131 0131 0131 0131

34.2048 21.6576 34.2048 42.7099 45.5317 45.5317 45.5317 45.5317

Change Valid Sex to F Change Valid Sex to F Change Valid Sex to F Added 04/11/07 coverage effect. 01/01/06 to PDD SI=T, effect. 01/01/06 if needed add 282N Taxonomy SI= T, effect. 05/01/06 If needed add 282N Taxonomy

X X X X

58578

Laparo proc, uterus

T

T

0130

34.3958

1,643.09

3,746.39

4,293.97

58579 58600 58605 58611 58615 58660 58661 58662 58670 58671 58672 58673

Hysteroscope procedure Division of fallopian tube Division of fallopian tube Ligate oviduct(s) add-on Occlude fallopian tube(s) Laparoscopy, lysis Laparoscopy, remove adnexa Laparoscopy, excise lesions Laparoscopy, tubal cautery Laparoscopy, tubal block Laparoscopy, fimbrioplasty Laparoscopy, salpingostomy

T T C C T T T T T T T T

T T C C T T T T T T T T

0190 0195 0000 0000 0193 0131 0131 0131 0131 0131 0131 0131

21.6576 32.4237 0.0000 0.0000 19.0203 45.5317 45.5317 45.5317 45.5317 45.5317 45.5317 45.5317

1,034.58 1,548.88 0.00 0.00 908.60 2,175.05 2,175.05 2,175.05 2,175.05 2,175.05 2,175.05 2,175.05

2,358.95 3,531.59 0.00 0.00 2,071.69 4,959.31 4,959.31 4,959.31 4,959.31 4,959.31 4,959.31 4,959.31

2,703.73 4,047.77 0.00 0.00 2,374.49 5,684.18 5,684.18 5,684.18 5,684.18 5,684.18 5,684.18 5,684.18

58679 58700 58720 58740 58750 58752 58760 58770 58800 58805 58820 58822 58823 58825 58900 58920 58925 58940 58943 58950 58951 58952 58953 58954 58956 58957 58958 58960 58970 58974 58976

Laparo proc, oviduct-ovary Removal of fallopian tube Removal of ovary/tube(s) Revise fallopian tube(s) Repair oviduct Revise ovarian tube(s) Remove tubal obstruction Create new tubal opening Drainage of ovarian cyst(s) Drainage of ovarian cyst(s) Drain ovary abscess, open Drain ovary abscess, percut Drain pelvic abscess, percut Transposition, ovary(s) Biopsy of ovary(s) Partial removal of ovary(s) Removal of ovarian cyst(s) Removal of ovary(s) Removal of ovary(s) Resect ovarian malignancy Resect ovarian malignancy Resect ovarian malignancy Tah, rad dissect for debulk Tah rad debulk/lymph remove Bso, omentectomy w/tah Resect recurrent gyn mal Resect recur gyn mal w/lym Exploration of abdomen Retrieval of oocyte Transfer of embryo Transfer of embryo

T C C C C C C T T T T C T C T T T C C C C C C C C C C C T T T

T C C C 1 1 1 1 T T T C T C T T T C C C C C C C C C C C 1 1 1

0130 0000 0000 0000 0000 0000 0000 0195 0193 0195 0195 0000 0193 0000 0193 0195 0195 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0189 0189 0189

34.3958 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 32.4237 19.0203 32.4237 32.4237 0.0000 19.0203 0.0000 19.0203 32.4237 32.4237 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 2.7584 2.7584 2.7584

1,643.09 0.00 0.00 0.00 0.00 0.00 0.00 0.00 908.60 1,548.88 1,548.88 0.00 908.60 0.00 908.60 1,548.88 1,548.88 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

3,746.39 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2,071.69 3,531.59 3,531.59 0.00 2,071.69 0.00 2,071.69 3,531.59 3,531.59 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

4,293.97 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2,374.49 4,047.77 4,047.77 0.00 2,374.49 0.00 2,374.49 4,047.77 4,047.77 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

X

Added 1/1/07 to book Added 1/1/07 to book

58999 59000 59001 59012 59015 59020 59025 59030 59050 59051 59070 59072 59074 59076 59100 59120 59121 59130 59135 59136 59140 59150 59151 59160 59200 59300 59320 59325 59350 59400 59409 59410 59412 59414 59425 59426 59430 59510 59514 59515 59525 59610 59612 59614 59618 59620 59622 59812 59820 59821 59830 59840 59841 59850 59851 59852 59855 59856 59857 59866 59870 59871

Genital surgery procedure Amniocentesis, diagnostic Amniocentesis, therapeutic Fetal cord puncture,prenatal Chorion biopsy Fetal contract stress test Fetal non-stress test Fetal scalp blood sample Fetal monitor w/report Fetal monitor/interpret only Transabdom amnioinfus w/us Umbilical cord occlud w/us Fetal fluid drainage w/us Fetal shunt placement, w/us Remove uterus lesion Treat ectopic pregnancy Treat ectopic pregnancy Treat ectopic pregnancy Treat ectopic pregnancy Treat ectopic pregnancy Treat ectopic pregnancy Treat ectopic pregnancy Treat ectopic pregnancy D & c after delivery Insert cervical dilator Episiotomy or vaginal repair Revision of cervix Revision of cervix Repair of uterus Obstetrical care Obstetrical care Obstetrical care Antepartum manipulation Deliver placenta Antepartum care only Antepartum care only Care after delivery Cesarean delivery Cesarean delivery only Cesarean delivery Remove uterus after cesarean Vbac delivery Vbac delivery only Vbac care after delivery Attempted vbac delivery Attempted vbac delivery only Attempted vbac after care Treatment of miscarriage Care of miscarriage Treatment of miscarriage Treat uterus infection Abortion Abortion Abortion Abortion Abortion Abortion Abortion Abortion Abortion (mpr) Evacuate mole of uterus Remove cerclage suture

T T T T T T T T M B T T T T T C C C C C C T T T T T T C C B T B T T B B B B C B C B T B B C B T T T C T T C C C C C C T T T

T T T T T T T T 1 B T T T T T C C C C C C T T T T T T C C B T B T T B B B B C B C B T B B C B T T T C T T C C C C C C T T T

0191 0189 0192 0189 0189 0188 0188 0189 0000 0000 0189 0189 0189 0189 0195 0000 0000 0000 0000 0000 0000 0131 0131 0193 0189 0193 0193 0000 0000 0000 0193 0000 0193 0193 0000 0000 0000 0000 0000 0000 0000 0000 0193 0000 0000 0000 0000 0193 0193 0193 0000 0193 0193 0000 0000 0000 0000 0000 0000 0189 0193 0193

0.1309 2.7584 6.0783 2.7584 2.7584 1.3520 1.3520 2.7584 0.0000 0.0000 2.7584 2.7584 2.7584 2.7584 32.4237 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 45.5317 45.5317 19.0203 2.7584 19.0203 19.0203 0.0000 0.0000 0.0000 19.0203 0.0000 19.0203 19.0203 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 19.0203 0.0000 0.0000 0.0000 0.0000 19.0203 19.0203 19.0203 0.0000 19.0203 19.0203 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 2.7584 19.0203 19.0203

6.25 131.77 290.36 131.77 131.77 64.59 64.59 131.77 0.00 0.00 131.77 131.77 131.77 131.77 1,548.88 0.00 0.00 0.00 0.00 0.00 0.00 2,175.05 2,175.05 908.60 131.77 908.60 908.60 0.00 0.00 0.00 908.60 0.00 908.60 908.60 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 908.60 0.00 0.00 0.00 0.00 908.60 908.60 908.60 0.00 908.60 908.60 0.00 0.00 0.00 0.00 0.00 0.00 131.77 908.60 908.60

14.26 300.44 662.05 300.44 300.44 147.26 147.26 300.44 0.00 0.00 300.44 300.44 300.44 300.44 3,531.59 0.00 0.00 0.00 0.00 0.00 0.00 4,959.31 4,959.31 2,071.69 300.44 2,071.69 2,071.69 0.00 0.00 0.00 2,071.69 0.00 2,071.69 2,071.69 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2,071.69 0.00 0.00 0.00 0.00 2,071.69 2,071.69 2,071.69 0.00 2,071.69 2,071.69 0.00 0.00 0.00 0.00 0.00 0.00 300.44 2,071.69 2,071.69

16.34 344.36 758.81 344.36 344.36 168.78 168.78 344.36 0.00 0.00 344.36 344.36 344.36 344.36 4,047.77 0.00 0.00 0.00 0.00 0.00 0.00 5,684.18 5,684.18 2,374.49 344.36 2,374.49 2,374.49 0.00 0.00 0.00 2,374.49 0.00 2,374.49 2,374.49 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2,374.49 0.00 0.00 0.00 0.00 2,374.49 2,374.49 2,374.49 0.00 2,374.49 2,374.49 0.00 0.00 0.00 0.00 0.00 0.00 344.36 2,374.49 2,374.49

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

SI change 1/1/07 (Addendum B) SI change 1/1/07 (Addendum B) SI change 1/1/07 (Addendum B) SI change 1/1/07 (Addendum B) SI change 1/1/07 (Addendum B)

59897

Fetal invas px w/us

T

T

0189

2.7584

131.77

300.44

344.36

SI= T, effect. 05/01/06 If needed add 282N Taxonomy SI= T, effect. 05/01/06 If needed add 282N Taxonomy SI= T, effect. 05/01/06 If needed add 282N Taxonomy

59898

Laparo proc, ob care/deliver

T

T

0130

34.3958

1,643.09

3,746.39

4,293.97

59899 60000 60100 60200 60210 60212 60220 60225 60240 60252 60254 60260 60270 60271 60280 60281 60300 60500 60502 60505 60512 60520 60521 60522 60540

Maternity care procedure Drain thyroid/tongue cyst Biopsy of thyroid Remove thyroid lesion Partial thyroid excision Partial thyroid excision Partial removal of thyroid Partial removal of thyroid Removal of thyroid Removal of thyroid Extensive thyroid surgery Repeat thyroid surgery Removal of thyroid Removal of thyroid Remove thyroid duct lesion Remove thyroid duct lesion Aspir/inj thyroid cyst Explore parathyroid glands Re-explore parathyroids Explore parathyroid glands Autotransplant parathyroid Removal of thymus gland Removal of thymus gland Removal of thymus gland Explore adrenal gland

T T T T T T T T T T C T C T T T T T T C T T C C C

T T T T T T T T T T C T C T T T T T T C 1 T C C C

0191 0252 0004 0114 0114 0114 0114 0114 0114 0256 0000 0256 0000 0256 0114 0114 0004 0256 0256 0000 0022 0256 0000 0000 0000

0.1309 7.4474 4.3270 44.3240 44.3240 44.3240 44.3240 44.3240 44.3240 39.8776 0.0000 39.8776 0.0000 39.8776 44.3240 44.3240 4.3270 39.8776 39.8776 0.0000 21.1098 39.8776 0.0000 0.0000 0.0000

6.25 355.76 206.70 2,117.36 2,117.36 2,117.36 2,117.36 2,117.36 2,117.36 1,904.95 0.00 1,904.95 0.00 1,904.95 2,117.36 2,117.36 206.70 1,904.95 1,904.95 0.00 0.00 1,904.95 0.00 0.00 0.00

14.26 811.17 471.30 4,827.77 4,827.77 4,827.77 4,827.77 4,827.77 4,827.77 4,343.47 0.00 4,343.47 0.00 4,343.47 4,827.77 4,827.77 471.30 4,343.47 4,343.47 0.00 0.00 4,343.47 0.00 0.00 0.00

16.34 929.73 540.18 5,533.41 5,533.41 5,533.41 5,533.41 5,533.41 5,533.41 4,978.32 0.00 4,978.32 0.00 4,978.32 5,533.41 5,533.41 540.18 4,978.32 4,978.32 0.00 0.00 4,978.32 0.00 0.00 0.00

X

X SI change 1/1/07 (TR 1155)

SI change 1/1/07 (TR 1155)

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

31 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only C C C C C C C C

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 0.00 0.00 0.00 0.00

Children's Hospital Outpatient Fee 0.00 0.00 0.00 0.00

Critical PDD Access Update to Hospital ACS Outpatient Fee 0.00 0.00 0.00 0.00

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

60545 60600 60605 60650

Explore adrenal gland Remove carotid body lesion Remove carotid body lesion Laparoscopy adrenalectomy

0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000

60659

Laparo proc, endocrine

T

T

0130

34.3958

1,643.09

3,746.39

4,293.97

SI= T, effect. 05/01/06 If needed add 282N Taxonomy SI= T, effect. 05/01/06 If needed add 282N Taxonomy

60699 61000 61001 61020 61026 61050 61055 61070 61105 61107 61108 61120 61140 61150 61151 61154 61156 61210 61215 61250 61253 61304 61305 61312 61313 61314 61315 61316 61320 61321 61322 61323 61330 61332 61333 61334 61340 61343 61345 61440 61450 61458 61460 61470 61480 61490 61500 61501 61510 61512 61514 61516 61517 61518 61519 61520 61521 61522 61524 61526 61530 61531 61533 61534 61535 61536 61537 61538 61539 61540 61541 61542 61543 61544 61545 61546 61548 61550 61552 61556 61557 61558 61559 61563 61564 61566 61567 61570 61571 61575 61576 61580 61581 61582 61583 61584 61585 61586 61590 61591 61592 61595 61596 61597 61598 61600 61601 61605 61606 61607 61608 61609 61610 61611 61612 61613 61615 61616 61618 61619 61623 61624 61626 61630 61635 61640 61641 61642 61680 61682 61684 61686 61690 61692 61697 61698 61700 61702 61703 61705 61708 61710 61711 61720 61735 61750 61751 61760 61770 61790 61791 61793 61795 61850

Endocrine surgery procedure Remove cranial cavity fluid Remove cranial cavity fluid Remove brain cavity fluid Injection into brain canal Remove brain canal fluid Injection into brain canal Brain canal shunt procedure Twist drill hole Drill skull for implantation Drill skull for drainage Burr hole for puncture Pierce skull for biopsy Pierce skull for drainage Pierce skull for drainage Pierce skull & remove clot Pierce skull for drainage Pierce skull, implant device Insert brain-fluid device Pierce skull & explore Pierce skull & explore Open skull for exploration Open skull for exploration Open skull for drainage Open skull for drainage Open skull for drainage Open skull for drainage Implt cran bone flap to abdo Open skull for drainage Open skull for drainage Decompressive craniotomy Decompressive lobectomy Decompress eye socket Explore/biopsy eye socket Explore orbit/remove lesion Explore orbit/remove object Subtemporal decompression Incise skull (press relief) Relieve cranial pressure Incise skull for surgery Incise skull for surgery Incise skull for brain wound Incise skull for surgery Incise skull for surgery Incise skull for surgery Incise skull for surgery Removal of skull lesion Remove infected skull bone Removal of brain lesion Remove brain lining lesion Removal of brain abscess Removal of brain lesion Implt brain chemotx add-on Removal of brain lesion Remove brain lining lesion Removal of brain lesion Removal of brain lesion Removal of brain abscess Removal of brain lesion Removal of brain lesion Removal of brain lesion Implant brain electrodes Implant brain electrodes Removal of brain lesion Remove brain electrodes Removal of brain lesion Removal of brain tissue Removal of brain tissue Removal of brain tissue Removal of brain tissue Incision of brain tissue Removal of brain tissue Removal of brain tissue Remove & treat brain lesion Excision of brain tumor Removal of pituitary gland Removal of pituitary gland Release of skull seams Release of skull seams Incise skull/sutures Incise skull/sutures Excision of skull/sutures Excision of skull/sutures Excision of skull tumor Excision of skull tumor Removal of brain tissue Incision of brain tissue Remove foreign body, brain Incise skull for brain wound Skull base/brainstem surgery Skull base/brainstem surgery Craniofacial approach, skull Craniofacial approach, skull Craniofacial approach, skull Craniofacial approach, skull Orbitocranial approach/skull Orbitocranial approach/skull Resect nasopharynx, skull Infratemporal approach/skull Infratemporal approach/skull Orbitocranial approach/skull Transtemporal approach/skull Transcochlear approach/skull Transcondylar approach/skull Transpetrosal approach/skull Resect/excise cranial lesion Resect/excise cranial lesion Resect/excise cranial lesion Resect/excise cranial lesion Resect/excise cranial lesion Resect/excise cranial lesion Transect artery, sinus Transect artery, sinus Transect artery, sinus Transect artery, sinus Remove aneurysm, sinus Resect/excise lesion, skull Resect/excise lesion, skull Repair dura Repair dura Endovasc tempory vessel occl Transcath occlusion, cns Transcath occlusion, non-cns Intracranial angioplasty Intracran angioplsty w/stent Dilate ic vasospasm, init Dilate ic vasospasm add-on Dilate ic vasospasm add-on Intracranial vessel surgery Intracranial vessel surgery Intracranial vessel surgery Intracranial vessel surgery Intracranial vessel surgery Intracranial vessel surgery Brain aneurysm repr, complx Brain aneurysm repr, complx Brain aneurysm repr, simple Inner skull vessel surgery Clamp neck artery Revise circulation to head Revise circulation to head Revise circulation to head Fusion of skull arteries Incise skull/brain surgery Incise skull/brain surgery Incise skull/brain biopsy Brain biopsy w/ct/mr guide Implant brain electrodes Incise skull for treatment Treat trigeminal nerve Treat trigeminal tract Focus radiation beam Brain surgery using computer Implant neuroelectrodes

T T T T T T T T C C C C C C C C C C T C C C C C C C C C C C C C T C C T C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C T C T E E E E E C C C C C C C C C C C C C C C T C C C C T T T B N C

T T T T T T T T C C C C C C C C C C T C C C C C C C C C C C C C T C C T C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C T C T 3 3 3 3 3 C C C C C C C C C C C C C C C T C C C C T T T B N C

0114 0212 0212 0212 0212 0212 0212 0121 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0224 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0256 0000 0000 0256 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0082 0000 0082 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0221 0000 0000 0000 0000 0221 0220 0203 0000 0000 0000

44.3240 8.5263 8.5263 8.5263 8.5263 8.5263 8.5263 3.2383 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 36.2768 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 39.8776 0.0000 0.0000 39.8776 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 87.5137 0.0000 87.5137 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 33.2707 0.0000 0.0000 0.0000 0.0000 33.2707 18.0518 14.4879 0.0000 0.0000 0.0000

2,117.36 407.30 407.30 407.30 407.30 407.30 407.30 154.69 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1,732.94 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1,904.95 0.00 0.00 1,904.95 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 4,180.53 0.00 4,180.53 M01 M01 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1,589.34 0.00 0.00 0.00 0.00 1,589.34 862.33 692.09 0.00 0.00 0.00

4,827.77 928.68 928.68 928.68 928.68 928.68 928.68 352.72 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3,951.27 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 4,343.47 0.00 0.00 4,343.47 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 9,531.99 0.00 9,531.99 M01 M01 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3,623.84 0.00 0.00 0.00 0.00 3,623.84 1,966.20 1,578.02 0.00 0.00 0.00

5,533.41 1,064.42 1,064.42 1,064.42 1,064.42 1,064.42 1,064.42 404.27 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 4,528.80 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 4,978.32 0.00 0.00 4,978.32 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 10,925.21 0.00 10,925.21 M01 M01 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 4,153.51 0.00 0.00 0.00 0.00 4,153.51 2,253.59 1,808.67 0.00 0.00 0.00

SI change 1/1/07 (TR 1155)

X

X

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

32 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only C C C C C C C T S S T T C C C C C C C C C C C C C C C C N C C C C C C C C T C C C C T T S C C T T T T T T T T T T N T N N T T T T T T T T T T T T T S S T T T T T T T T T T T T T C C T T T T C C T T T T T T C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C T S S T T C C C C C C C C C C C C C C C C N C C C C C C C C T C C C C T T S C C T T T T T T T T T T N T N N T T T T T T T T T T T T T S S T T T T T T T T T T T T T C C T T T T C C T T T T T T C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C C

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1,073.55 8,907.86 12,898.81 1,644.08 1,145.36 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 407.30 0.00 0.00 0.00 0.00 733.48 1,732.94 111.16 0.00 0.00 692.09 692.09 407.30 445.95 195.69 195.69 195.69 337.00 337.00 337.00 0.00 1,589.34 0.00 0.00 407.30 407.30 337.00 337.00 337.00 337.00 1,732.94 2,234.32 692.09 1,732.94 8,784.56 8,784.56 1,589.34 111.16 111.16 2,234.32 2,234.32 2,234.32 2,234.32 2,234.32 2,234.32 2,234.32 2,234.32 2,234.32 2,234.32 2,234.32 2,234.32 2,234.32 0.00 0.00 2,234.32 2,234.32 2,234.32 2,234.32 0.00 0.00 2,234.32 2,234.32 2,234.32 2,234.32 2,234.32 2,234.32 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Children's Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2,447.80 20,310.74 29,410.47 3,748.66 2,611.52 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 928.68 0.00 0.00 0.00 0.00 1,672.41 3,951.27 253.45 0.00 0.00 1,578.02 1,578.02 928.68 1,016.81 446.18 446.18 446.18 768.39 768.39 768.39 0.00 3,623.84 0.00 0.00 928.68 928.68 768.39 768.39 768.39 768.39 3,951.27 5,094.45 1,578.02 3,951.27 20,029.60 20,029.60 3,623.84 253.45 253.45 5,094.45 5,094.45 5,094.45 5,094.45 5,094.45 5,094.45 5,094.45 5,094.45 5,094.45 5,094.45 5,094.45 5,094.45 5,094.45 0.00 0.00 5,094.45 5,094.45 5,094.45 5,094.45 0.00 0.00 5,094.45 5,094.45 5,094.45 5,094.45 5,094.45 5,094.45 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Critical PDD Access Update to Hospital ACS Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2,805.58 23,279.40 33,709.17 4,296.57 2,993.23 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1,064.42 0.00 0.00 0.00 0.00 1,916.86 4,528.80 290.49 0.00 0.00 1,808.67 1,808.67 1,064.42 1,165.43 511.39 511.39 511.39 880.70 880.70 880.70 0.00 4,153.51 0.00 0.00 1,064.42 1,064.42 880.70 880.70 880.70 880.70 4,528.80 5,839.07 1,808.67 4,528.80 22,957.18 22,957.18 4,153.51 290.49 290.49 5,839.07 5,839.07 5,839.07 5,839.07 5,839.07 5,839.07 5,839.07 5,839.07 5,839.07 5,839.07 5,839.07 5,839.07 5,839.07 0.00 0.00 5,839.07 5,839.07 5,839.07 5,839.07 0.00 0.00 5,839.07 5,839.07 5,839.07 5,839.07 5,839.07 5,839.07 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

61860 61863 61864 61867 61868 61870 61875 61880 61885 61886 61888 62000 62005 62010 62100 62115 62116 62117 62120 62121 62140 62141 62142 62143 62145 62146 62147 62148 62160 62161 62162 62163 62164 62165 62180 62190 62192 62194 62200 62201 62220 62223 62225 62230 62252 62256 62258 62263 62264 62268 62269 62270 62272 62273 62280 62281 62282 62284 62287 62290 62291 62292 62294 62310 62311 62318 62319 62350 62351 62355 62360 62361 62362 62365 62367 62368 63001 63003 63005 63011 63012 63015 63016 63017 63020 63030 63035 63040 63042 63043 63044 63045 63046 63047 63048 63050 63051 63055 63056 63057 63064 63066 63075 63076 63077 63078 63081 63082 63085 63086 63087 63088 63090 63091 63101 63102 63103 63170 63172 63173 63180 63182 63185 63190 63191 63194 63195 63196 63197 63198 63199 63200 63250 63251 63252 63265 63266 63267 63268 63270 63271 63272 63273 63275 63276 63277 63278 63280 63281 63282 63283 63285 63286 63287 63290 63295 63300 63301 63302 63303 63304 63305 63306

Implant neuroelectrodes Implant neuroelectrode Implant neuroelectrde, add’l Implant neuroelectrode Implant neuroelectrde, add’l Implant neuroelectrodes Implant neuroelectrodes Revise/remove neuroelectrode Insrt/redo neurostim 1 array Implant neurostim arrays Revise/remove neuroreceiver Treat skull fracture Treat skull fracture Treatment of head injury Repair brain fluid leakage Reduction of skull defect Reduction of skull defect Reduction of skull defect Repair skull cavity lesion Incise skull repair Repair of skull defect Repair of skull defect Remove skull plate/flap Replace skull plate/flap Repair of skull & brain Repair of skull with graft Repair of skull with graft Retr bone flap to fix skull Neuroendoscopy add-on Dissect brain w/scope Remove colloid cyst w/scope Neuroendoscopy w/fb removal Remove brain tumor w/scope Remove pituit tumor w/scope Establish brain cavity shunt Establish brain cavity shunt Establish brain cavity shunt Replace/irrigate catheter Establish brain cavity shunt Brain cavity shunt w/scope Establish brain cavity shunt Establish brain cavity shunt Replace/irrigate catheter Replace/revise brain shunt Csf shunt reprogram Remove brain cavity shunt Replace brain cavity shunt Epidural lysis mult sessions Epidural lysis on single day Drain spinal cord cyst Needle biopsy, spinal cord Spinal fluid tap, diagnostic Drain cerebro spinal fluid Inject epidural patch Treat spinal cord lesion Treat spinal cord lesion Treat spinal canal lesion Injection for myelogram Percutaneous diskectomy Inject for spine disk x-ray Inject for spine disk x-ray Injection into disk lesion Injection into spinal artery Inject spine c/t Inject spine l/s (cd) Inject spine w/cath, c/t Inject spine w/cath l/s (cd) Implant spinal canal cath Implant spinal canal cath Remove spinal canal catheter Insert spine infusion device Implant spine infusion pump Implant spine infusion pump Remove spine infusion device Analyze spine infusion pump Analyze spine infusion pump Removal of spinal lamina Removal of spinal lamina Removal of spinal lamina Removal of spinal lamina Removal of spinal lamina Removal of spinal lamina Removal of spinal lamina Removal of spinal lamina Neck spine disk surgery Low back disk surgery Spinal disk surgery add-on Laminotomy, single cervical Laminotomy, single lumbar Laminotomy, add’l cervical Laminotomy, add’l lumbar Removal of spinal lamina Removal of spinal lamina Removal of spinal lamina Remove spinal lamina add-on Cervical laminoplasty C-laminoplasty w/graft/plate Decompress spinal cord Decompress spinal cord Decompress spine cord add-on Decompress spinal cord Decompress spine cord add-on Neck spine disk surgery Neck spine disk surgery Spine disk surgery, thorax Spine disk surgery, thorax Removal of vertebral body Remove vertebral body add-on Removal of vertebral body Remove vertebral body add-on Removal of vertebral body Remove vertebral body add-on Removal of vertebral body Remove vertebral body add-on Removal of vertebral body Removal of vertebral body Remove vertebral body add-on Incise spinal cord tract(s) Drainage of spinal cyst Drainage of spinal cyst Revise spinal cord ligaments Revise spinal cord ligaments Incise spinal column/nerves Incise spinal column/nerves Incise spinal column/nerves Incise spinal column & cord Incise spinal column & cord Incise spinal column & cord Incise spinal column & cord Incise spinal column & cord Incise spinal column & cord Release of spinal cord Revise spinal cord vessels Revise spinal cord vessels Revise spinal cord vessels Excise intraspinal lesion Excise intraspinal lesion Excise intraspinal lesion Excise intraspinal lesion Excise intraspinal lesion Excise intraspinal lesion Excise intraspinal lesion Excise intraspinal lesion Biopsy/excise spinal tumor Biopsy/excise spinal tumor Biopsy/excise spinal tumor Biopsy/excise spinal tumor Biopsy/excise spinal tumor Biopsy/excise spinal tumor Biopsy/excise spinal tumor Biopsy/excise spinal tumor Biopsy/excise spinal tumor Biopsy/excise spinal tumor Biopsy/excise spinal tumor Biopsy/excise spinal tumor Repair of laminectomy defect Removal of vertebral body Removal of vertebral body Removal of vertebral body Removal of vertebral body Removal of vertebral body Removal of vertebral body Removal of vertebral body

0000 0000 0000 0000 0000 0000 0000 0687 0039 0315 0688 0254 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0212 0000 0000 0000 0000 0427 0224 0691 0000 0000 0203 0203 0212 0685 0206 0206 0206 0207 0207 0207 0000 0221 0000 0000 0212 0212 0207 0207 0207 0207 0224 0208 0203 0224 0227 0227 0221 0691 0691 0208 0208 0208 0208 0208 0208 0208 0208 0208 0208 0208 0208 0208 0000 0000 0208 0208 0208 0208 0000 0000 0208 0208 0208 0208 0208 0208 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 22.4734 186.4739 270.0190 34.4166 23.9765 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 8.5263 0.0000 0.0000 0.0000 0.0000 15.3545 36.2768 2.3269 0.0000 0.0000 14.4879 14.4879 8.5263 9.3354 4.0964 4.0964 4.0964 7.0546 7.0546 7.0546 0.0000 33.2707 0.0000 0.0000 8.5263 8.5263 7.0546 7.0546 7.0546 7.0546 36.2768 46.7724 14.4879 36.2768 183.8928 183.8928 33.2707 2.3269 2.3269 46.7724 46.7724 46.7724 46.7724 46.7724 46.7724 46.7724 46.7724 46.7724 46.7724 46.7724 46.7724 46.7724 0.0000 0.0000 46.7724 46.7724 46.7724 46.7724 0.0000 0.0000 46.7724 46.7724 46.7724 46.7724 46.7724 46.7724 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

X SI change 1/1/07 (TR 1155)

X

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

33 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only C C T T T S S T S T C C C C C C C C T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T A S S S S S S S S S S T S T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T C C C T T T T T T T T T T T T T T T T T T T C C T T T T T T T T T T T T T T T T T T T C C T T T T T T T T T C C T T T S S T S T C C C C C C C C T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T 3 S S S S S S S S S S T S T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T C C C T T T T T T T T T T T T T T T T T T T C C T T T T T T T T T T T T T T T T T T T C C T T T T T T T T T

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 0.00 0.00 862.33 862.33 862.33 3,047.09 3,958.21 1,073.55 11,502.97 1,644.08 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1,732.94 1,732.94 270.45 110.89 110.89 195.69 195.69 337.00 337.00 195.69 195.69 337.00 195.69 195.69 195.69 195.69 195.69 337.00 195.69 195.69 692.09 195.69 195.69 337.00 195.69 337.00 195.69 337.00 110.89 337.00 195.69 337.00 195.69 110.89 110.89 337.00 337.00 337.00 337.00 M01 10,545.91 3,047.09 3,047.09 3,047.09 3,047.09 10,545.91 3,958.21 3,958.21 3,958.21 3,958.21 1,073.55 8,907.86 1,644.08 692.09 692.09 692.09 110.89 110.89 110.89 337.00 692.09 337.00 692.09 110.89 337.00 337.00 110.89 110.89 692.09 692.09 862.33 862.33 862.33 862.33 862.33 862.33 862.33 862.33 862.33 862.33 862.33 862.33 862.33 862.33 862.33 862.33 862.33 862.33 862.33 862.33 862.33 0.00 0.00 0.00 862.33 862.33 1,589.34 862.33 862.33 862.33 862.33 862.33 862.33 862.33 862.33 1,589.34 862.33 862.33 862.33 1,589.34 862.33 862.33 862.33 0.00 0.00 862.33 1,256.85 1,256.85 1,256.85 1,589.34 1,589.34 1,589.34 1,589.34 1,589.34 1,589.34 1,589.34 1,589.34 1,589.34 1,589.34 1,589.34 1,589.34 1,589.34 1,589.34 1,589.34 0.00 0.00 1,589.34 1,589.34 1,589.34 1,589.34 1,589.34 1,589.34 1,589.34 1,589.34 1,589.34

Children's Hospital Outpatient Fee 0.00 0.00 1,966.20 1,966.20 1,966.20 6,947.64 9,025.08 2,447.80 26,227.83 3,748.66 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3,951.27 3,951.27 616.64 252.84 252.84 446.18 446.18 768.39 768.39 446.18 446.18 768.39 446.18 446.18 446.18 446.18 446.18 768.39 446.18 446.18 1,578.02 446.18 446.18 768.39 446.18 768.39 446.18 768.39 252.84 768.39 446.18 768.39 446.18 252.84 252.84 768.39 768.39 768.39 768.39 M01 24,045.64 6,947.64 6,947.64 6,947.64 6,947.64 24,045.64 9,025.08 9,025.08 9,025.08 9,025.08 2,447.80 20,310.74 3,748.66 1,578.02 1,578.02 1,578.02 252.84 252.84 252.84 768.39 1,578.02 768.39 1,578.02 252.84 768.39 768.39 252.84 252.84 1,578.02 1,578.02 1,966.20 1,966.20 1,966.20 1,966.20 1,966.20 1,966.20 1,966.20 1,966.20 1,966.20 1,966.20 1,966.20 1,966.20 1,966.20 1,966.20 1,966.20 1,966.20 1,966.20 1,966.20 1,966.20 1,966.20 1,966.20 0.00 0.00 0.00 1,966.20 1,966.20 3,623.84 1,966.20 1,966.20 1,966.20 1,966.20 1,966.20 1,966.20 1,966.20 1,966.20 3,623.84 1,966.20 1,966.20 1,966.20 3,623.84 1,966.20 1,966.20 1,966.20 0.00 0.00 1,966.20 2,865.74 2,865.74 2,865.74 3,623.84 3,623.84 3,623.84 3,623.84 3,623.84 3,623.84 3,623.84 3,623.84 3,623.84 3,623.84 3,623.84 3,623.84 3,623.84 3,623.84 3,623.84 0.00 0.00 3,623.84 3,623.84 3,623.84 3,623.84 3,623.84 3,623.84 3,623.84 3,623.84 3,623.84

Critical PDD Access Update to Hospital ACS Outpatient Fee 0.00 0.00 2,253.59 2,253.59 2,253.59 7,963.12 10,344.20 2,805.58 30,061.35 4,296.57 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 4,528.80 4,528.80 706.77 289.79 289.79 511.39 511.39 880.70 880.70 511.39 511.39 880.70 511.39 511.39 511.39 511.39 511.39 880.70 511.39 511.39 1,808.67 511.39 511.39 880.70 511.39 880.70 511.39 880.70 289.79 880.70 511.39 880.70 511.39 289.79 289.79 880.70 880.70 880.70 880.70 M01 27,560.20 7,963.12 7,963.12 7,963.12 7,963.12 27,560.20 10,344.20 10,344.20 10,344.20 10,344.20 2,805.58 23,279.40 4,296.57 1,808.67 1,808.67 1,808.67 289.79 289.79 289.79 880.70 1,808.67 880.70 1,808.67 289.79 880.70 880.70 289.79 289.79 1,808.67 1,808.67 2,253.59 2,253.59 2,253.59 2,253.59 2,253.59 2,253.59 2,253.59 2,253.59 2,253.59 2,253.59 2,253.59 2,253.59 2,253.59 2,253.59 2,253.59 2,253.59 2,253.59 2,253.59 2,253.59 2,253.59 2,253.59 0.00 0.00 0.00 2,253.59 2,253.59 4,153.51 2,253.59 2,253.59 2,253.59 2,253.59 2,253.59 2,253.59 2,253.59 2,253.59 4,153.51 2,253.59 2,253.59 2,253.59 4,153.51 2,253.59 2,253.59 2,253.59 0.00 0.00 2,253.59 3,284.60 3,284.60 3,284.60 4,153.51 4,153.51 4,153.51 4,153.51 4,153.51 4,153.51 4,153.51 4,153.51 4,153.51 4,153.51 4,153.51 4,153.51 4,153.51 4,153.51 4,153.51 0.00 0.00 4,153.51 4,153.51 4,153.51 4,153.51 4,153.51 4,153.51 4,153.51 4,153.51 4,153.51

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

63307 63308 63600 63610 63615 63650 63655 63660 63685 63688 63700 63702 63704 63706 63707 63709 63710 63740 63741 63744 63746 64400 64402 64405 64408 64410 64412 64413 64415 64416 64417 64418 64420 64421 64425 64430 64435 64445 64446 64447 64448 64449 64450 64470 64472 64475 64476 64479 64480 64483 64484 64505 64508 64510 64517 64520 64530 64550 64553 64555 64560 64561 64565 64573 64575 64577 64580 64581 64585 64590 64595 64600 64605 64610 64612 64613 64614 64620 64622 64623 64626 64627 64630 64640 64650 64653 64680 64681 64702 64704 64708 64712 64713 64714 64716 64718 64719 64721 64722 64726 64727 64732 64734 64736 64738 64740 64742 64744 64746 64752 64755 64760 64761 64763 64766 64771 64772 64774 64776 64778 64782 64783 64784 64786 64787 64788 64790 64792 64795 64802 64804 64809 64818 64820 64821 64822 64823 64831 64832 64834 64835 64836 64837 64840 64856 64857 64858 64859 64861 64862 64864 64865 64866 64868 64870 64872 64874 64876 64885 64886 64890 64891 64892

Removal of vertebral body Remove vertebral body add-on Remove spinal cord lesion Stimulation of spinal cord Remove lesion of spinal cord Implant neuroelectrodes Implant neuroelectrodes Revise/remove neuroelectrode Insrt/redo spine n generator Revise/remove neuroreceiver Repair of spinal herniation Repair of spinal herniation Repair of spinal herniation Repair of spinal herniation Repair spinal fluid leakage Repair spinal fluid leakage Graft repair of spine defect Install spinal shunt Install spinal shunt Revision of spinal shunt Removal of spinal shunt N block inj, trigeminal N block inj, facial N block inj, occipital N block inj, vagus N block inj, phrenic N block inj, spinal accessor N block inj, cervical plexus N block inj, brachial plexus N block cont infuse, b plex N block inj, axillary N block inj, suprascapular N block inj, intercost, sng N block inj, intercost, mlt N block inj, ilio-ing/hypogi N block inj, pudendal N block inj, paracervical N block inj, sciatic, sng N blk inj, sciatic, cont inf N block inj fem, single N block inj fem, cont inf N block inj, lumbar plexus N block, other peripheral Inj paravertebral c/t Inj paravertebral c/t add-on Inj paravertebral l/s Inj paravertebral l/s add-on Inj foramen epidural c/t Inj foramen epidural add-on Inj foramen epidural l/s Inj foramen epidural add-on N block, spenopalatine gangl N block, carotid sinus s/p N block, stellate ganglion N block inj, hypogas plxs N block, lumbar/thoracic N block inj, celiac pelus Apply neurostimulator Implant neuroelectrodes Implant neuroelectrodes Implant neuroelectrodes Implant neuroelectrodes Implant neuroelectrodes Implant neuroelectrodes Implant neuroelectrodes Implant neuroelectrodes Implant neuroelectrodes Implant neuroelectrodes Revise/remove neuroelectrode Insrt/redo perph n generator Revise/remove neuroreceiver Injection treatment of nerve Injection treatment of nerve Injection treatment of nerve Destroy nerve, face muscle Destroy nerve, spine muscle Destroy nerve, extrem musc Injection treatment of nerve Destr paravertebrl nerve l/s Destr paravertebral n add-on Destr paravertebrl nerve c/t Destr paravertebral n add-on Injection treatment of nerve Injection treatment of nerve Chemodenerv eccrine glands Chemodenerv eccrine glands Injection treatment of nerve Injection treatment of nerve Revise finger/toe nerve Revise hand/foot nerve Revise arm/leg nerve Revision of sciatic nerve Revision of arm nerve(s) Revise low back nerve(s) Revision of cranial nerve Revise ulnar nerve at elbow Revise ulnar nerve at wrist Carpal tunnel surgery Relieve pressure on nerve(s) Release foot/toe nerve Internal nerve revision Incision of brow nerve Incision of cheek nerve Incision of chin nerve Incision of jaw nerve Incision of tongue nerve Incision of facial nerve Incise nerve, back of head Incise diaphragm nerve Incision of vagus nerve Incision of stomach nerves Incision of vagus nerve Incision of pelvis nerve Incise hip/thigh nerve Incise hip/thigh nerve Sever cranial nerve Incision of spinal nerve Remove skin nerve lesion Remove digit nerve lesion Digit nerve surgery add-on Remove limb nerve lesion Limb nerve surgery add-on Remove nerve lesion Remove sciatic nerve lesion Implant nerve end Remove skin nerve lesion Removal of nerve lesion Removal of nerve lesion Biopsy of nerve Remove sympathetic nerves Remove sympathetic nerves Remove sympathetic nerves Remove sympathetic nerves Remove sympathetic nerves Remove sympathetic nerves Remove sympathetic nerves Remove sympathetic nerves Repair of digit nerve Repair nerve add-on Repair of hand or foot nerve Repair of hand or foot nerve Repair of hand or foot nerve Repair nerve add-on Repair of leg nerve Repair/transpose nerve Repair arm/leg nerve Repair sciatic nerve Nerve surgery Repair of arm nerves Repair of low back nerves Repair of facial nerve Repair of facial nerve Fusion of facial/other nerve Fusion of facial/other nerve Fusion of facial/other nerve Subsequent repair of nerve Repair & revise nerve add-on Repair nerve/shorten bone Nerve graft, head or neck Nerve graft, head or neck Nerve graft, hand or foot Nerve graft, hand or foot Nerve graft, arm or leg

0000 0000 0220 0220 0220 0040 0061 0687 0222 0688 0000 0000 0000 0000 0000 0000 0000 0000 0224 0224 0109 0204 0204 0206 0206 0207 0207 0206 0206 0207 0206 0206 0206 0206 0206 0207 0206 0206 0203 0206 0206 0207 0206 0207 0206 0207 0204 0207 0206 0207 0206 0204 0204 0207 0207 0207 0207 0000 0225 0040 0040 0040 0040 0225 0061 0061 0061 0061 0687 0039 0688 0203 0203 0203 0204 0204 0204 0207 0203 0207 0203 0204 0207 0207 0204 0204 0203 0203 0220 0220 0220 0220 0220 0220 0220 0220 0220 0220 0220 0220 0220 0220 0220 0220 0220 0220 0220 0220 0220 0000 0000 0000 0220 0220 0221 0220 0220 0220 0220 0220 0220 0220 0220 0221 0220 0220 0220 0221 0220 0220 0220 0000 0000 0220 0054 0054 0054 0221 0221 0221 0221 0221 0221 0221 0221 0221 0221 0221 0221 0221 0221 0221 0000 0000 0221 0221 0221 0221 0221 0221 0221 0221 0221

0.0000 0.0000 18.0518 18.0518 18.0518 63.7866 82.8597 22.4734 240.7990 34.4166 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 36.2768 36.2768 5.6614 2.3213 2.3213 4.0964 4.0964 7.0546 7.0546 4.0964 4.0964 7.0546 4.0964 4.0964 4.0964 4.0964 4.0964 7.0546 4.0964 4.0964 14.4879 4.0964 4.0964 7.0546 4.0964 7.0546 4.0964 7.0546 2.3213 7.0546 4.0964 7.0546 4.0964 2.3213 2.3213 7.0546 7.0546 7.0546 7.0546 0.0000 220.7642 63.7866 63.7866 63.7866 63.7866 220.7642 82.8597 82.8597 82.8597 82.8597 22.4734 186.4739 34.4166 14.4879 14.4879 14.4879 2.3213 2.3213 2.3213 7.0546 14.4879 7.0546 14.4879 2.3213 7.0546 7.0546 2.3213 2.3213 14.4879 14.4879 18.0518 18.0518 18.0518 18.0518 18.0518 18.0518 18.0518 18.0518 18.0518 18.0518 18.0518 18.0518 18.0518 18.0518 18.0518 18.0518 18.0518 18.0518 18.0518 18.0518 18.0518 0.0000 0.0000 0.0000 18.0518 18.0518 33.2707 18.0518 18.0518 18.0518 18.0518 18.0518 18.0518 18.0518 18.0518 33.2707 18.0518 18.0518 18.0518 33.2707 18.0518 18.0518 18.0518 0.0000 0.0000 18.0518 26.3105 26.3105 26.3105 33.2707 33.2707 33.2707 33.2707 33.2707 33.2707 33.2707 33.2707 33.2707 33.2707 33.2707 33.2707 33.2707 33.2707 33.2707 0.0000 0.0000 33.2707 33.2707 33.2707 33.2707 33.2707 33.2707 33.2707 33.2707 33.2707

X

X

SI change 1/1/07 (TR 1155)

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

34 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only T T T T T T T T T T T T T T T T T T T T 1 T

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 1,589.34 1,589.34 1,589.34 1,589.34 1,589.34 1,589.34 1,589.34 1,589.34 1,589.34 0.00 862.33

Children's Hospital Outpatient Fee 3,623.84 3,623.84 3,623.84 3,623.84 3,623.84 3,623.84 3,623.84 3,623.84 3,623.84 0.00 1,966.20

Critical PDD Access Update to Hospital ACS Outpatient Fee 4,153.51 4,153.51 4,153.51 4,153.51 4,153.51 4,153.51 4,153.51 4,153.51 4,153.51 0.00 2,253.59

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

64893 64895 64896 64897 64898 64901 64902 64905 64907 64910 64911

Nerve graft, arm or leg Nerve graft, hand or foot Nerve graft, hand or foot Nerve graft, arm or leg Nerve graft, arm or leg Nerve graft add-on Nerve graft add-on Nerve pedicle transfer Nerve pedicle transfer Nerve repair w/allograft Neurorraphy w/vein autograft

0221 0221 0221 0221 0221 0221 0221 0221 0221 0220 0220

33.2707 33.2707 33.2707 33.2707 33.2707 33.2707 33.2707 33.2707 33.2707 18.0518 18.0518

Added 1/1/07 to book Added 1/1/07 to book SI= T, effect. 05/01/06 If needed add 282N Taxonomy

64999 65091 65093 65101 65103 65105 65110 65112 65114 65125 65130 65135 65140 65150 65155 65175 65205 65210 65220 65222 65235 65260 65265 65270 65272 65273 65275 65280 65285 65286 65290 65400 65410 65420 65426 65430 65435 65436 65450 65600 65710 65730 65750 65755 65760 65765 65767

Nervous system surgery Revise eye Revise eye with implant Removal of eye Remove eye/insert implant Remove eye/attach implant Removal of eye Remove eye/revise socket Remove eye/revise socket Revise ocular implant Insert ocular implant Insert ocular implant Attach ocular implant Revise ocular implant Reinsert ocular implant Removal of ocular implant Remove foreign body from eye Remove foreign body from eye Remove foreign body from eye Remove foreign body from eye Remove foreign body from eye Remove foreign body from eye Remove foreign body from eye Repair of eye wound Repair of eye wound Repair of eye wound Repair of eye wound Repair of eye wound Repair of eye wound Repair of eye wound Repair of eye socket wound Removal of eye lesion Biopsy of cornea Removal of eye lesion Removal of eye lesion Corneal smear Curette/treat cornea Curette/treat cornea Treatment of corneal lesion Revision of cornea Corneal transplant Corneal transplant Corneal transplant Corneal transplant Revision of cornea Revision of cornea Corneal tissue transplant

T T T T T T T T T T T T T T T T S S S S T T T T T C T T T T T T T T T S T T S T T T T T E E E

T T T T T T T T T T T T T T T T S S S S T T T T T C T T T T T T T T T S T T S T T T T T 1 1 1

0204 0242 0242 0242 0242 0242 0242 0242 0242 0240 0241 0241 0242 0241 0242 0240 0698 0698 0698 0698 0233 0236 0237 0240 0234 0000 0234 0236 0672 0232 0243 0233 0233 0233 0234 0698 0239 0233 0231 0240 0244 0244 0244 0244 0000 0000 0000

2.3213 37.7243 37.7243 37.7243 37.7243 37.7243 37.7243 37.7243 37.7243 18.7307 24.3077 24.3077 37.7243 24.3077 37.7243 18.7307 0.8696 0.8696 0.8696 0.8696 16.1710 18.2350 27.8450 18.7307 23.1758 0.0000 23.1758 18.2350 37.2078 5.1169 24.1291 16.1710 16.1710 16.1710 23.1758 0.8696 7.2847 16.1710 2.1790 18.7307 37.4896 37.4896 37.4896 37.4896 0.0000 0.0000 0.0000

110.89 1,802.09 1,802.09 1,802.09 1,802.09 1,802.09 1,802.09 1,802.09 1,802.09 894.77 1,161.18 1,161.18 1,802.09 1,161.18 1,802.09 894.77 41.54 41.54 41.54 41.54 772.49 871.09 1,330.16 894.77 1,107.11 0.00 1,107.11 871.09 1,777.42 244.43 1,152.65 772.49 772.49 772.49 1,107.11 41.54 347.99 772.49 104.09 894.77 1,790.88 1,790.88 1,790.88 1,790.88 0.00 0.00 0.00

252.84 4,108.93 4,108.93 4,108.93 4,108.93 4,108.93 4,108.93 4,108.93 4,108.93 2,040.15 2,647.59 2,647.59 4,108.93 2,647.59 4,108.93 2,040.15 94.72 94.72 94.72 94.72 1,761.35 1,986.16 3,032.88 2,040.15 2,524.31 0.00 2,524.31 1,986.16 4,052.67 557.33 2,628.14 1,761.35 1,761.35 1,761.35 2,524.31 94.72 793.45 1,761.35 237.34 2,040.15 4,083.37 4,083.37 4,083.37 4,083.37 0.00 0.00 0.00

289.79 4,709.50 4,709.50 4,709.50 4,709.50 4,709.50 4,709.50 4,709.50 4,709.50 2,338.34 3,034.57 3,034.57 4,709.50 3,034.57 4,709.50 2,338.34 108.56 108.56 108.56 108.56 2,018.79 2,276.46 3,476.17 2,338.34 2,893.27 0.00 2,893.27 2,276.46 4,645.02 638.79 3,012.28 2,018.79 2,018.79 2,018.79 2,893.27 108.56 909.42 2,018.79 272.03 2,338.34 4,680.20 4,680.20 4,680.20 4,680.20 0.00 0.00 0.00

65770 65771 65772 65775 65780 65781 65782 65800 65805 65810 65815 65820 65850 65855 65860 65865 65870 65875 65880 65900 65920 65930 66020 66030 66130 66150 66155 66160 66165 66170 66172 66180 66185 66220 66225 66250 66500 66505 66600 66605 66625 66630 66635 66680 66682 66700 66710 66711 66720 66740 66761 66762 66770 66820 66821 66825 66830 66840 66850 66852 66920 66930 66940 66982 66983 66984 66985 66986 66990

Revise cornea with implant Radial keratotomy Correction of astigmatism Correction of astigmatism Ocular reconst, transplant Ocular reconst, transplant Ocular reconst, transplant Drainage of eye Drainage of eye Drainage of eye Drainage of eye Relieve inner eye pressure Incision of eye Laser surgery of eye Incise inner eye adhesions Incise inner eye adhesions Incise inner eye adhesions Incise inner eye adhesions Incise inner eye adhesions Remove eye lesion Remove implant of eye Remove blood clot from eye Injection treatment of eye Injection treatment of eye Remove eye lesion Glaucoma surgery Glaucoma surgery Glaucoma surgery Glaucoma surgery Glaucoma surgery Incision of eye Implant eye shunt Revise eye shunt Repair eye lesion Repair/graft eye lesion Follow-up surgery of eye Incision of iris Incision of iris Remove iris and lesion Removal of iris Removal of iris Removal of iris Removal of iris Repair iris & ciliary body Repair iris & ciliary body Destruction, ciliary body Ciliary transsleral therapy Ciliary endoscopic ablation Destruction, ciliary body Destruction, ciliary body Revision of iris Revision of iris Removal of inner eye lesion Incision, secondary cataract After cataract laser surgery Reposition intraocular lens Removal of lens lesion Removal of lens material Removal of lens material Removal of lens material Extraction of lens Extraction of lens Extraction of lens Cataract surgery, complex Cataract surg w/iol, 1 stage Cataract surg w/iol, 1 stage Insert lens prosthesis Exchange lens prosthesis Ophthalmic endoscope add-on

T E T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T N

S 1 1 1 1 1 1 T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T T N

0293 0000 0233 0233 0244 0244 0244 0233 0233 0234 0234 0232 0234 0247 0247 0233 0234 0234 0233 0233 0234 0234 0233 0232 0234 0234 0234 0234 0234 0234 0234 0673 0673 0672 0673 0233 0232 0232 0234 0234 0232 0234 0234 0234 0234 0233 0233 0233 0233 0234 0247 0247 0247 0232 0247 0234 0232 0245 0249 0249 0249 0249 0245 0246 0246 0246 0246 0246 0000

84.8039 0.0000 16.1710 16.1710 37.4896 37.4896 37.4896 16.1710 16.1710 23.1758 23.1758 5.1169 23.1758 5.2001 5.2001 16.1710 23.1758 23.1758 16.1710 16.1710 23.1758 23.1758 16.1710 5.1169 23.1758 23.1758 23.1758 23.1758 23.1758 23.1758 23.1758 39.7101 39.7101 37.2078 39.7101 16.1710 5.1169 5.1169 23.1758 23.1758 5.1169 23.1758 23.1758 23.1758 23.1758 16.1710 16.1710 16.1710 16.1710 23.1758 5.2001 5.2001 5.2001 5.1169 5.2001 23.1758 5.1169 14.9171 28.7035 28.7035 28.7035 28.7035 14.9171 23.8649 23.8649 23.8649 23.8649 23.8649 0.0000

4,051.08 0.00 0.00 0.00 0.00 0.00 0.00 772.49 772.49 1,107.11 1,107.11 244.43 1,107.11 248.41 248.41 772.49 1,107.11 1,107.11 772.49 772.49 1,107.11 1,107.11 772.49 244.43 1,107.11 1,107.11 1,107.11 1,107.11 1,107.11 1,107.11 1,107.11 1,896.95 1,896.95 1,777.42 1,896.95 772.49 244.43 244.43 1,107.11 1,107.11 244.43 1,107.11 1,107.11 1,107.11 1,107.11 772.49 772.49 772.49 772.49 1,107.11 248.41 248.41 248.41 244.43 248.41 1,107.11 244.43 712.59 1,371.17 1,371.17 1,371.17 1,371.17 712.59 1,140.03 1,140.03 1,140.03 1,140.03 1,140.03 0.00

9,236.84 0.00 0.00 0.00 0.00 0.00 0.00 1,761.35 1,761.35 2,524.31 2,524.31 557.33 2,524.31 566.39 566.39 1,761.35 2,524.31 2,524.31 1,761.35 1,761.35 2,524.31 2,524.31 1,761.35 557.33 2,524.31 2,524.31 2,524.31 2,524.31 2,524.31 2,524.31 2,524.31 4,325.22 4,325.22 4,052.67 4,325.22 1,761.35 557.33 557.33 2,524.31 2,524.31 557.33 2,524.31 2,524.31 2,524.31 2,524.31 1,761.35 1,761.35 1,761.35 1,761.35 2,524.31 566.39 566.39 566.39 557.33 566.39 2,524.31 557.33 1,624.77 3,126.39 3,126.39 3,126.39 3,126.39 1,624.77 2,599.36 2,599.36 2,599.36 2,599.36 2,599.36 0.00

10,586.92 0.00 0.00 0.00 0.00 0.00 0.00 2,018.79 2,018.79 2,893.27 2,893.27 638.79 2,893.27 649.18 649.18 2,018.79 2,893.27 2,893.27 2,018.79 2,018.79 2,893.27 2,893.27 2,018.79 638.79 2,893.27 2,893.27 2,893.27 2,893.27 2,893.27 2,893.27 2,893.27 4,957.41 4,957.41 4,645.02 4,957.41 2,018.79 638.79 638.79 2,893.27 2,893.27 638.79 2,893.27 2,893.27 2,893.27 2,893.27 2,018.79 2,018.79 2,018.79 2,018.79 2,893.27 649.18 649.18 649.18 638.79 649.18 2,893.27 638.79 1,862.25 3,583.34 3,583.34 3,583.34 3,583.34 1,862.25 2,979.29 2,979.29 2,979.29 2,979.29 2,979.29 0.00

Covering C1818 & L8609 so cover Proc. Factor Code = S If needed add 282N tax

66999 67005 67010 67015 67025 67027 67028 67030 67031 67036 67039 67040 67041 67042 67043 67101 67105 67107 67108 67110 67112 67113 67115 67120 67121 67141 67145 67208

Eye surgery procedure Partial removal of eye fluid Partial removal of eye fluid Release of eye fluid Replace eye fluid Implant eye drug system Injection eye drug Incise inner eye strands Laser surgery, eye strands Removal of inner eye fluid Laser treatment of retina Laser treatment of retina Vit for macular pucker Vit for macular hole Vit for membrane dissect Repair detached retina Repair detached retina Repair detached retina Repair detached retina Repair detached retina Rerepair detached retina Repair retinal detach, cplx Release encircling material Remove eye implant material Remove eye implant material Treatment of retina Treatment of retina Treatment of retinal lesion

T T T T T T S T T T T T T T T T T T T T T T T T T T T T

T T T T T T S T T T T T T T T T T T T T T T T T T T T T

0232 0237 0237 0237 0237 0672 0231 0236 0247 0672 0672 0672 0672 0672 0672 0236 0247 0672 0672 0236 0672 0672 0236 0236 0237 0235 0247 0236

5.1169 27.8450 27.8450 27.8450 27.8450 37.2078 2.1790 18.2350 5.2001 37.2078 37.2078 37.2078 37.2078 37.2078 37.2078 18.2350 5.2001 37.2078 37.2078 18.2350 37.2078 37.2078 18.2350 18.2350 27.8450 4.1331 5.2001 18.2350

244.43 1,330.16 1,330.16 1,330.16 1,330.16 1,777.42 104.09 871.09 248.41 1,777.42 1,777.42 1,777.42 1,777.42 1,777.42 1,777.42 871.09 248.41 1,777.42 1,777.42 871.09 1,777.42 1,777.42 871.09 871.09 1,330.16 197.44 248.41 871.09

557.33 3,032.88 3,032.88 3,032.88 3,032.88 4,052.67 237.34 1,986.16 566.39 4,052.67 4,052.67 4,052.67 4,052.67 4,052.67 4,052.67 1,986.16 566.39 4,052.67 4,052.67 1,986.16 4,052.67 4,052.67 1,986.16 1,986.16 3,032.88 450.18 566.39 1,986.16

638.79 3,476.17 3,476.17 3,476.17 3,476.17 4,645.02 272.03 2,276.46 649.18 4,645.02 4,645.02 4,645.02 4,645.02 4,645.02 4,645.02 2,276.46 649.18 4,645.02 4,645.02 2,276.46 4,645.02 4,645.02 2,276.46 2,276.46 3,476.17 515.98 649.18 2,276.46

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

X

X X X

X

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

35 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only T T T T T T T T T T T T T T T T T T T T

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 248.41 871.09 197.44 197.44 197.44 1,330.16 248.41 248.41 894.77 1,330.16

Children's Hospital Outpatient Fee 566.39 1,986.16 450.18 450.18 450.18 3,032.88 566.39 566.39 2,040.15 3,032.88

Critical PDD Access Update to Hospital ACS Outpatient Fee 649.18 2,276.46 515.98 515.98 515.98 3,476.17 649.18 649.18 2,338.34 3,476.17

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

67210 67218 67220 67221 67225 67227 67228 67229 67250 67255

Treatment of retinal lesion Treatment of retinal lesion Treatment of choroid lesion Ocular photodynamic ther Eye photodynamic ther add-on Treatment of retinal lesion Treatment of retinal lesion Tr retinal les preterm inf Reinforce eye wall Reinforce/graft eye wall

0247 0236 0235 0235 0235 0237 0247 0247 0240 0237

5.2001 18.2350 4.1331 4.1331 4.1331 27.8450 5.2001 5.2001 18.7307 27.8450

X

67299 67311 67312 67314 67316 67318 67320 67331 67332 67334 67335 67340 67343 67345 67346

Eye surgery procedure Revise eye muscle Revise two eye muscles Revise eye muscle Revise two eye muscles Revise eye muscle(s) Revise eye muscle(s) add-on Eye surgery follow-up add-on Rerevise eye muscles add-on Revise eye muscle w/suture Eye suture during surgery Revise eye muscle add-on Release eye tissue Destroy nerve of eye muscle Biopsy, eye muscle

T T T T T T T T T T T T T T T

T T T T T T T T T T T T T T T

0235 0243 0243 0243 0243 0243 0243 0243 0243 0243 0243 0243 0243 0238 0699

4.1331 24.1291 24.1291 24.1291 24.1291 24.1291 24.1291 24.1291 24.1291 24.1291 24.1291 24.1291 24.1291 2.9022 13.7453

197.44 1,152.65 1,152.65 1,152.65 1,152.65 1,152.65 1,152.65 1,152.65 1,152.65 1,152.65 1,152.65 1,152.65 1,152.65 138.64 656.61

450.18 2,628.14 2,628.14 2,628.14 2,628.14 2,628.14 2,628.14 2,628.14 2,628.14 2,628.14 2,628.14 2,628.14 2,628.14 316.11 1,497.14

515.98 3,012.28 3,012.28 3,012.28 3,012.28 3,012.28 3,012.28 3,012.28 3,012.28 3,012.28 3,012.28 3,012.28 3,012.28 362.31 1,715.96

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

Added 1/1/07 to book SI= T, effect. 05/01/06 If needed add 282N Taxonomy

67399 67400 67405 67412 67413 67414 67415 67420 67430 67440 67445 67450 67500 67505 67515 67550 67560 67570

Eye muscle surgery procedure Explore/biopsy eye socket Explore/drain eye socket Explore/treat eye socket Explore/treat eye socket Explr/decompress eye socket Aspiration, orbital contents Explore/treat eye socket Explore/treat eye socket Explore/drain eye socket Explr/decompress eye socket Explore/biopsy eye socket Inject/treat eye socket Inject/treat eye socket Inject/treat eye socket Insert eye socket implant Revise eye socket implant Decompress optic nerve

T T T T T T T T T T T T S T T T T T

T T T T T T T T T T T T S T T T T T

0243 0241 0241 0241 0241 0242 0240 0242 0242 0242 0242 0242 0231 0238 0238 0242 0241 0242

24.1291 24.3077 24.3077 24.3077 24.3077 37.7243 18.7307 37.7243 37.7243 37.7243 37.7243 37.7243 2.1790 2.9022 2.9022 37.7243 24.3077 37.7243

1,152.65 1,161.18 1,161.18 1,161.18 1,161.18 1,802.09 894.77 1,802.09 1,802.09 1,802.09 1,802.09 1,802.09 104.09 138.64 138.64 1,802.09 1,161.18 1,802.09

2,628.14 2,647.59 2,647.59 2,647.59 2,647.59 4,108.93 2,040.15 4,108.93 4,108.93 4,108.93 4,108.93 4,108.93 237.34 316.11 316.11 4,108.93 2,647.59 4,108.93

3,012.28 3,034.57 3,034.57 3,034.57 3,034.57 4,709.50 2,338.34 4,709.50 4,709.50 4,709.50 4,709.50 4,709.50 272.03 362.31 362.31 4,709.50 3,034.57 4,709.50

67599 67700 67710 67715 67800 67801 67805 67808 67810 67820 67825 67830 67835 67840 67850 67875 67880 67882 67900 67901 67902 67903 67904 67906 67908 67909 67911 67912 67914 67915 67916 67917 67921 67922 67923 67924 67930 67935 67938 67950 67961 67966 67971 67973 67974 67975

Orbit surgery procedure Drainage of eyelid abscess Incision of eyelid Incision of eyelid fold Remove eyelid lesion Remove eyelid lesions Remove eyelid lesions Remove eyelid lesion(s) Biopsy of eyelid Revise eyelashes Revise eyelashes Revise eyelashes Revise eyelashes Remove eyelid lesion Treat eyelid lesion Closure of eyelid by suture Revision of eyelid Revision of eyelid Repair brow defect Repair eyelid defect Repair eyelid defect Repair eyelid defect Repair eyelid defect Repair eyelid defect Repair eyelid defect Revise eyelid defect Revise eyelid defect Correction eyelid w/implant Repair eyelid defect Repair eyelid defect Repair eyelid defect Repair eyelid defect Repair eyelid defect Repair eyelid defect Repair eyelid defect Repair eyelid defect Repair eyelid wound Repair eyelid wound Remove eyelid foreign body Revision of eyelid Revision of eyelid Revision of eyelid Reconstruction of eyelid Reconstruction of eyelid Reconstruction of eyelid Reconstruction of eyelid

T T T T T T T T T S T T T T T T T T T T T T T T T T T T T T T T T T T T T T S T T T T T T T

T T T T T T T T T S T T T T T T T T T T T T T T T T T T T T T T T T T T T T S T T T T T T T

0238 0238 0239 0240 0238 0239 0238 0240 0238 0698 0238 0239 0240 0239 0239 0239 0233 0240 0240 0240 0240 0240 0240 0240 0240 0240 0240 0240 0240 0240 0240 0240 0240 0240 0240 0240 0240 0240 0231 0240 0240 0240 0241 0241 0241 0240

2.9022 2.9022 7.2847 18.7307 2.9022 7.2847 2.9022 18.7307 2.9022 0.8696 2.9022 7.2847 18.7307 7.2847 7.2847 7.2847 16.1710 18.7307 18.7307 18.7307 18.7307 18.7307 18.7307 18.7307 18.7307 18.7307 18.7307 18.7307 18.7307 18.7307 18.7307 18.7307 18.7307 18.7307 18.7307 18.7307 18.7307 18.7307 2.1790 18.7307 18.7307 18.7307 24.3077 24.3077 24.3077 18.7307

138.64 138.64 347.99 894.77 138.64 347.99 138.64 894.77 138.64 41.54 138.64 347.99 894.77 347.99 347.99 347.99 772.49 894.77 894.77 894.77 894.77 894.77 894.77 894.77 894.77 894.77 894.77 894.77 894.77 894.77 894.77 894.77 894.77 894.77 894.77 894.77 894.77 894.77 104.09 894.77 894.77 894.77 1,161.18 1,161.18 1,161.18 894.77

316.11 316.11 793.45 2,040.15 316.11 793.45 316.11 2,040.15 316.11 94.72 316.11 793.45 2,040.15 793.45 793.45 793.45 1,761.35 2,040.15 2,040.15 2,040.15 2,040.15 2,040.15 2,040.15 2,040.15 2,040.15 2,040.15 2,040.15 2,040.15 2,040.15 2,040.15 2,040.15 2,040.15 2,040.15 2,040.15 2,040.15 2,040.15 2,040.15 2,040.15 237.34 2,040.15 2,040.15 2,040.15 2,647.59 2,647.59 2,647.59 2,040.15

362.31 362.31 909.42 2,338.34 362.31 909.42 362.31 2,338.34 362.31 108.56 362.31 909.42 2,338.34 909.42 909.42 909.42 2,018.79 2,338.34 2,338.34 2,338.34 2,338.34 2,338.34 2,338.34 2,338.34 2,338.34 2,338.34 2,338.34 2,338.34 2,338.34 2,338.34 2,338.34 2,338.34 2,338.34 2,338.34 2,338.34 2,338.34 2,338.34 2,338.34 272.03 2,338.34 2,338.34 2,338.34 3,034.57 3,034.57 3,034.57 2,338.34

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

67999 68020 68040 68100 68110 68115 68130 68135 68200 68320 68325 68326 68328 68330 68335 68340 68360 68362 68371

Revision of eyelid Incise/drain eyelid lining Treatment of eyelid lesions Biopsy of eyelid lining Remove eyelid lining lesion Remove eyelid lining lesion Remove eyelid lining lesion Remove eyelid lining lesion Treat eyelid by injection Revise/graft eyelid lining Revise/graft eyelid lining Revise/graft eyelid lining Revise/graft eyelid lining Revise eyelid lining Revise/graft eyelid lining Separate eyelid adhesions Revise eyelid lining Revise eyelid lining Harvest eye tissue, alograft

T T S T T T T T S T T T T T T T T T T

T T S T T T T T S T T T T T T T T T 1

0238 0240 0698 0232 0699 0240 0233 0239 0698 0240 0241 0241 0241 0234 0241 0240 0234 0234 0233

2.9022 18.7307 0.8696 5.1169 13.7453 18.7307 16.1710 7.2847 0.8696 18.7307 24.3077 24.3077 24.3077 23.1758 24.3077 18.7307 23.1758 23.1758 16.1710

138.64 894.77 41.54 244.43 656.61 894.77 772.49 347.99 41.54 894.77 1,161.18 1,161.18 1,161.18 1,107.11 1,161.18 894.77 1,107.11 1,107.11 0.00

316.11 2,040.15 94.72 557.33 1,497.14 2,040.15 1,761.35 793.45 94.72 2,040.15 2,647.59 2,647.59 2,647.59 2,524.31 2,647.59 2,040.15 2,524.31 2,524.31 0.00

362.31 2,338.34 108.56 638.79 1,715.96 2,338.34 2,018.79 909.42 108.56 2,338.34 3,034.57 3,034.57 3,034.57 2,893.27 3,034.57 2,338.34 2,893.27 2,893.27 0.00

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

68399 68400 68420 68440 68500 68505 68510 68520 68525 68530 68540 68550 68700 68705 68720 68745 68750 68760 68761 68770 68801 68810 68811 68815 68816 68840 68850

Eyelid lining surgery Incise/drain tear gland Incise/drain tear sac Incise tear duct opening Removal of tear gland Partial removal, tear gland Biopsy of tear gland Removal of tear sac Biopsy of tear sac Clearance of tear duct Remove tear gland lesion Remove tear gland lesion Repair tear ducts Revise tear duct opening Create tear sac drain Create tear duct drain Create tear duct drain Close tear duct opening Close tear duct opening Close tear system fistula Dilate tear duct opening Probe nasolacrimal duct Probe nasolacrimal duct Probe nasolacrimal duct Probe nl duct w/balloon Explore/irrigate tear ducts Injection for tear sac x-ray

T T T T T T T T T T T T T T T T T S S T S S T T T S N

T T T T T T T T T T T T T T T T T S S T S S T T T S N

0238 0238 0240 0238 0241 0241 0240 0241 0240 0240 0241 0241 0241 0238 0241 0241 0241 0231 0231 0240 0698 0231 0240 0240 0240 0231 0000

2.9022 2.9022 18.7307 2.9022 24.3077 24.3077 18.7307 24.3077 18.7307 18.7307 24.3077 24.3077 24.3077 2.9022 24.3077 24.3077 24.3077 2.1790 2.1790 18.7307 0.8696 2.1790 18.7307 18.7307 18.7307 2.1790 0.0000

138.64 138.64 894.77 138.64 1,161.18 1,161.18 894.77 1,161.18 894.77 894.77 1,161.18 1,161.18 1,161.18 138.64 1,161.18 1,161.18 1,161.18 104.09 104.09 894.77 41.54 104.09 894.77 894.77 894.77 104.09 0.00

316.11 316.11 2,040.15 316.11 2,647.59 2,647.59 2,040.15 2,647.59 2,040.15 2,040.15 2,647.59 2,647.59 2,647.59 316.11 2,647.59 2,647.59 2,647.59 237.34 237.34 2,040.15 94.72 237.34 2,040.15 2,040.15 2,040.15 237.34 0.00

362.31 362.31 2,338.34 362.31 3,034.57 3,034.57 2,338.34 3,034.57 2,338.34 2,338.34 3,034.57 3,034.57 3,034.57 362.31 3,034.57 3,034.57 3,034.57 272.03 272.03 2,338.34 108.56 272.03 2,338.34 2,338.34 2,338.34 272.03 0.00

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

X

68899 69000 69005 69020 69090 69100 69105 69110 69120 69140 69145 69150 69155 69200 69205

Tear duct system surgery Drain external ear lesion Drain external ear lesion Drain outer ear canal lesion Pierce earlobes Biopsy of external ear Biopsy of external ear canal Remove external ear, partial Removal of external ear Remove ear canal lesion(s) Remove ear canal lesion(s) Extensive ear canal surgery Extensive ear/neck surgery Clear outer ear canal Clear outer ear canal

T T T T E T T T T T T T C X T

T T T T 1 T T T T T T T C X T

0238 0006 0008 0006 0000 0251 0253 0021 0254 0254 0021 0252 0000 0340 0022

2.9022 1.4066 18.3197 1.4066 0.0000 2.5002 16.3288 16.1001 23.9765 23.9765 16.1001 7.4474 0.0000 0.6310 21.1098

138.64 67.19 875.13 67.19 0.00 119.43 780.03 769.10 1,145.36 1,145.36 769.10 355.76 0.00 30.14 1,008.42

316.11 153.21 1,995.38 153.21 0.00 272.32 1,778.53 1,753.62 2,611.52 2,611.52 1,753.62 811.17 0.00 68.73 2,299.28

362.31 175.60 2,287.03 175.60 0.00 312.12 2,038.49 2,009.94 2,993.23 2,993.23 2,009.94 929.73 0.00 78.77 2,635.35

SI change 1/1/07 (TR 1155) SI= T effect. 05/01/06 if needed add 282N Taxonomy

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

36 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only X T T T T T X T T 1 T T

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 30.14 37.88 780.03 0.00 1,904.95 1,904.95

Children's Hospital Outpatient Fee 68.73 86.37 1,778.53 0.00 4,343.47 4,343.47

Critical PDD Access Update to Hospital ACS Outpatient Fee 78.77 99.00 2,038.49 0.00 4,978.32 4,978.32

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

69210 69220 69222 69300 69310 69320

Remove impacted ear wax Clean out mastoid cavity Clean out mastoid cavity Revise external ear Rebuild outer ear canal Rebuild outer ear canal

0340 0013 0253 0254 0256 0256

0.6310 0.7930 16.3288 23.9765 39.8776 39.8776

69399 69400 69401 69405 69420 69421 69424 69433 69436 69440 69450 69501 69502 69505 69511 69530 69535 69540 69550 69552 69554 69601 69602 69603 69604 69605 69610 69620 69631 69632 69633 69635 69636 69637 69641 69642 69643 69644 69645 69646 69650 69660 69661 69662 69666 69667 69670 69676 69700 69710 69711 69714 69715 69717 69718 69720 69725 69740 69745

Outer ear surgery procedure Inflate middle ear canal Inflate middle ear canal Catheterize middle ear canal Incision of eardrum Incision of eardrum Remove ventilating tube Create eardrum opening Create eardrum opening Exploration of middle ear Eardrum revision Mastoidectomy Mastoidectomy Remove mastoid structures Extensive mastoid surgery Extensive mastoid surgery Remove part of temporal bone Remove ear lesion Remove ear lesion Remove ear lesion Remove ear lesion Mastoid surgery revision Mastoid surgery revision Mastoid surgery revision Mastoid surgery revision Mastoid surgery revision Repair of eardrum Repair of eardrum Repair eardrum structures Rebuild eardrum structures Rebuild eardrum structures Repair eardrum structures Rebuild eardrum structures Rebuild eardrum structures Revise middle ear & mastoid Revise middle ear & mastoid Revise middle ear & mastoid Revise middle ear & mastoid Revise middle ear & mastoid Revise middle ear & mastoid Release middle ear bone Revise middle ear bone Revise middle ear bone Revise middle ear bone Repair middle ear structures Repair middle ear structures Remove mastoid air cells Remove middle ear nerve Close mastoid fistula Implant/replace hearing aid Remove/repair hearing aid Implant temple bone w/stimul Temple bne implnt w/stimulat Temple bone implant revision Revise temple bone implant Release facial nerve Release facial nerve Repair facial nerve Repair facial nerve

T T T T T T T T T T T T T T T T C T T T C T T T T T T T T T T T T T T T T T T T T T T T T T T T T E T T T T T T T T T

T T T T T T T T T T T T T T T T C T T T C T T T T T T T T T T T T T T T T T T T T T T T T T T T T 3 T T T T T T T T T

0251 0251 0251 0252 0251 0253 0253 0252 0253 0254 0256 0256 0254 0256 0256 0256 0000 0253 0256 0256 0000 0256 0256 0256 0256 0256 0254 0254 0256 0256 0256 0256 0256 0256 0256 0256 0256 0256 0256 0256 0254 0256 0256 0256 0256 0256 0256 0256 0256 0000 0256 0256 0256 0256 0256 0256 0256 0256 0256

2.5002 2.5002 2.5002 7.4474 2.5002 16.3288 16.3288 7.4474 16.3288 23.9765 39.8776 39.8776 23.9765 39.8776 39.8776 39.8776 0.0000 16.3288 39.8776 39.8776 0.0000 39.8776 39.8776 39.8776 39.8776 39.8776 23.9765 23.9765 39.8776 39.8776 39.8776 39.8776 39.8776 39.8776 39.8776 39.8776 39.8776 39.8776 39.8776 39.8776 23.9765 39.8776 39.8776 39.8776 39.8776 39.8776 39.8776 39.8776 39.8776 0.0000 39.8776 39.8776 39.8776 39.8776 39.8776 39.8776 39.8776 39.8776 39.8776

119.43 119.43 119.43 355.76 119.43 780.03 780.03 355.76 780.03 1,145.36 1,904.95 1,904.95 1,145.36 1,904.95 1,904.95 1,904.95 0.00 780.03 1,904.95 1,904.95 0.00 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95 1,145.36 1,145.36 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95 1,145.36 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95 M01 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95

272.32 272.32 272.32 811.17 272.32 1,778.53 1,778.53 811.17 1,778.53 2,611.52 4,343.47 4,343.47 2,611.52 4,343.47 4,343.47 4,343.47 0.00 1,778.53 4,343.47 4,343.47 0.00 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47 2,611.52 2,611.52 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47 2,611.52 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47 M01 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47

312.12 312.12 312.12 929.73 312.12 2,038.49 2,038.49 929.73 2,038.49 2,993.23 4,978.32 4,978.32 2,993.23 4,978.32 4,978.32 4,978.32 0.00 2,038.49 4,978.32 4,978.32 0.00 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32 2,993.23 2,993.23 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32 2,993.23 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32 M01 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

69799 69801 69802 69805 69806 69820 69840 69905 69910 69915 69930

Middle ear surgery procedure Incise inner ear Incise inner ear Explore inner ear Explore inner ear Establish inner ear window Revise inner ear window Remove inner ear Remove inner ear & mastoid Incise inner ear nerve Implant cochlear device

T T T T T T T T T T T

T T T T T T T T T T T

0251 0256 0256 0256 0256 0256 0256 0256 0256 0256 0259

2.5002 39.8776 39.8776 39.8776 39.8776 39.8776 39.8776 39.8776 39.8776 39.8776 393.2242

119.43 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95 1,904.95 18,784.32

272.32 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47 4,343.47 42,829.98

312.12 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32 4,978.32 49,090.11

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

69949 69950 69955 69960 69970

Inner ear surgery procedure Incise inner ear nerve Release facial nerve Release inner ear canal Remove inner ear lesion

T C T T T

T C T T T

0251 0000 0256 0256 0256

2.5002 0.0000 39.8776 39.8776 39.8776

119.43 0.00 1,904.95 1,904.95 1,904.95

272.32 0.00 4,343.47 4,343.47 4,343.47

312.12 0.00 4,978.32 4,978.32 4,978.32

SI= T, effect. 05/01/06 If needed add 282N Taxonomy

X SI= T, effect. 05/01/06 If needed add 282N Taxonomy X X

69979 69990 70010 70015 70030 70100 70110 70120 70130 70134 70140 70150 70160 70170 70190 70200 70210 70220 70240 70250 70260 70300 70310 70320 70328 70330 70332 70336 70350 70355 70360 70370 70371 70373 70380 70390 70450 70460 70470 70480 70481 70482 70486 70487 70488 70490 70491 70492 70496 70498 70540 70542 70543 70544 70545 70546 70547 70548 70549 70551 70552 70553 70554 70555 70557 70558 70559 71010 71015 71020 71021 71022 71023 71030

Temporal bone surgery Microsurgery add-on Contrast x-ray of brain Contrast x-ray of brain X-ray eye for foreign body X-ray exam of jaw X-ray exam of jaw X-ray exam of mastoids X-ray exam of mastoids X-ray exam of middle ear X-ray exam of facial bones X-ray exam of facial bones X-ray exam of nasal bones X-ray exam of tear duct X-ray exam of eye sockets X-ray exam of eye sockets X-ray exam of sinuses X-ray exam of sinuses X-ray exam, pituitary saddle X-ray exam of skull X-ray exam of skull X-ray exam of teeth X-ray exam of teeth Full mouth x-ray of teeth X-ray exam of jaw joint X-ray exam of jaw joints X-ray exam of jaw joint Magnetic image, jaw joint X-ray head for orthodontia Panoramic x-ray of jaws X-ray exam of neck Throat x-ray & fluoroscopy Speech evaluation, complex Contrast x-ray of larynx X-ray exam of salivary gland X-ray exam of salivary duct Ct head/brain w/o dye Ct head/brain w/dye Ct head/brain w/o & w/dye Ct orbit/ear/fossa w/o dye Ct orbit/ear/fossa w/dye Ct orbit/ear/fossa w/o&w/dye Ct maxillofacial w/o dye Ct maxillofacial w/dye Ct maxillofacial w/o & w/dye Ct soft tissue neck w/o dye Ct soft tissue neck w/dye Ct sft tsue nck w/o & w/dye Ct angiography, head Ct angiography, neck Mri orbit/face/neck w/o dye Mri orbit/face/neck w/dye Mri orbt/fac/nck w/o & w/dye Mr angiography head w/o dye Mr angiography head w/dye Mr angiograph head w/o&w/dye Mr angiography neck w/o dye Mr angiography neck w/dye Mr angiograph neck w/o&w/dye Mri brain w/o dye Mri brain w/dye Mri brain w/o & w/dye Fmri brain by tech Fmri brain by phys/psych Mri brain w/o dye Mri brain w/dye Mri brain w/o & w/dye Chest x-ray Chest x-ray Chest x-ray Chest x-ray Chest x-ray Chest x-ray and fluoroscopy Chest x-ray

T N Q Q X X X X X X X X X Q X X X X X X X X X X X X Q S X X X X X Q X Q S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S X X X X X X X

T N Q Q X X X X X X X X X Q X X X X X X X X X X X X Q S X X X X X Q X Q S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S X X X X X X X

0251 0000 0274 0274 0260 0260 0260 0260 0260 0261 0260 0260 0260 0317 0260 0260 0260 0260 0260 0260 0261 0262 0262 0262 0260 0260 0275 0335 0260 0260 0260 0272 0272 0263 0260 0263 0332 0283 0333 0332 0283 0333 0332 0283 0333 0332 0283 0333 0662 0662 0336 0284 0337 0336 0284 0337 0336 0284 0337 0336 0284 0337 0336 0336 0336 0284 0337 0260 0260 0260 0260 0260 0272 0260

2.5002 0.0000 7.5589 7.5589 0.6954 0.6954 0.6954 0.6954 0.6954 1.1570 0.6954 0.6954 0.6954 5.3623 0.6954 0.6954 0.6954 0.6954 0.6954 0.6954 1.1570 0.5749 0.5749 0.5749 0.6954 0.6954 4.0031 4.8830 0.6954 0.6954 0.6954 1.3271 1.3271 2.6838 0.6954 2.6838 3.0109 4.3564 5.1125 3.0109 4.3564 5.1125 3.0109 4.3564 5.1125 3.0109 4.3564 5.1125 5.1641 5.1641 5.3933 6.2350 8.2463 5.3933 6.2350 8.2463 5.3933 6.2350 8.2463 5.3933 6.2350 8.2463 5.3933 5.3933 5.3933 6.2350 8.2463 0.6954 0.6954 0.6954 0.6954 0.6954 1.3271 0.6954

119.43 0.00 361.09 361.09 33.22 33.22 33.22 33.22 33.22 55.27 33.22 33.22 33.22 256.16 33.22 33.22 33.22 33.22 33.22 33.22 55.27 27.46 27.46 27.46 33.22 33.22 191.23 233.26 33.22 33.22 33.22 63.40 63.40 128.21 33.22 128.21 143.83 208.11 244.22 143.83 208.11 244.22 143.83 208.11 244.22 143.83 208.11 244.22 246.69 246.69 257.64 297.85 393.93 257.64 297.85 393.93 257.64 297.85 393.93 257.64 297.85 393.93 257.64 257.64 257.64 297.85 393.93 33.22 33.22 33.22 33.22 33.22 63.40 33.22

272.32 0.00 823.32 823.32 75.74 75.74 75.74 75.74 75.74 126.02 75.74 75.74 75.74 584.06 75.74 75.74 75.74 75.74 75.74 75.74 126.02 62.62 62.62 62.62 75.74 75.74 436.02 531.86 75.74 75.74 75.74 144.55 144.55 292.32 75.74 292.32 327.95 474.50 556.85 327.95 474.50 556.85 327.95 474.50 556.85 327.95 474.50 556.85 562.47 562.47 587.44 679.12 898.19 587.44 679.12 898.19 587.44 679.12 898.19 587.44 679.12 898.19 587.44 587.44 587.44 679.12 898.19 75.74 75.74 75.74 75.74 75.74 144.55 75.74

312.12 0.00 943.65 943.65 86.81 86.81 86.81 86.81 86.81 144.44 86.81 86.81 86.81 669.43 86.81 86.81 86.81 86.81 86.81 86.81 144.44 71.77 71.77 71.77 86.81 86.81 499.75 609.59 86.81 86.81 86.81 165.68 165.68 335.05 86.81 335.05 375.88 543.85 638.24 375.88 543.85 638.24 375.88 543.85 638.24 375.88 543.85 638.24 644.69 644.69 673.30 778.38 1,029.47 673.30 778.38 1,029.47 673.30 778.38 1,029.47 673.30 778.38 1,029.47 673.30 673.30 673.30 778.38 1,029.47 86.81 86.81 86.81 86.81 86.81 165.68 86.81

X

X

X X

TC line SI= S; PC line SI=1 Added 1/1/07 to book

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

37 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only X X Q Q N X X X X X X S S S S S S S B X X X X X X X X X X X X X X X S S S S S S S S S S S S S S S S S S E X X S S S S S S S B X X X Q Q Q Q N Q N N Q X X X X Q X X X X Q X X X X Q X X X S S S S S S S S S S E X X X Q N X Q X X X X X Q X X X X Q X X X X S S S S S S S S S S B X X X X S S S S S S S B Q S S S N S S S S S S S S S X X Q Q N X X X X X X S S S S S S S B X X X X X X X X X X X X X X X S S S S S S S S S S S S S S S S S S 3 X X S S S S S S S B X X X Q Q Q Q N Q N N Q X X X X Q X X X X Q X X X X Q X X X S S S S S S S S S S 3 X X X Q N X Q X X X X X Q X X X X Q X X X X S S S S S S S S S S B X X X X S S S S S S S B Q S S S N S S S S S S S S S

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 63.40 33.22 128.21 256.16 0.00 33.22 33.22 33.22 55.27 33.22 33.22 143.83 208.11 244.22 246.69 257.64 297.85 393.93 0.00 33.22 33.22 33.22 55.27 55.27 33.22 33.22 33.22 33.22 33.22 55.27 33.22 55.27 55.27 55.27 143.83 208.11 244.22 143.83 208.11 244.22 143.83 208.11 244.22 257.64 297.85 257.64 297.85 257.64 297.85 393.93 393.93 393.93 M01 33.22 33.22 246.69 143.83 208.11 244.22 257.64 297.85 393.93 0.00 33.22 33.22 33.22 361.09 361.09 361.09 361.09 0.00 964.11 0.00 0.00 964.11 33.22 33.22 33.22 33.22 191.23 33.22 33.22 33.22 33.22 191.23 33.22 33.22 33.22 33.22 191.23 33.22 33.22 33.22 143.83 208.11 244.22 246.69 257.64 297.85 393.93 257.64 297.85 393.93 M01 33.22 33.22 55.27 191.23 0.00 33.22 191.23 33.22 33.22 33.22 33.22 33.22 191.23 33.22 33.22 33.22 33.22 191.23 33.22 33.22 33.22 33.22 143.83 208.11 244.22 246.69 257.64 297.85 393.93 257.64 297.85 393.93 0.00 33.22 33.22 33.22 55.27 143.83 208.11 244.22 246.69 257.64 297.85 393.93 0.00 256.16 66.09 66.09 66.09 0.00 66.09 66.09 106.15 66.09 66.09 106.15 66.09 106.15 66.09

Children's Hospital Outpatient Fee 144.55 75.74 292.32 584.06 0.00 75.74 75.74 75.74 126.02 75.74 75.74 327.95 474.50 556.85 562.47 587.44 679.12 898.19 0.00 75.74 75.74 75.74 126.02 126.02 75.74 75.74 75.74 75.74 75.74 126.02 75.74 126.02 126.02 126.02 327.95 474.50 556.85 327.95 474.50 556.85 327.95 474.50 556.85 587.44 679.12 587.44 679.12 587.44 679.12 898.19 898.19 898.19 M01 75.74 75.74 562.47 327.95 474.50 556.85 587.44 679.12 898.19 0.00 75.74 75.74 75.74 823.32 823.32 823.32 823.32 0.00 2,198.26 0.00 0.00 2,198.26 75.74 75.74 75.74 75.74 436.02 75.74 75.74 75.74 75.74 436.02 75.74 75.74 75.74 75.74 436.02 75.74 75.74 75.74 327.95 474.50 556.85 562.47 587.44 679.12 898.19 587.44 679.12 898.19 M01 75.74 75.74 126.02 436.02 0.00 75.74 436.02 75.74 75.74 75.74 75.74 75.74 436.02 75.74 75.74 75.74 75.74 436.02 75.74 75.74 75.74 75.74 327.95 474.50 556.85 562.47 587.44 679.12 898.19 587.44 679.12 898.19 0.00 75.74 75.74 75.74 126.02 327.95 474.50 556.85 562.47 587.44 679.12 898.19 0.00 584.06 150.68 150.68 150.68 0.00 150.68 150.68 242.04 150.68 150.68 242.04 150.68 242.04 150.68

Critical PDD Access Update to Hospital ACS Outpatient Fee 165.68 86.81 335.05 669.43 0.00 86.81 86.81 86.81 144.44 86.81 86.81 375.88 543.85 638.24 644.69 673.30 778.38 1,029.47 0.00 86.81 86.81 86.81 144.44 144.44 86.81 86.81 86.81 86.81 86.81 144.44 86.81 144.44 144.44 144.44 375.88 543.85 638.24 375.88 543.85 638.24 375.88 543.85 638.24 673.30 778.38 673.30 778.38 673.30 778.38 1,029.47 1,029.47 1,029.47 M01 86.81 86.81 644.69 375.88 543.85 638.24 673.30 778.38 1,029.47 0.00 86.81 86.81 86.81 943.65 943.65 943.65 943.65 0.00 2,519.56 0.00 0.00 2,519.56 86.81 86.81 86.81 86.81 499.75 86.81 86.81 86.81 86.81 499.75 86.81 86.81 86.81 86.81 499.75 86.81 86.81 86.81 375.88 543.85 638.24 644.69 673.30 778.38 1,029.47 673.30 778.38 1,029.47 M01 86.81 86.81 144.44 499.75 0.00 86.81 499.75 86.81 86.81 86.81 86.81 86.81 499.75 86.81 86.81 86.81 86.81 499.75 86.81 86.81 86.81 86.81 375.88 543.85 638.24 644.69 673.30 778.38 1,029.47 673.30 778.38 1,029.47 0.00 86.81 86.81 86.81 144.44 375.88 543.85 638.24 644.69 673.30 778.38 1,029.47 0.00 669.43 172.70 172.70 172.70 0.00 172.70 172.70 277.42 172.70 172.70 277.42 172.70 277.42 172.70

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

71034 71035 71040 71060 71090 71100 71101 71110 71111 71120 71130 71250 71260 71270 71275 71550 71551 71552 71555 72010 72020 72040 72050 72052 72069 72070 72072 72074 72080 72090 72100 72110 72114 72120 72125 72126 72127 72128 72129 72130 72131 72132 72133 72141 72142 72146 72147 72148 72149 72156 72157 72158 72159 72170 72190 72191 72192 72193 72194 72195 72196 72197 72198 72200 72202 72220 72240 72255 72265 72270 72275 72285 72291 72292 72295 73000 73010 73020 73030 73040 73050 73060 73070 73080 73085 73090 73092 73100 73110 73115 73120 73130 73140 73200 73201 73202 73206 73218 73219 73220 73221 73222 73223 73225 73500 73510 73520 73525 73530 73540 73542 73550 73560 73562 73564 73565 73580 73590 73592 73600 73610 73615 73620 73630 73650 73660 73700 73701 73702 73706 73718 73719 73720 73721 73722 73723 73725 74000 74010 74020 74022 74150 74160 74170 74175 74181 74182 74183 74185 74190 74210 74220 74230 74235 74240 74241 74245 74246 74247 74249 74250 74251 74260

Chest x-ray and fluoroscopy Chest x-ray Contrast x-ray of bronchi Contrast x-ray of bronchi X-ray & pacemaker insertion X-ray exam of ribs X-ray exam of ribs/chest X-ray exam of ribs X-ray exam of ribs/chest X-ray exam of breastbone X-ray exam of breastbone Ct thorax w/o dye Ct thorax w/dye Ct thorax w/o & w/dye Ct angiography, chest Mri chest w/o dye Mri chest w/dye Mri chest w/o & w/dye Mri angio chest w or w/o dye X-ray exam of spine X-ray exam of spine X-ray exam of neck spine X-ray exam of neck spine X-ray exam of neck spine X-ray exam of trunk spine X-ray exam of thoracic spine X-ray exam of thoracic spine X-ray exam of thoracic spine X-ray exam of trunk spine X-ray exam of trunk spine X-ray exam of lower spine X-ray exam of lower spine X-ray exam of lower spine X-ray exam of lower spine Ct neck spine w/o dye Ct neck spine w/dye Ct neck spine w/o & w/dye Ct chest spine w/o dye Ct chest spine w/dye Ct chest spine w/o & w/dye Ct lumbar spine w/o dye Ct lumbar spine w/dye Ct lumbar spine w/o & w/dye Mri neck spine w/o dye Mri neck spine w/dye Mri chest spine w/o dye Mri chest spine w/dye Mri lumbar spine w/o dye Mri lumbar spine w/dye Mri neck spine w/o & w/dye Mri chest spine w/o & w/dye Mri lumbar spine w/o & w/dye Mr angio spine w/o&w/dye X-ray exam of pelvis X-ray exam of pelvis Ct angiograph pelv w/o&w/dye Ct pelvis w/o dye Ct pelvis w/dye Ct pelvis w/o & w/dye Mri pelvis w/o dye Mri pelvis w/dye Mri pelvis w/o & w/dye Mr angio pelvis w/o & w/dye X-ray exam sacroiliac joints X-ray exam sacroiliac joints X-ray exam of tailbone Contrast x-ray of neck spine Contrast x-ray, thorax spine Contrast x-ray, lower spine Contrast x-ray, spine Epidurography X-ray c/t spine disk Perq vertebroplasty, fluor Perq vertebroplasty, ct X-ray of lower spine disk X-ray exam of collar bone X-ray exam of shoulder blade X-ray exam of shoulder X-ray exam of shoulder Contrast x-ray of shoulder X-ray exam of shoulders X-ray exam of humerus X-ray exam of elbow X-ray exam of elbow Contrast x-ray of elbow X-ray exam of forearm X-ray exam of arm, infant X-ray exam of wrist X-ray exam of wrist Contrast x-ray of wrist X-ray exam of hand X-ray exam of hand X-ray exam of finger(s) Ct upper extremity w/o dye Ct upper extremity w/dye Ct uppr extremity w/o&w/dye Ct angio upr extrm w/o&w/dye Mri upper extremity w/o dye Mri upper extremity w/dye Mri uppr extremity w/o&w/dye Mri joint upr extrem w/o dye Mri joint upr extrem w/dye Mri joint upr extr w/o&w/dye Mr angio upr extr w/o&w/dye X-ray exam of hip X-ray exam of hip X-ray exam of hips Contrast x-ray of hip X-ray exam of hip X-ray exam of pelvis & hips X-ray exam, sacroiliac joint X-ray exam of thigh X-ray exam of knee, 1 or 2 X-ray exam of knee, 3 X-ray exam, knee, 4 or more X-ray exam of knees Contrast x-ray of knee joint X-ray exam of lower leg X-ray exam of leg, infant X-ray exam of ankle X-ray exam of ankle Contrast x-ray of ankle X-ray exam of foot X-ray exam of foot X-ray exam of heel X-ray exam of toe(s) Ct lower extremity w/o dye Ct lower extremity w/dye Ct lwr extremity w/o&w/dye Ct angio lwr extr w/o&w/dye Mri lower extremity w/o dye Mri lower extremity w/dye Mri lwr extremity w/o&w/dye Mri jnt of lwr extre w/o dye Mri joint of lwr extr w/dye Mri joint lwr extr w/o&w/dye Mr ang lwr ext w or w/o dye X-ray exam of abdomen X-ray exam of abdomen X-ray exam of abdomen X-ray exam series, abdomen Ct abdomen w/o dye Ct abdomen w/dye Ct abdomen w/o & w/dye Ct angio abdom w/o & w/dye Mri abdomen w/o dye Mri abdomen w/dye Mri abdomen w/o & w/dye Mri angio, abdom w orw/o dye X-ray exam of peritoneum Contrst x-ray exam of throat Contrast x-ray, esophagus Cine/vid x-ray, throat/esoph Remove esophagus obstruction X-ray exam, upper gi tract X-ray exam, upper gi tract X-ray exam, upper gi tract Contrst x-ray uppr gi tract Contrst x-ray uppr gi tract Contrst x-ray uppr gi tract X-ray exam of small bowel X-ray exam of small bowel X-ray exam of small bowel

0272 0260 0263 0317 0000 0260 0260 0260 0261 0260 0260 0332 0283 0333 0662 0336 0284 0337 0000 0260 0260 0260 0261 0261 0260 0260 0260 0260 0260 0261 0260 0261 0261 0261 0332 0283 0333 0332 0283 0333 0332 0283 0333 0336 0284 0336 0284 0336 0284 0337 0337 0337 0000 0260 0260 0662 0332 0283 0333 0336 0284 0337 0000 0260 0260 0260 0274 0274 0274 0274 0000 0388 0000 0000 0388 0260 0260 0260 0260 0275 0260 0260 0260 0260 0275 0260 0260 0260 0260 0275 0260 0260 0260 0332 0283 0333 0662 0336 0284 0337 0336 0284 0337 0000 0260 0260 0261 0275 0000 0260 0275 0260 0260 0260 0260 0260 0275 0260 0260 0260 0260 0275 0260 0260 0260 0260 0332 0283 0333 0662 0336 0284 0337 0336 0284 0337 0000 0260 0260 0260 0261 0332 0283 0333 0662 0336 0284 0337 0000 0317 0276 0276 0276 0000 0276 0276 0277 0276 0276 0277 0276 0277 0276

1.3271 0.6954 2.6838 5.3623 0.0000 0.6954 0.6954 0.6954 1.1570 0.6954 0.6954 3.0109 4.3564 5.1125 5.1641 5.3933 6.2350 8.2463 0.0000 0.6954 0.6954 0.6954 1.1570 1.1570 0.6954 0.6954 0.6954 0.6954 0.6954 1.1570 0.6954 1.1570 1.1570 1.1570 3.0109 4.3564 5.1125 3.0109 4.3564 5.1125 3.0109 4.3564 5.1125 5.3933 6.2350 5.3933 6.2350 5.3933 6.2350 8.2463 8.2463 8.2463 0.0000 0.6954 0.6954 5.1641 3.0109 4.3564 5.1125 5.3933 6.2350 8.2463 0.0000 0.6954 0.6954 0.6954 7.5589 7.5589 7.5589 7.5589 0.0000 20.1823 0.0000 0.0000 20.1823 0.6954 0.6954 0.6954 0.6954 4.0031 0.6954 0.6954 0.6954 0.6954 4.0031 0.6954 0.6954 0.6954 0.6954 4.0031 0.6954 0.6954 0.6954 3.0109 4.3564 5.1125 5.1641 5.3933 6.2350 8.2463 5.3933 6.2350 8.2463 0.0000 0.6954 0.6954 1.1570 4.0031 0.0000 0.6954 4.0031 0.6954 0.6954 0.6954 0.6954 0.6954 4.0031 0.6954 0.6954 0.6954 0.6954 4.0031 0.6954 0.6954 0.6954 0.6954 3.0109 4.3564 5.1125 5.1641 5.3933 6.2350 8.2463 5.3933 6.2350 8.2463 0.0000 0.6954 0.6954 0.6954 1.1570 3.0109 4.3564 5.1125 5.1641 5.3933 6.2350 8.2463 0.0000 5.3623 1.3834 1.3834 1.3834 0.0000 1.3834 1.3834 2.2222 1.3834 1.3834 2.2222 1.3834 2.2222 1.3834

X X X

Added 1/1/07 to book Added 1/1/07 to book

X X X X X X X X X

X

X

X

X X X

X

X

X

X

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

38 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only S S S S S N N N Q N N N N N N N N S S S S Q Q Q Q Q Q Q Q Q Q X Q N S S S S S S N N N Q N N N N N N N N S S S S Q Q Q Q Q Q Q Q Q Q X Q N S

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 66.09 106.15 66.09 66.09 66.09 0.00 0.00 0.00 256.16 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 124.78 124.78 124.78 124.78 124.78 124.78 124.78 124.78 124.78 124.78 128.21 256.16 256.16 256.16 55.27 128.21 0.00 124.78

Children's Hospital Outpatient Fee 150.68 242.04 150.68 150.68 150.68 0.00 0.00 0.00 584.06 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 284.51 284.51 284.51 284.51 284.51 284.51 284.51 284.51 284.51 284.51 292.32 584.06 584.06 584.06 126.02 292.32 0.00 284.51

Critical PDD Access Update to Hospital ACS Outpatient Fee 172.70 277.42 172.70 172.70 172.70 0.00 0.00 0.00 669.43 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 326.09 326.09 326.09 326.09 326.09 326.09 326.09 326.09 326.09 326.09 335.05 669.43 669.43 669.43 144.44 335.05 0.00 326.09

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

74270 74280 74283 74290 74291 74300 74301 74305 74320 74327 74328 74329 74330 74340 74355 74360 74363 74400 74410 74415 74420 74425 74430 74440 74445 74450 74455 74470 74475 74480 74485 74710 74740 74742 74775

Contrast x-ray exam of colon Contrast x-ray exam of colon Contrast x-ray exam of colon Contrast x-ray, gallbladder Contrast x-rays, gallbladder X-ray bile ducts/pancreas X-rays at surgery add-on X-ray bile ducts/pancreas Contrast x-ray of bile ducts X-ray bile stone removal X-ray bile duct endoscopy X-ray for pancreas endoscopy X-ray bile/panc endoscopy X-ray guide for GI tube X-ray guide, intestinal tube X-ray guide, GI dilation X-ray, bile duct dilation Contrst x-ray, urinary tract Contrst x-ray, urinary tract Contrst x-ray, urinary tract Contrst x-ray, urinary tract Contrst x-ray, urinary tract Contrast x-ray, bladder X-ray, male genital tract X-ray exam of penis X-ray, urethra/bladder X-ray, urethra/bladder X-ray exam of kidney lesion X-ray control, cath insert X-ray control, cath insert X-ray guide, GU dilation X-ray measurement of pelvis X-ray, female genital tract X-ray, fallopian tube X-ray exam of perineum

0276 0277 0276 0276 0276 0000 0000 0000 0317 0000 0000 0000 0000 0000 0000 0000 0000 0278 0278 0278 0278 0278 0278 0278 0278 0278 0278 0263 0317 0317 0317 0261 0263 0000 0278

1.3834 2.2222 1.3834 1.3834 1.3834 0.0000 0.0000 0.0000 5.3623 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 2.6121 2.6121 2.6121 2.6121 2.6121 2.6121 2.6121 2.6121 2.6121 2.6121 2.6838 5.3623 5.3623 5.3623 1.1570 2.6838 0.0000 2.6121

X X X X X

X X X X

X X X X X X X X X X X X

75557 75558 75559 75560 75561 75562 75563 75564 75600 75605 75625 75630 75635 75650 75658 75660 75662 75665 75671 75676 75680 75685 75705 75710 75716 75722 75724 75726 75731 75733 75736 75741 75743 75746 75756 75774 75790 75801 75803 75805 75807 75809 75810 75820 75822 75825 75827 75831 75833 75840 75842 75860 75870 75872 75880 75885 75887 75889 75891 75893 75894 75896 75898 75900 75901 75902 75940 75945 75946 75952 75953 75954 75956 75957 75958 75959 75960 75961 75962 75964 75966 75968 75970 75978 75980 75982 75984 75989 75992 75993 75994 75995 75996 76000 76001 76010 76080 76098 76100 76101 76102 76120 76125 76140 76150 76350 76376 76377 76380 76390

Cardiac mri for morph Cardiac mri flow/velocity Cardiac mri w/stress img Cardiac mri flow/vel/stress Cardiac mri for morph w/dye Card mri flow/vel w/dye Card mri w/stress img & dye Ht mri w/flo/vel/strs & dye Contrast x-ray exam of aorta Contrast x-ray exam of aorta Contrast x-ray exam of aorta X-ray aorta, leg arteries Ct angio abdominal arteries Artery x-rays, head & neck Artery x-rays, arm Artery x-rays, head & neck Artery x-rays, head & neck Artery x-rays, head & neck Artery x-rays, head & neck Artery x-rays, neck Artery x-rays, neck Artery x-rays, spine Artery x-rays, spine Artery x-rays, arm/leg Artery x-rays, arms/legs Artery x-rays, kidney Artery x-rays, kidneys Artery x-rays, abdomen Artery x-rays, adrenal gland Artery x-rays, adrenals Artery x-rays, pelvis Artery x-rays, lung Artery x-rays, lungs Artery x-rays, lung Artery x-rays, chest Artery x-ray, each vessel Visualize A-V shunt Lymph vessel x-ray, arm/leg Lymph vessel x-ray,arms/legs Lymph vessel x-ray, trunk Lymph vessel x-ray, trunk Nonvascular shunt, x-ray Vein x-ray, spleen/liver Vein x-ray, arm/leg Vein x-ray, arms/legs Vein x-ray, trunk Vein x-ray, chest Vein x-ray, kidney Vein x-ray, kidneys Vein x-ray, adrenal gland Vein x-ray, adrenal glands Vein x-ray, neck Vein x-ray, skull Vein x-ray, skull Vein x-ray, eye socket Vein x-ray, liver Vein x-ray, liver Vein x-ray, liver Vein x-ray, liver Venous sampling by catheter X-rays, transcath therapy X-rays, transcath therapy Follow-up angiography Arterial catheter exchange Remove cva device obstruct Remove cva lumen obstruct X-ray placement, vein filter Intravascular us Intravascular us add-on Endovasc repair abdom aorta Abdom aneurysm endovas rpr Iliac aneurysm endovas rpr Xray, endovasc thor ao repr Xray, endovasc thor ao repr Xray, place prox ext thor ao Xray, place dist ext thor ao Transcath iv stent rs&i Retrieval, broken catheter Repair arterial blockage Repair artery blockage, each Repair arterial blockage Repair artery blockage, each Vascular biopsy Repair venous blockage Contrast xray exam bile duct Contrast xray exam bile duct Xray control catheter change Abscess drainage under x-ray Atherectomy, x-ray exam Atherectomy, x-ray exam Atherectomy, x-ray exam Atherectomy, x-ray exam Atherectomy, x-ray exam Fluoroscope examination Fluoroscope exam, extensive X-ray, nose to rectum X-ray exam of fistula X-ray exam, breast specimen X-ray exam of body section Complex body section x-ray Complex body section x-rays Cine/video x-rays Cine/video x-rays add-on X-ray consultation X-ray exam, dry process Special x-ray contrast study 3d render w/o postprocess 3d rendering w/postprocess CAT scan follow-up study Mr spectroscopy

S E S E S E S E Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q N Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q N N Q C N N N Q N C C C C C C C N N Q N Q N N Q N N N N N N N N N Q N X Q X X X X X N E X N N N S E

S 1 S 1 S 1 S 1 Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q N Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q N N Q C N N N Q N C C C C C C C N N Q N Q N N Q N N N N N N N N N Q N X Q X X X X X N 1 X N N N S 3

0336 0000 0336 0000 0337 0000 0337 0000 0279 0279 0279 0279 0662 0280 0279 0280 0280 0279 0280 0279 0279 0279 0279 0279 0279 0279 0279 0279 0279 0279 0279 0279 0279 0668 0668 0000 0668 0317 0317 0317 0317 0263 0279 0668 0668 0279 0668 0279 0279 0279 0279 0668 0668 0668 0668 0279 0668 0279 0279 0279 0000 0000 0263 0000 0000 0000 0000 0267 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0083 0000 0083 0000 0000 0083 0000 0000 0000 0000 0000 0000 0000 0000 0000 0272 0000 0260 0263 0260 0261 0263 0263 0272 0000 0000 0260 0000 0000 0000 0282 0000

5.3933 0.0000 5.3933 0.0000 8.2463 0.0000 8.2463 0.0000 28.8788 28.8788 28.8788 28.8788 5.1641 44.7114 28.8788 44.7114 44.7114 28.8788 44.7114 28.8788 28.8788 28.8788 28.8788 28.8788 28.8788 28.8788 28.8788 28.8788 28.8788 28.8788 28.8788 28.8788 28.8788 9.3506 9.3506 0.0000 9.3506 5.3623 5.3623 5.3623 5.3623 2.6838 28.8788 9.3506 9.3506 28.8788 9.3506 28.8788 28.8788 28.8788 28.8788 9.3506 9.3506 9.3506 9.3506 28.8788 9.3506 28.8788 28.8788 28.8788 0.0000 0.0000 2.6838 0.0000 0.0000 0.0000 0.0000 2.3792 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 45.3845 0.0000 45.3845 0.0000 0.0000 45.3845 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 1.3271 0.0000 0.6954 2.6838 0.6954 1.1570 2.6838 2.6838 1.3271 0.0000 0.0000 0.6954 0.0000 0.0000 0.0000 1.5839 0.0000

257.64 0.00 257.64 0.00 393.93 0.00 393.93 0.00 1,379.54 1,379.54 1,379.54 1,379.54 246.69 2,135.86 1,379.54 2,135.86 2,135.86 1,379.54 2,135.86 1,379.54 1,379.54 1,379.54 1,379.54 1,379.54 1,379.54 1,379.54 1,379.54 1,379.54 1,379.54 1,379.54 1,379.54 1,379.54 1,379.54 446.68 446.68 0.00 446.68 256.16 256.16 256.16 256.16 128.21 1,379.54 446.68 446.68 1,379.54 446.68 1,379.54 1,379.54 1,379.54 1,379.54 446.68 446.68 446.68 446.68 1,379.54 446.68 1,379.54 1,379.54 1,379.54 0.00 0.00 128.21 0.00 0.00 0.00 0.00 113.65 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2,168.02 0.00 2,168.02 0.00 0.00 2,168.02 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 63.40 0.00 33.22 128.21 33.22 55.27 128.21 128.21 63.40 0.00 0.00 33.22 0.00 0.00 0.00 75.66 M01

587.44 0.00 587.44 0.00 898.19 0.00 898.19 0.00 3,145.48 3,145.48 3,145.48 3,145.48 562.47 4,869.97 3,145.48 4,869.97 4,869.97 3,145.48 4,869.97 3,145.48 3,145.48 3,145.48 3,145.48 3,145.48 3,145.48 3,145.48 3,145.48 3,145.48 3,145.48 3,145.48 3,145.48 3,145.48 3,145.48 1,018.47 1,018.47 0.00 1,018.47 584.06 584.06 584.06 584.06 292.32 3,145.48 1,018.47 1,018.47 3,145.48 1,018.47 3,145.48 3,145.48 3,145.48 3,145.48 1,018.47 1,018.47 1,018.47 1,018.47 3,145.48 1,018.47 3,145.48 3,145.48 3,145.48 0.00 0.00 292.32 0.00 0.00 0.00 0.00 259.14 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 4,943.28 0.00 4,943.28 0.00 0.00 4,943.28 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 144.55 0.00 75.74 292.32 75.74 126.02 292.32 292.32 144.55 0.00 0.00 75.74 0.00 0.00 0.00 172.52 M01

673.30 0.00 673.30 0.00 1,029.47 0.00 1,029.47 0.00 3,605.23 3,605.23 3,605.23 3,605.23 644.69 5,581.77 3,605.23 5,581.77 5,581.77 3,605.23 5,581.77 3,605.23 3,605.23 3,605.23 3,605.23 3,605.23 3,605.23 3,605.23 3,605.23 3,605.23 3,605.23 3,605.23 3,605.23 3,605.23 3,605.23 1,167.33 1,167.33 0.00 1,167.33 669.43 669.43 669.43 669.43 335.05 3,605.23 1,167.33 1,167.33 3,605.23 1,167.33 3,605.23 3,605.23 3,605.23 3,605.23 1,167.33 1,167.33 1,167.33 1,167.33 3,605.23 1,167.33 3,605.23 3,605.23 3,605.23 0.00 0.00 335.05 0.00 0.00 0.00 0.00 297.02 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 5,665.80 0.00 5,665.80 0.00 0.00 5,665.80 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 165.68 0.00 86.81 335.05 86.81 144.44 335.05 335.05 165.68 0.00 0.00 86.81 0.00 0.00 0.00 197.73 M01

X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X SI change 1/1/07 (TR 1155) X X X X X X X X

X X X X X X X X X X X X X X X X X

X

X

X X

76496

Fluoroscopic procedure

X

X

0272

1.3271

63.40

144.55

165.68

SI= X, effect. 05/01/06 If needed add 282N Taxonomy SI= S, effect. 05/01/06 If needed add 282N Taxonomy SI= S, effect. 05/01/06 If needed add 282N Taxonomy SI= X, effect. 05/01/06 If needed add 282N Taxonomy

76497

Ct procedure

S

S

0282

1.5839

75.66

172.52

197.73

76498

Mri procedure

S

S

0335

4.8830

233.26

531.86

609.59

76499

Radiographic procedure

X

X

0260

0.6954

33.22

75.74

86.81

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

39 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only S T S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S N N N N N N N N N N N N S Q X N S T S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S N N N N N N N N N N N N S Q X N

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 45.72 244.43 72.10 72.10 72.10 28.20 45.72 72.10 45.72 72.10 45.72 45.72 72.10 72.10 72.10 72.10 72.10 72.10 72.10 45.72 72.10 72.10 113.65 45.72 72.10 45.72 45.72 45.72 45.72 72.10 72.10 70.17 70.17 72.10 45.72 45.72 45.72 72.10 113.65 72.10 45.72 72.10 72.10 72.10 72.10 45.72 45.72 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 45.72 113.65 30.14 0.00

Children's Hospital Outpatient Fee 104.24 557.33 164.40 164.40 164.40 64.30 104.24 164.40 104.24 164.40 104.24 104.24 164.40 164.40 164.40 164.40 164.40 164.40 164.40 104.24 164.40 164.40 259.14 104.24 164.40 104.24 104.24 104.24 104.24 164.40 164.40 159.99 159.99 164.40 104.24 104.24 104.24 164.40 259.14 164.40 104.24 164.40 164.40 164.40 164.40 104.24 104.24 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 104.24 259.14 68.73 0.00

Critical PDD Access Update to Hospital ACS Outpatient Fee 119.47 638.79 188.43 188.43 188.43 73.69 119.47 188.43 119.47 188.43 119.47 119.47 188.43 188.43 188.43 188.43 188.43 188.43 188.43 119.47 188.43 188.43 297.02 119.47 188.43 119.47 119.47 119.47 119.47 188.43 188.43 183.38 183.38 188.43 119.47 119.47 119.47 188.43 297.02 188.43 119.47 188.43 188.43 188.43 188.43 119.47 119.47 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 119.47 297.02 78.77 0.00

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

76506 76510 76511 76512 76513 76514 76516 76519 76529 76536 76604 76645 76700 76705 76770 76775 76776 76800 76801 76802 76805 76810 76811 76812 76813 76814 76815 76816 76817 76818 76819 76820 76821 76825 76826 76827 76828 76830 76831 76856 76857 76870 76872 76873 76880 76885 76886 76930 76932 76936 76937 76940 76941 76942 76945 76946 76948 76950 76965 76970 76975 76977 76998

Echo exam of head Ophth us, b & quant a Ophth us, quant a only Ophth us, b w/non-quant a Echo exam of eye, water bath Echo exam of eye, thickness Echo exam of eye Echo exam of eye Echo exam of eye Us exam of head and neck Us exam, chest, b-scan Us exam, breast(s) Us exam, abdom, complete Echo exam of abdomen Us exam abdo back wall, comp Us exam abdo back wall, lim Us exam k transpl w/doppler Us exam, spinal canal Ob us < 14 wks, single fetus Ob us < 14 wks, add’l fetus Ob us >/= 14 wks, sngl fetus Ob us >/= 14 wks, addl fetus Ob us, detailed, sngl fetus Ob us, detailed, addl fetus Ob us nuchal meas, 1 gest Ob us nuchal meas, add-on Ob us, limited, fetus(s) Ob us, follow-up, per fetus Transvaginal us, obstetric Fetal biophys profile w/nst Fetal biophys profil w/o nst Umbilical artery echo Middle cerebral artery echo Echo exam of fetal heart Echo exam of fetal heart Echo exam of fetal heart Echo exam of fetal heart Transvaginal us, non-ob Echo exam, uterus Us exam, pelvic, complete Us exam, pelvic, limited Us exam, scrotum Us, transrectal Echograp trans r, pros study Us exam, extremity Us exam infant hips, dynamic Us exam infant hips, static Echo guide, cardiocentesis Echo guide for heart biopsy Echo guide for artery repair Us guide, vascular access Us guide, tissue ablation Echo guide for transfusion Echo guide for biopsy Echo guide, villus sampling Echo guide for amniocentesis Echo guide, ova aspiration Echo guidance radiotherapy Echo guidance radiotherapy Ultrasound exam follow-up GI endoscopic ultrasound Us bone density measure Us guide, intraop

0265 0232 0266 0266 0266 0230 0265 0266 0265 0266 0265 0265 0266 0266 0266 0266 0266 0266 0266 0265 0266 0266 0267 0265 0266 0265 0265 0265 0265 0266 0266 0096 0096 0266 0265 0265 0265 0266 0267 0266 0265 0266 0266 0266 0266 0265 0265 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0265 0267 0340 0000

0.9570 5.1169 1.5094 1.5094 1.5094 0.5903 0.9570 1.5094 0.9570 1.5094 0.9570 0.9570 1.5094 1.5094 1.5094 1.5094 1.5094 1.5094 1.5094 0.9570 1.5094 1.5094 2.3792 0.9570 1.5094 0.9570 0.9570 0.9570 0.9570 1.5094 1.5094 1.4689 1.4689 1.5094 0.9570 0.9570 0.9570 1.5094 2.3792 1.5094 0.9570 1.5094 1.5094 1.5094 1.5094 0.9570 0.9570 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.9570 2.3792 0.6310 0.0000

X

X

TC line SI= S; PC line SI=1

Added 1/1/07 to book TC line SI= S; PC line SI=1

X X X X X X X X X X X X Added 1/1/07 to book SI= S, effect. 05/01/06 If needed add 282N Taxonomy TC line SI=N; PC line SI=1 TC line SI=N; PC line SI=1 TC line SI=N; PC line SI=1 TC line SI= S; PC line SI=1 TC line SI= S; PC line SI=1 Added 1/1/07 to book TC line SI= S; PC line SI=1 TC line SI= S; PC line SI=1 Added 1/1/07 to book TC line SI= X; PC line SI=1 TC line SI= X; PC line SI=1 TC line SI=3;PC line SI=1 TC line SI=3;PC line SI=1 TC line SI=3;PC line SI=1 TC line SI= X; PC line SI=1 TC line SI=3;PC line SI=1 TC line SI=3;PC line SI=1 TC line SI=3;PC line SI=1 TC line SI=B;PC line SI=1 TC line SI=B;PC line SI=1 Added 1/1/07 to book TC line SI=X; PC line SI=1 TC line SI=X; PC line SI=1 TC line SI=X; PC line SI=1 TC line SI=X; PC line SI=1 TC line SI=X; PC line SI=1 TC line SI=X; PC line SI=1 TC line SI=S; PC line SI=1 TC line SI=S; PC line SI=1 TC line SI=S; PC line SI=1 TC line SI=S; PC line SI=1 TC line SI=X; PC line SI=1 TC line SI=X; PC line SI=1 TC line SI=S; PC line SI=1 X

76999 77001 77002 77003 77011 77012 77013 77014 77021 77022 77031 77032 77051 77052 77053 77054 77055 77056 77057 77058 77059 77071 77072 77073 77074 77075 77076 77077 77078 77079 77080 77081 77082 77083 77084 77261 77262 77263 77280 77285 77290 77295

Echo examination procedure Fluoroguide for vein device Needle localization by xray Fluoroguide for spine inject Ct scan for localization Ct scan for needle biopsy Ct guide for tissue ablation Ct scan for therapy guide Mr guidance for needle place Mri for tissue ablation Stereotact guide for brst bx Guidance for needle, breast Computer dx mammogram add-on Comp screen mammogram add-on X-ray of mammary duct X-ray of mammary ducts Mammogram, one breast Mammogram, both breasts Mammogram, screening Mri, one breast Mri, both breasts X-ray stress view X-rays for bone age X-rays, bone length studies X-rays, bone survey, limited X-rays, bone survey complete X-rays, bone survey, infant Joint survey, single view Ct bone density, axial Ct bone density, peripheral Dxa bone density, axial Dxa bone density/peripheral Dxa bone density, vert fx Radiographic absorptiometry Magnetic image, bone marrow Radiation therapy planning Radiation therapy planning Radiation therapy planning Set radiation therapy field Set radiation therapy field Set radiation therapy field Set radiation therapy field

S N N N N N N N N N N N A A Q Q A A A B B X X X X X X X S S S S X X S B B B X X X X

S N N N N N N N N N N N 3 3 Q Q 3 3 3 B B X X X X X X X S S S S X X S B B B X X X X

0265 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0263 0263 0000 0000 0000 0000 0000 0260 0260 0260 0261 0261 0260 0260 0288 0282 0288 0665 0260 0261 0335 0000 0000 0000 0304 0305 0305 0310

0.9570 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 2.6838 2.6838 0.0000 0.0000 0.0000 0.0000 0.0000 0.6954 0.6954 0.6954 1.1570 1.1570 0.6954 0.6954 1.1384 1.5839 1.1384 0.5087 0.6954 1.1570 4.8830 0.0000 0.0000 0.0000 1.5576 3.9276 3.9276 13.5621

45.72 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 128.21 128.21 M01 M01 M01 0.00 0.00 33.22 33.22 33.22 55.27 55.27 33.22 33.22 54.38 75.66 54.38 24.30 33.22 55.27 233.26 0.00 0.00 0.00 74.41 187.62 187.62 647.86

104.24 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 292.32 292.32 M01 M01 M01 0.00 0.00 75.74 75.74 75.74 126.02 126.02 75.74 75.74 123.99 172.52 123.99 55.41 75.74 126.02 531.86 0.00 0.00 0.00 169.65 427.79 427.79 1,477.18

119.47 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 335.05 335.05 M01 M01 M01 0.00 0.00 86.81 86.81 86.81 144.44 144.44 86.81 86.81 142.12 197.73 142.12 63.51 86.81 144.44 609.59 0.00 0.00 0.00 194.45 490.32 490.32 1,693.09

X X X X X X X X

X X

77299 77300 77301 77305 77310 77315 77321 77326 77327 77328 77331 77332 77333 77334 77336 77370 77371 77372 77373

Radiation therapy planning Radiation therapy dose plan Radiotherapy dose plan, imrt Teletx isodose plan simple Teletx isodose plan intermed Teletx isodose plan complex Special teletx port plan Brachytx isodose calc simp Brachytx isodose calc interm Brachytx isodose plan compl Special radiation dosimetry Radiation treatment aid(s) Radiation treatment aid(s) Radiation treatment aid(s) Radiation physics consult Radiation physics consult Srs, multisource Srs, linear based Sbrt delivery

X X X X X X X X X X X X X X X X S B B

X X X X X X X X X X X X X X X X S B B

0304 0304 0310 0304 0305 0305 0305 0304 0305 0305 0304 0303 0303 0303 0304 0304 0127 0000 0000

1.5576 1.5576 13.5621 1.5576 3.9276 3.9276 3.9276 1.5576 3.9276 3.9276 1.5576 2.8878 2.8878 2.8878 1.5576 1.5576 126.4653 0.0000 0.0000

74.41 74.41 647.86 74.41 187.62 187.62 187.62 74.41 187.62 187.62 74.41 137.95 137.95 137.95 74.41 74.41 6,041.25 0.00 0.00

169.65 169.65 1,477.18 169.65 427.79 427.79 427.79 169.65 427.79 427.79 169.65 314.54 314.54 314.54 169.65 169.65 13,774.60 0.00 0.00

194.45 194.45 1,693.09 194.45 490.32 490.32 490.32 194.45 490.32 490.32 194.45 360.51 360.51 360.51 194.45 194.45 15,787.93 0.00 0.00

SI= X, effect. 05/01/06 If needed add 282N Taxonomy

Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book SI= X, effect. 05/01/06 If needed add 282N Taxonomy

77399 77401 77402 77403 77404 77406 77407 77408 77409 77411 77412 77413 77414 77416 77417 77418 77421 77422 77423 77427 77431 77432 77435 77470

External radiation dosimetry Radiation treatment delivery Radiation treatment delivery Radiation treatment delivery Radiation treatment delivery Radiation treatment delivery Radiation treatment delivery Radiation treatment delivery Radiation treatment delivery Radiation treatment delivery Radiation treatment delivery Radiation treatment delivery Radiation treatment delivery Radiation treatment delivery Radiology port film(s) Radiation tx delivery, imrt Stereoscopic x-ray guidance Neutron beam tx, simple Neutron beam tx, complex Radiation tx management, x5 Radiation therapy management Stereotactic radiation trmt Sbrt management Special radiation treatment

X S S S S S S S S S S S S S N S N S S B B B N S

X S S S S S S S S S S S S S N S N S S B B B N S

0304 0300 0300 0300 0300 0300 0300 0300 0300 0301 0301 0301 0301 0301 0000 0412 0000 0301 0301 0000 0000 0000 0000 0299

1.5576 1.4229 1.4229 1.4229 1.4229 1.4229 1.4229 1.4229 1.4229 2.2167 2.2167 2.2167 2.2167 2.2167 0.0000 5.4582 0.0000 2.2167 2.2167 0.0000 0.0000 0.0000 0.0000 5.7996

74.41 67.97 67.97 67.97 67.97 67.97 67.97 67.97 67.97 105.89 105.89 105.89 105.89 105.89 0.00 260.74 0.00 105.89 105.89 0.00 0.00 0.00 0.00 277.05

169.65 154.98 154.98 154.98 154.98 154.98 154.98 154.98 154.98 241.44 241.44 241.44 241.44 241.44 0.00 594.51 0.00 241.44 241.44 0.00 0.00 0.00 0.00 631.69

194.45 177.63 177.63 177.63 177.63 177.63 177.63 177.63 177.63 276.73 276.73 276.73 276.73 276.73 0.00 681.40 0.00 276.73 276.73 0.00 0.00 0.00 0.00 724.02

X X

Added 1/1/07 to book

77499 77520 77522 77523 77525 77600 77605

Radiation therapy management Proton trmt, simple w/o comp Proton trmt, simple w/comp Proton trmt, intermediate Proton treatment, complex Hyperthermia treatment Hyperthermia treatment

B S S S S S S

B S S S S S S

0000 0664 0664 0667 0667 0299 0299

0.0000 12.8205 12.8205 15.3404 15.3404 5.7996 5.7996

0.00 612.44 612.44 732.81 732.81 277.05 277.05

0.00 1,396.41 1,396.41 1,670.88 1,670.88 631.69 631.69

0.00 1,600.51 1,600.51 1,915.10 1,915.10 724.02 724.02

SI= B, effect. 05/01/06 If needed add 282N Taxonomy

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

40 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only S S S S S S S S S Q S S S S S N S S S S S S S S S Q S S S S S N

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 277.05 277.05 277.05 105.89 406.71 406.71 406.71 406.71 406.71 865.73 557.85 557.85 557.85 557.85 67.97 0.00

Children's Hospital Outpatient Fee 631.69 631.69 631.69 241.44 927.34 927.34 927.34 927.34 927.34 1,973.94 1,271.96 1,271.96 1,271.96 1,271.96 154.98 0.00

Critical PDD Access Update to Hospital ACS Outpatient Fee 724.02 724.02 724.02 276.73 1,062.89 1,062.89 1,062.89 1,062.89 1,062.89 2,262.45 1,457.87 1,457.87 1,457.87 1,457.87 177.63 0.00

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

77610 77615 77620 77750 77761 77762 77763 77776 77777 77778 77781 77782 77783 77784 77789 77790

Hyperthermia treatment Hyperthermia treatment Hyperthermia treatment Infuse radioactive materials Apply intrcav radiat simple Apply intrcav radiat interm Apply intrcav radiat compl Apply interstit radiat simpl Apply interstit radiat inter Apply interstit radiat compl High intensity brachytherapy High intensity brachytherapy High intensity brachytherapy High intensity brachytherapy Apply surface radiation Radiation handling

0299 0299 0299 0301 0312 0312 0312 0312 0312 0651 0313 0313 0313 0313 0300 0000

5.7996 5.7996 5.7996 2.2167 8.5140 8.5140 8.5140 8.5140 8.5140 18.1228 11.6779 11.6779 11.6779 11.6779 1.4229 0.0000

X

77799 78000 78001 78003 78006 78007 78010 78011 78015 78016 78018 78020 78070 78075

Radium/radioisotope therapy Thyroid, single uptake Thyroid, multiple uptakes Thyroid suppress/stimul Thyroid imaging with uptake Thyroid image, mult uptakes Thyroid imaging Thyroid imaging with flow Thyroid met imaging Thyroid met imaging/studies Thyroid met imaging, body Thyroid met uptake Parathyroid nuclear imaging Adrenal nuclear imaging

S S S S S S S S S S S N S S

S S S S S S S S S S S N S S

0312 0389 0389 0392 0391 0391 0390 0390 0406 0406 0406 0000 0391 0408

8.5140 1.8190 1.8190 2.9022 3.4513 3.4513 2.0471 2.0471 5.0681 5.0681 5.0681 0.0000 3.4513 15.4033

406.71 86.89 86.89 138.64 164.87 164.87 97.79 97.79 242.10 242.10 242.10 0.00 164.87 735.82

927.34 198.13 198.13 316.11 375.92 375.92 222.97 222.97 552.02 552.02 552.02 0.00 375.92 1,677.73

1,062.89 227.08 227.08 362.31 430.86 430.86 255.56 255.56 632.70 632.70 632.70 0.00 430.86 1,922.95

SI= S, effect. 05/01/06 If needed add 282N Taxonomy

X

78099 78102 78103 78104 78110 78111 78120 78121 78122 78130 78135 78140 78185 78190 78191 78195

Endocrine nuclear procedure Bone marrow imaging, ltd Bone marrow imaging, mult Bone marrow imaging, body Plasma volume, single Plasma volume, multiple Red cell mass, single Red cell mass, multiple Blood volume Red cell survival study Red cell survival kinetics Red cell sequestration Spleen imaging Platelet survival, kinetics Platelet survival Lymph system imaging

S S S S S S S S S S S S S S S S

S S S S S S S S S S S S S S S S

0390 0400 0400 0400 0393 0393 0393 0393 0393 0393 0393 0393 0400 0392 0392 0400

2.0471 3.9293 3.9293 3.9293 5.6921 5.6921 5.6921 5.6921 5.6921 5.6921 5.6921 5.6921 3.9293 2.9022 2.9022 3.9293

97.79 187.70 187.70 187.70 271.91 271.91 271.91 271.91 271.91 271.91 271.91 271.91 187.70 138.64 138.64 187.70

222.97 427.98 427.98 427.98 619.98 619.98 619.98 619.98 619.98 619.98 619.98 619.98 427.98 316.11 316.11 427.98

255.56 490.53 490.53 490.53 710.60 710.60 710.60 710.60 710.60 710.60 710.60 710.60 490.53 362.31 362.31 490.53

SI= S, effect. 05/01/06 If needed add 282N Taxonomy

78199 78201 78202 78205 78206 78215 78216 78220 78223 78230 78231 78232 78258 78261 78262 78264 78267 78268 78270 78271 78272 78278 78282 78290 78291

Blood/lymph nuclear exam Liver imaging Liver imaging with flow Liver imaging (3D) Liver image (3d) with flow Liver and spleen imaging Liver & spleen image/flow Liver function study Hepatobiliary imaging Salivary gland imaging Serial salivary imaging Salivary gland function exam Esophageal motility study Gastric mucosa imaging Gastroesophageal reflux exam Gastric emptying study Breath tst attain/anal c-14 Breath test analysis, c-14 Vit B-12 absorption exam Vit b-12 absrp exam, int fac Vit B-12 absorp, combined Acute GI blood loss imaging GI protein loss exam Meckel’s divert exam Leveen/shunt patency exam

S S S S S S S S S S S S S S S S A A S S S S S S S

S S S S S S S S S S S S S S S S 3 3 S S S S S S S

0400 0394 0394 0394 0394 0394 0394 0394 0394 0395 0395 0395 0395 0395 0395 0395 0000 0000 0392 0392 0392 0395 0395 0395 0395

3.9293 4.4603 4.4603 4.4603 4.4603 4.4603 4.4603 4.4603 4.4603 3.7911 3.7911 3.7911 3.7911 3.7911 3.7911 3.7911 0.0000 0.0000 2.9022 2.9022 2.9022 3.7911 3.7911 3.7911 3.7911

187.70 213.07 213.07 213.07 213.07 213.07 213.07 213.07 213.07 181.10 181.10 181.10 181.10 181.10 181.10 181.10 M01 M01 138.64 138.64 138.64 181.10 181.10 181.10 181.10

427.98 485.82 485.82 485.82 485.82 485.82 485.82 485.82 485.82 412.93 412.93 412.93 412.93 412.93 412.93 412.93 M01 M01 316.11 316.11 316.11 412.93 412.93 412.93 412.93

490.53 556.82 556.82 556.82 556.82 556.82 556.82 556.82 556.82 473.28 473.28 473.28 473.28 473.28 473.28 473.28 M01 M01 362.31 362.31 362.31 473.28 473.28 473.28 473.28

SI= S, effect. 05/01/06 If needed add 282N Taxonomy

78299 78300 78305 78306 78315 78320 78350 78351

GI nuclear procedure Bone imaging, limited area Bone imaging, multiple areas Bone imaging, whole body Bone imaging, 3 phase Bone imaging (3D) Bone mineral, single photon Bone mineral, dual photon

S S S S S S E E

S S S S S S 3 3

0395 0396 0396 0396 0396 0396 0000 0000

3.7911 3.8039 3.8039 3.8039 3.8039 3.8039 0.0000 0.0000

181.10 181.71 181.71 181.71 181.71 181.71 M01 M01

412.93 414.32 414.32 414.32 414.32 414.32 M01 M01

473.28 474.88 474.88 474.88 474.88 474.88 M01 M01

SI= S, effect. 05/01/06 If needed add 282N Taxonomy

SI change 1/1/07 (TR 1155)

78399 78414 78428 78445 78456 78457 78458 78459 78460 78461 78464 78465 78466 78468 78469 78472 78473 78478 78480 78481 78483 78491 78492 78494 78496

Musculoskeletal nuclear exam Non-imaging heart function Cardiac shunt imaging Vascular flow imaging Acute venous thrombus image Venous thrombosis imaging Ven thrombosis images, bilat Heart muscle imaging (PET) Heart muscle blood, single Heart muscle blood, multiple Heart image (3d), single Heart image (3d), multiple Heart infarct image Heart infarct image (ef) Heart infarct image (3D) Gated heart, planar, single Gated heart, multiple Heart wall motion add-on Heart function add-on Heart first pass, single Heart first pass, multiple Heart image (pet), single Heart image (pet), multiple Heart image, spect Heart first pass add-on

S S S S S S S S S S S S S S S S S N N S S S S S N

S S S S S S S S S S S S S S S S S N N S S S S S N

0396 0398 0398 0397 0397 0397 0397 0307 0377 0377 0377 0377 0398 0398 0398 0398 0398 0000 0000 0398 0398 0307 0307 0398 0000

3.8039 4.8620 4.8620 3.1433 3.1433 3.1433 3.1433 21.9955 11.8512 11.8512 11.8512 11.8512 4.8620 4.8620 4.8620 4.8620 4.8620 0.0000 0.0000 4.8620 4.8620 21.9955 21.9955 4.8620 0.0000

181.71 232.26 232.26 150.16 150.16 150.16 150.16 1,050.73 566.13 566.13 566.13 566.13 232.26 232.26 232.26 232.26 232.26 0.00 0.00 232.26 232.26 1,050.73 1,050.73 232.26 0.00

414.32 529.57 529.57 342.37 342.37 342.37 342.37 2,395.75 1,290.83 1,290.83 1,290.83 1,290.83 529.57 529.57 529.57 529.57 529.57 0.00 0.00 529.57 529.57 2,395.75 2,395.75 529.57 0.00

474.88 606.97 606.97 392.41 392.41 392.41 392.41 2,745.92 1,479.50 1,479.50 1,479.50 1,479.50 606.97 606.97 606.97 606.97 606.97 0.00 0.00 606.97 606.97 2,745.92 2,745.92 606.97 0.00

SI= S, effect. 05/01/06 If needed add 282N Taxonomy

X X

X SI= S, effect. 05/01/06 If needed add 282N Taxonomy

78499 78580 78584 78585 78586 78587 78588 78591 78593 78594 78596

Cardiovascular nuclear exam Lung perfusion imaging Lung V/Q image single breath Lung V/Q imaging Aerosol lung image, single Aerosol lung image, multiple Perfusion lung image Vent image, 1 breath, 1 proj Vent image, 1 proj, gas Vent image, mult proj, gas Lung differential function

S S S S S S S S S S S

S S S S S S S S S S S

0398 0401 0378 0378 0401 0401 0378 0401 0401 0401 0378

4.8620 3.3954 4.9509 4.9509 3.3954 3.3954 4.9509 3.3954 3.3954 3.3954 4.9509

232.26 162.20 236.50 236.50 162.20 162.20 236.50 162.20 162.20 162.20 236.50

529.57 369.83 539.25 539.25 369.83 369.83 539.25 369.83 369.83 369.83 539.25

606.97 423.88 618.07 618.07 423.88 423.88 618.07 423.88 423.88 423.88 618.07

78599 78600 78601 78605 78606 78607 78608 78609 78610 78630 78635 78645 78647 78650 78660

Respiratory nuclear exam Brain image < 4 views Brain image w/flow < 4 views Brain imaging 4+ views Brain image w/ flow 4 + views Brain imaging (3D) Brain imaging (PET) Brain imaging (PET) Brain flow imaging only Cerebrospinal fluid scan CSF ventriculography CSF shunt evaluation Cerebrospinal fluid scan CSF leakage imaging Nuclear exam of tear flow

S S S S S S S E S S S S S S S

S S S S S S S 1 S S S S S S S

0401 0403 0403 0403 0402 0402 0308 0000 0402 0402 0402 0403 0402 0402 0403

3.3954 3.2295 3.2295 3.2295 8.8235 8.8235 16.6001 0.0000 8.8235 8.8235 8.8235 3.2295 8.8235 8.8235 3.2295

162.20 154.27 154.27 154.27 421.50 421.50 792.99 0.00 421.50 421.50 421.50 154.27 421.50 421.50 154.27

369.83 351.76 351.76 351.76 961.06 961.06 1,808.08 0.00 961.06 961.06 961.06 351.76 961.06 961.06 351.76

423.88 403.17 403.17 403.17 1,101.53 1,101.53 2,072.36 0.00 1,101.53 1,101.53 1,101.53 403.17 1,101.53 1,101.53 403.17

SI= S, effect. 05/01/06 If needed add 282N Taxonomy Description Change Description Change Description Change Description Change

x x x x

78699 78700 78701 78707 78708 78709 78710 78725 78730 78740 78761

Nervous system nuclear exam Kidney imaging, static Kidney imaging with flow Kidney flow/function image Kidney flow/function image Kidney flow/function image Kidney imaging (3D) Kidney function study Urinary bladder retention Ureteral reflux study Testicular imaging/flow

S S S S S S S S S S S

S S S S S S S S S S S

0403 0404 0404 0404 0404 0404 0404 0392 0389 0404 0404

3.2295 5.0824 5.0824 5.0824 5.0824 5.0824 5.0824 2.9022 1.8190 5.0824 5.0824

154.27 242.79 242.79 242.79 242.79 242.79 242.79 138.64 86.89 242.79 242.79

351.76 553.58 553.58 553.58 553.58 553.58 553.58 316.11 198.13 553.58 553.58

403.17 634.49 634.49 634.49 634.49 634.49 634.49 362.31 227.08 634.49 634.49

SI= S, effect. 05/01/06 If needed add 282N Taxonomy

X

78799 78800 78801

Genitourinary nuclear exam Tumor imaging, limited area Tumor imaging, mult areas

S S S

S S S

0404 0406 0406

5.0824 5.0681 5.0681

242.79 242.10 242.10

553.58 552.02 552.02

634.49 632.70 632.70

SI= S, effect. 05/01/06 If needed add 282N Taxonomy

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

41 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only S S S S S S S S S S S S N N S S S S S S S S S S S S N N

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 402.11 735.82 735.82 402.11 402.11 402.11 792.99 792.99 792.99 792.99 792.99 792.99 0.00 0.00

Children's Hospital Outpatient Fee 916.84 1,677.73 1,677.73 916.84 916.84 916.84 1,808.08 1,808.08 1,808.08 1,808.08 1,808.08 1,808.08 0.00 0.00

Critical PDD Access Update to Hospital ACS Outpatient Fee 1,050.85 1,922.95 1,922.95 1,050.85 1,050.85 1,050.85 2,072.36 2,072.36 2,072.36 2,072.36 2,072.36 2,072.36 0.00 0.00

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

78802 78803 78804 78805 78806 78807 78811 78812 78813 78814 78815 78816 78890 78891

Tumor imaging, whole body Tumor imaging (3D) Tumor imaging, whole body Abscess imaging, ltd area Abscess imaging, whole body Nuclear localization/abscess Pet image, ltd area Pet image, skull-thigh Pet image, full body Pet image w/ct, lmtd Pet image w/ct, skull-thigh Pet image w/ct, full body Nuclear medicine data proc Nuclear med data proc

0414 0408 0408 0414 0414 0414 0308 0308 0308 0308 0308 0308 0000 0000

8.4176 15.4033 15.4033 8.4176 8.4176 8.4176 16.6001 16.6001 16.6001 16.6001 16.6001 16.6001 0.0000 0.0000

description change description Change description Change description Change description Change

x x x x x

78999 79005 79101 79200 79300 79403 79440 79445

Nuclear diagnostic exam Nuclear rx, oral admin Nuclear rx, iv admin Nuclear rx, intracav admin Nuclr rx, interstit colloid Hematopoietic nuclear tx Nuclear rx, intra-articular Nuclear rx, intra-arterial

S S S S S S S S

S S S S S 1 S S

0389 0407 0407 0413 0407 0413 0413 0407

1.8190 3.3020 3.3020 5.2741 3.3020 5.2741 5.2741 3.3020

86.89 157.74 157.74 251.94 157.74 0.00 251.94 157.74

198.13 359.65 359.65 574.45 359.65 0.00 574.45 359.65

227.08 412.22 412.22 658.42 412.22 0.00 658.42 412.22

SI=S, effect. 05/01/06 If needed add 282N Taxonomy

79999 80047 80048 80050 80051 80053 80055 80061 80069 80074 80076 80100 80101 80102 80103 80150 80152 80154 80156 80157 80158 80160 80162 80164 80166 80168 80170 80172 80173 80174 80176 80178 80182 80184 80185 80186 80188 80190 80192 80194 80195 80196 80197 80198 80200 80201 80202 80299 80400 80402 80406 80408 80410 80412 80414 80415 80416 80417 80418 80420 80422 80424 80426 80428 80430 80432 80434 80435 80436 80438 80439 80440 80500 80502 81000 81001 81002 81003 81005 81007 81015 81020 81025 81050

Nuclear medicine therapy Metabolic panel ionized ca Metabolic panel total ca General health panel Electrolyte panel Comprehen metabolic panel Obstetric panel Lipid panel Renal function panel Acute hepatitis panel Hepatic function panel Drug screen, qualitate/multi Drug screen, single Drug confirmation Drug analysis, tissue prep Assay of amikacin Assay of amitriptyline Assay of benzodiazepines Assay, carbamazepine, total Assay, carbamazepine, free Assay of cyclosporine Assay of desipramine Assay of digoxin Assay, dipropylacetic acid Assay of doxepin Assay of ethosuximide Assay of gentamicin Assay of gold Assay of haloperidol Assay of imipramine Assay of lidocaine Assay of lithium Assay of nortriptyline Assay of phenobarbital Assay of phenytoin, total Assay of phenytoin, free Assay of primidone Assay of procainamide Assay of procainamide Assay of quinidine Assay of sirolimus Assay of salicylate Assay of tacrolimus Assay of theophylline Assay of tobramycin Assay of topiramate Assay of vancomycin Quantitative assay, drug Acth stimulation panel Acth stimulation panel Acth stimulation panel Aldosterone suppression eval Calcitonin stimul panel CRH stimulation panel Testosterone response Estradiol response panel Renin stimulation panel Renin stimulation panel Pituitary evaluation panel Dexamethasone panel Glucagon tolerance panel Glucagon tolerance panel Gonadotropin hormone panel Growth hormone panel Growth hormone panel Insulin suppression panel Insulin tolerance panel Insulin tolerance panel Metyrapone panel TRH stimulation panel TRH stimulation panel TRH stimulation panel Lab pathology consultation Lab pathology consultation Urinalysis, nonauto w/scope Urinalysis, auto w/scope Urinalysis nonauto w/o scope Urinalysis, auto, w/o scope Urinalysis Urine screen for bacteria Microscopic exam of urine Urinalysis, glass test Urine pregnancy test Urinalysis, volume measure

S A A E A A E A A A A A A A N A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A X X A A A A A A A A A A

S 3 3 3 3 3 3 3 3 3 3 3 3 3 N 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 1 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 X X 3 3 3 3 3 3 3 3 3 3

0407 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0433 0342 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

3.3020 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.2397 0.0969 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

157.74 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 11.45 4.63 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

359.65 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 26.11 10.55 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

412.22 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 29.92 12.10 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

SI= S, effect. 05/01/06 If needed add 282N Taxonomy Verified w/ Angies schedule Description Change

X x

81099 82000 82003 82009 82010 82013 82016 82017 82024 82030 82040 82042 82043 82044 82045 82055 82075 82085 82088 82101 82103 82104 82105 82106 82107 82108 82120 82127 82128 82131 82135 82136 82139 82140 82143 82145 82150 82154 82157 82160 82163 82164 82172 82175 82180 82190 82205 82232 82239 82240 82247

Urinalysis test procedure Assay of blood acetaldehyde Assay of acetaminophen Test for acetone/ketones Acetone assay Acetylcholinesterase assay Acylcarnitines, qual Acylcarnitines, quant Assay of acth Assay of adp & amp Assay of serum albumin Assay of urine albumin Microalbumin, quantitative Microalbumin, semiquant Albumin, ischemia modified Assay of ethanol Assay of breath ethanol Assay of aldolase Assay of aldosterone Assay of urine alkaloids Alpha-1-antitrypsin, total Alpha-1-antitrypsin, pheno Alpha-fetoprotein, serum Alpha-fetoprotein, amniotic Alpha-fetoprotein l3 Assay of aluminum Amines, vaginal fluid qual Amino acid, single qual Amino acids, mult qual Amino acids, single quant Assay, aminolevulinic acid Amino acids, quant, 2-5 Amino acids, quan, 6 or more Assay of ammonia Amniotic fluid scan Assay of amphetamines Assay of amylase Androstanediol glucuronide Assay of androstenedione Assay of androsterone Assay of angiotensin II Angiotensin I enzyme test Assay of apolipoprotein Assay of arsenic Assay of ascorbic acid Atomic absorption Assay of barbiturates Assay of beta-2 protein Bile acids, total Bile acids, cholylglycine Bilirubin, total

A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A

3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

SI= 3, effect. 08/01/00 If needed add 282N Taxonomy

Added 1/1/07 to book change valid sex to F x

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

42 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

Children's Hospital Outpatient Fee M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

Critical PDD Access Update to Hospital ACS Outpatient Fee M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

82248 82252 82261 82270 82271 82272 82274 82286 82300 82306 82307 82308 82310 82330 82331 82340 82355 82360 82365 82370 82373 82374 82375 82376 82378 82379 82380 82382 82383 82384 82387 82390 82397 82415 82435 82436 82438 82441 82465 82480 82482 82485 82486 82487 82488 82489 82491 82492 82495 82507 82520 82523 82525 82528 82530 82533 82540 82541 82542 82543 82544 82550 82552 82553 82554 82565 82570 82575 82585 82595 82600 82607 82608 82610 82615 82626 82627 82633 82634 82638 82646 82649 82651 82652 82654 82656 82657 82658 82664 82666 82668 82670 82671 82672 82677 82679 82690 82693 82696 82705 82710 82715 82725 82726 82728 82731 82735 82742 82746 82747 82757 82759 82760 82775 82776 82784 82785 82787 82800 82803 82805 82810 82820 82926 82928 82938 82941 82943 82945 82946 82947 82948 82950 82951 82952 82953 82955 82960 82962 82963 82965 82975 82977 82978 82979 82980 82985 83001 83002 83003 83008 83009 83010 83012 83013 83014 83015 83018 83020 83021 83026 83030 83033

Bilirubin, direct Fecal bilirubin test Assay of biotinidase Test for blood, feces Occult blood, feces, single Occult bld feces, 1-3 tests Assay test for blood, fecal Assay of bradykinin Assay of cadmium Assay of vitamin D Assay of vitamin D Assay of calcitonin Assay of calcium Assay of calcium Calcium infusion test Assay of calcium in urine Calculus analysis, qual Calculus assay, quant Calculus spectroscopy X-ray assay, calculus Assay, c-d transfer measure Assay, blood carbon dioxide Assay, blood carbon monoxide Test for carbon monoxide Carcinoembryonic antigen Assay of carnitine Assay of carotene Assay, urine catecholamines Assay, blood catecholamines Assay, three catecholamines Assay of cathepsin-d Assay of ceruloplasmin Chemiluminescent assay Assay of chloramphenicol Assay of blood chloride Assay of urine chloride Assay, other fluid chlorides Test for chlorohydrocarbons Assay, bld/serum cholesterol Assay, serum cholinesterase Assay, rbc cholinesterase Assay, chondroitin sulfate Gas/liquid chromatography Paper chromatography Paper chromatography Thin layer chromatography Chromotography, quant, sing Chromotography, quant, mult Assay of chromium Assay of citrate Assay of cocaine Collagen crosslinks Assay of copper Assay of corticosterone Cortisol, free Total cortisol Assay of creatine Column chromotography, qual Column chromotography, quant Column chromotograph/isotope Column chromotograph/isotope Assay of ck (cpk) Assay of cpk in blood Creatine, MB fraction Creatine, isoforms Assay of creatinine Assay of urine creatinine Creatinine clearance test Assay of cryofibrinogen Assay of cryoglobulin Assay of cyanide Vitamin B-12 B-12 binding capacity Cystatin c Test for urine cystines Dehydroepiandrosterone Dehydroepiandrosterone Desoxycorticosterone Deoxycortisol Assay of dibucaine number Assay of dihydrocodeinone Assay of dihydromorphinone Assay of dihydrotestosterone Assay of dihydroxyvitamin d Assay of dimethadione Pancreatic elastase, fecal Enzyme cell activity Enzyme cell activity, ra Electrophoretic test Assay of epiandrosterone Assay of erythropoietin Assay of estradiol Assay of estrogens Assay of estrogen Assay of estriol Assay of estrone Assay of ethchlorvynol Assay of ethylene glycol Assay of etiocholanolone Fats/lipids, feces, qual Fats/lipids, feces, quant Assay of fecal fat Assay of blood fatty acids Long chain fatty acids Assay of ferritin Assay of fetal fibronectin Assay of fluoride Assay of flurazepam Blood folic acid serum Assay of folic acid, rbc Assay of semen fructose Assay of rbc galactokinase Assay of galactose Assay galactose transferase Galactose transferase test Assay of gammaglobulin igm Assay of gammaglobulin ige Igg 1, 2, 3 or 4, each Blood pH Blood gases: pH, pO2 & pCO2 Blood gases W/02 saturation Blood gases, O2 sat only Hemoglobin-oxygen affinity Assay of gastric acid Assay of gastric acid Gastrin test Assay of gastrin Assay of glucagon Glucose other fluid Glucagon tolerance test Assay, glucose, blood quant Reagent strip/blood glucose Glucose test Glucose tolerance test (GTT) GTT-added samples Glucose-tolbutamide test Assay of g6pd enzyme Test for G6PD enzyme Glucose blood test Assay of glucosidase Assay of gdh enzyme Assay of glutamine Assay of GGT Assay of glutathione Assay, rbc glutathione Assay of glutethimide Glycated protein Gonadotropin (FSH) Gonadotropin (LH) Assay, growth hormone (hgh) Assay of guanosine H pylori (c-13), blood Assay of haptoglobin, quant Assay of haptoglobins H pylori (c-13), breath H pylori drug admin Heavy metal screen Quantitative screen, metals Hemoglobin electrophoresis Hemoglobin chromotography Hemoglobin, copper sulfate Fetal hemoglobin, chemical Fetal hemoglobin assay, qual

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

description change

x

Verified w/ Angies schedule

X

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

43 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

Children's Hospital Outpatient Fee M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

Critical PDD Access Update to Hospital ACS Outpatient Fee M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

83036 83037 83045 83050 83051 83055 83060 83065 83068 83069 83070 83071 83080 83088 83090 83150 83491 83497 83498 83499 83500 83505 83516 83518 83519 83520 83525 83527 83528 83540 83550 83570 83582 83586 83593 83605 83615 83625 83630 83631 83632 83633 83634 83655 83661 83662 83663 83664 83670 83690 83695 83698 83700 83701 83704 83718 83719 83721 83727 83735 83775 83785 83788 83789 83805 83825 83835 83840 83857 83858 83864 83866 83872 83873 83874 83880 83883 83885 83887 83890 83891 83892 83893 83894 83896 83897 83898 83900 83901 83902 83903 83904 83905 83906 83907 83908 83909 83912 83913 83914 83915 83916 83918 83919 83921 83925 83930 83935 83937 83945 83950 83970 83986 83992 83993 84022 84030 84035 84060 84061 84066 84075 84078 84080 84081 84085 84087 84100 84105 84106 84110 84119 84120 84126 84127 84132 84133 84134 84135 84138 84140 84143 84144 84146 84150 84152 84153 84154 84155 84156 84157 84160 84163 84165 84166 84181 84182 84202 84203 84206 84207 84210 84220

Glycated hemoglobin test Glycosylated hb, home device Blood methemoglobin test Blood methemoglobin assay Assay of plasma hemoglobin Blood sulfhemoglobin test Blood sulfhemoglobin assay Assay of hemoglobin heat Hemoglobin stability screen Assay of urine hemoglobin Assay of hemosiderin, qual Assay of hemosiderin, quant Assay of b hexosaminidase Assay of histamine Assay of homocystine Assay of for hva Assay of corticosteroids Assay of 5-hiaa Assay of progesterone Assay of progesterone Assay, free hydroxyproline Assay, total hydroxyproline Immunoassay, nonantibody Immunoassay, dipstick Immunoassay, nonantibody Immunoassay, RIA Assay of insulin Assay of insulin Assay of intrinsic factor Assay of iron Iron binding test Assay of idh enzyme Assay of ketogenic steroids Assay 17- ketosteroids Fractionation, ketosteroids Assay of lactic acid Lactate (LD) (LDH) enzyme Assay of ldh enzymes Lactoferrin, fecal (qual) Lactoferrin, fecal (quant) Placental lactogen Test urine for lactose Assay of urine for lactose Assay of lead L/s ratio, fetal lung Foam stability, fetal lung Fluoro polarize, fetal lung Lamellar bdy, fetal lung Assay of lap enzyme Assay of lipase Assay of lipoprotein(a) Assay lipoprotein pla2 Lipopro bld, electrophoretic Lipoprotein bld, hr fraction Lipoprotein, bld, by nmr Assay of lipoprotein Assay of blood lipoprotein Assay of blood lipoprotein Assay of lrh hormone Assay of magnesium Assay of md enzyme Assay of manganese Mass spectrometry qual Mass spectrometry quant Assay of meprobamate Assay of mercury Assay of metanephrines Assay of methadone Assay of methemalbumin Assay of methsuximide Mucopolysaccharides Mucopolysaccharides screen Assay synovial fluid mucin Assay of csf protein Assay of myoglobin Natriuretic peptide Assay, nephelometry not spec Assay of nickel Assay of nicotine Molecule isolate Molecule isolate nucleic Molecular diagnostics Molecule dot/slot/blot Molecule gel electrophor Molecular diagnostics Molecule nucleic transfer Molecule nucleic ampli Molecule nucleic ampli 2 seq Molecule nucleic ampli Molecular diagnostics Molecule mutation scan Molecule mutation identify Molecule mutation identify Molecule mutation identify Lyse cells for nucleic ext Nucleic acid, signal ampli Nucleic acid, high resolute Genetic examination Molecular, rna stabilization Mutation ident ola/sbce/aspe Assay of nucleotidase Oligoclonal bands Organic acids, total, quant Organic acids, qual, each Organic acid, single, quant Assay of opiates Assay of blood osmolality Assay of urine osmolality Assay of osteocalcin Assay of oxalate Oncoprotein, her-2/neu Assay of parathormone Assay of body fluid acidity Assay for phencyclidine Assay for calprotectin fecal Assay of phenothiazine Assay of blood pku Assay of phenylketones Assay acid phosphatase Phosphatase, forensic exam Assay prostate phosphatase Assay alkaline phosphatase Assay alkaline phosphatase Assay alkaline phosphatases Amniotic fluid enzyme test Assay of rbc pg6d enzyme Assay phosphohexose enzymes Assay of phosphorus Assay of urine phosphorus Test for porphobilinogen Assay of porphobilinogen Test urine for porphyrins Assay of urine porphyrins Assay of feces porphyrins Assay of feces porphyrins Assay of serum potassium Assay of urine potassium Assay of prealbumin Assay of pregnanediol Assay of pregnanetriol Assay of pregnenolone Assay of 17-hydroxypregneno Assay of progesterone Assay of prolactin Assay of prostaglandin Assay of psa, complexed Assay of psa, total Assay of psa, free Assay of protein, serum Assay of protein, urine Assay of protein, other Assay of protein, any source Pappa, serum Protein e-phoresis, serum Protein e-phoresis/urine/csf Western blot test Protein, western blot test Assay RBC protoporphyrin Test RBC protoporphyrin Assay of proinsulin Assay of vitamin b-6 Assay of pyruvate Assay of pyruvate kinase

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

Added 1/1/07 to book

Added 1/1/07 to book

Verified w/ Angies schedule

X

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

44 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A B X A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A N A A A A A A A A A A A A A A A A A A A A A A A 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 B X 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 N 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 24.56 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

Children's Hospital Outpatient Fee M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 56.01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

Critical PDD Access Update to Hospital ACS Outpatient Fee M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 64.19 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

84228 84233 84234 84235 84238 84244 84252 84255 84260 84270 84275 84285 84295 84300 84302 84305 84307 84311 84315 84375 84376 84377 84378 84379 84392 84402 84403 84425 84430 84432 84436 84437 84439 84442 84443 84445 84446 84449 84450 84460 84466 84478 84479 84480 84481 84482 84484 84485 84488 84490 84510 84512 84520 84525 84540 84545 84550 84560 84577 84578 84580 84583 84585 84586 84588 84590 84591 84597 84600 84620 84630 84681 84702 84703 84704 84830 84999 85002 85004 85007 85008 85009 85013 85014 85018 85025 85027 85032 85041 85044 85045 85046 85048 85049 85055 85060 85097 85130 85170 85175 85210 85220 85230 85240 85244 85245 85246 85247 85250 85260 85270 85280 85290 85291 85292 85293 85300 85301 85302 85303 85305 85306 85307 85335 85337 85345 85347 85348 85360 85362 85366 85370 85378 85379 85380 85384 85385 85390 85396 85400 85410 85415 85420 85421 85441 85445 85460 85461 85475 85520 85525 85530 85536 85540 85547 85549 85555 85557 85576 85597 85610 85611

Assay of quinine Assay of estrogen Assay of progesterone Assay of endocrine hormone Assay, nonendocrine receptor Assay of renin Assay of vitamin b-2 Assay of selenium Assay of serotonin Assay of sex hormone globul Assay of sialic acid Assay of silica Assay of serum sodium Assay of urine sodium Assay of sweat sodium Assay of somatomedin Assay of somatostatin Spectrophotometry Body fluid specific gravity Chromatogram assay, sugars Sugars, single, qual Sugars, multiple, qual Sugars, single, quant Sugars multiple quant Assay of urine sulfate Assay of testosterone Assay of total testosterone Assay of vitamin b-1 Assay of thiocyanate Assay of thyroglobulin Assay of total thyroxine Assay of neonatal thyroxine Assay of free thyroxine Assay of thyroid activity Assay thyroid stim hormone Assay of tsi Assay of vitamin e Assay of transcortin Transferase (AST) (SGOT) Alanine amino (ALT) (SGPT) Assay of transferrin Assay of triglycerides Assay of thyroid (t3 or t4) Assay, triiodothyronine (t3) Free assay (FT-3) T3 reverse Assay of troponin, quant Assay duodenal fluid trypsin Test feces for trypsin Assay of feces for trypsin Assay of tyrosine Assay of troponin, qual Assay of urea nitrogen Urea nitrogen semi-quant Assay of urine/urea-n Urea-N clearance test Assay of blood/uric acid Assay of urine/uric acid Assay of feces/urobilinogen Test urine urobilinogen Assay of urine urobilinogen Assay of urine urobilinogen Assay of urine vma Assay of vip Assay of vasopressin Assay of vitamin a Assay of nos vitamin Assay of vitamin k Assay of volatiles Xylose tolerance test Assay of zinc Assay of c-peptide Chorionic gonadotropin test Chorionic gonadotropin assay Hcg, free betachain test Ovulation tests Clinical chemistry test Bleeding time test Automated diff wbc count Bl smear w/diff wbc count Bl smear w/o diff wbc count Manual diff wbc count b-coat Spun microhematocrit Hematocrit Hemoglobin Complete cbc w/auto diff wbc Complete cbc, automated Manual cell count, each Automated rbc count Manual reticulocyte count Automated reticulocyte count Reticyte/hgb concentrate Automated leukocyte count Automated platelet count Reticulated platelet assay Blood smear interpretation Bone marrow interpretation Chromogenic substrate assay Blood clot retraction Blood clot lysis time Blood clot factor II test Blood clot factor V test Blood clot factor VII test Blood clot factor VIII test Blood clot factor VIII test Blood clot factor VIII test Blood clot factor VIII test Blood clot factor VIII test Blood clot factor IX test Blood clot factor X test Blood clot factor XI test Blood clot factor XII test Blood clot factor XIII test Blood clot factor XIII test Blood clot factor assay Blood clot factor assay Antithrombin III test Antithrombin III test Blood clot inhibitor antigen Blood clot inhibitor test Blood clot inhibitor assay Blood clot inhibitor test Assay activated protein c Factor inhibitor test Thrombomodulin Coagulation time Coagulation time Coagulation time Euglobulin lysis Fibrin degradation products Fibrinogen test Fibrinogen test Fibrin degrade, semiquant Fibrin degradation, quant Fibrin degradation, vte Fibrinogen Fibrinogen Fibrinolysins screen Clotting assay, whole blood Fibrinolytic plasmin Fibrinolytic antiplasmin Fibrinolytic plasminogen Fibrinolytic plasminogen Fibrinolytic plasminogen Heinz bodies, direct Heinz bodies, induced Hemoglobin, fetal Hemoglobin, fetal Hemolysin Heparin assay Heparin neutralization Heparin-protamine tolerance Iron stain peripheral blood Wbc alkaline phosphatase RBC mechanical fragility Muramidase RBC osmotic fragility RBC osmotic fragility Blood platelet aggregation Platelet neutralization Prothrombin time Prothrombin test

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0343 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.5142 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

Verified w/ Angies schedule SI = 3 effect. 08/01/00 add 282N tax if needed

X

Change Valid Sex to F

x

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

45 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only A A A A A A A A A A A A A A A A A A A A A A A A X X X A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A X A X X X A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 X X X 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 X 1 X X X 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 11.45 24.56 11.45 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 4.03 0.00 4.03 4.03 4.03 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

Children's Hospital Outpatient Fee M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 26.11 56.01 26.11 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 9.19 0.00 9.19 9.19 9.19 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

Critical PDD Access Update to Hospital ACS Outpatient Fee M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 29.92 64.19 29.92 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 10.54 0.00 10.54 10.54 10.54 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

85612 85613 85635 85651 85652 85660 85670 85675 85705 85730 85732 85810 85999 86000 86001 86003 86005 86021 86022 86023 86038 86039 86060 86063 86077 86078 86079 86140 86141 86146 86147 86148 86155 86156 86157 86160 86161 86162 86171 86185 86200 86215 86225 86226 86235 86243 86255 86256 86277 86280 86294 86300 86301 86304 86308 86309 86310 86316 86317 86318 86320 86325 86327 86329 86331 86332 86334 86335 86336 86337 86340 86341 86343 86344 86353 86355 86356 86357 86359 86360 86361 86367 86376 86378 86382 86384 86403 86406 86430 86431 86480 86485 86486 86490 86510 86580 86590 86592 86593 86602 86603 86606 86609 86611 86612 86615 86617 86618 86619 86622 86625 86628 86631 86632 86635 86638 86641 86644 86645 86648 86651 86652 86653 86654 86658 86663 86664 86665 86666 86668 86671 86674 86677 86682 86684 86687 86688 86689 86692 86694 86695 86696 86698 86701 86702 86703 86704 86705 86706 86707 86708 86709 86710 86713 86717 86720 86723 86727 86729 86732 86735

Viper venom prothrombin time Russell viper venom, diluted Reptilase test Rbc sed rate, nonautomated Rbc sed rate, automated RBC sickle cell test Thrombin time, plasma Thrombin time, titer Thromboplastin inhibition Thromboplastin time, partial Thromboplastin time, partial Blood viscosity examination Hematology procedure Agglutinins, febrile Allergen specific igg Allergen specific IgE Allergen specific IgE WBC antibody identification Platelet antibodies Immunoglobulin assay Antinuclear antibodies Antinuclear antibodies (ANA) Antistreptolysin o, titer Antistreptolysin o, screen Physician blood bank service Physician blood bank service Physician blood bank service C-reactive protein C-reactive protein, hs Glycoprotein antibody Cardiolipin antibody Phospholipid antibody Chemotaxis assay Cold agglutinin, screen Cold agglutinin, titer Complement, antigen Complement/function activity Complement, total (CH50) Complement fixation, each Counterimmunoelectrophoresis Ccp antibody Deoxyribonuclease, antibody DNA antibody DNA antibody, single strand Nuclear antigen antibody Fc receptor Fluorescent antibody, screen Fluorescent antibody, titer Growth hormone antibody Hemagglutination inhibition Immunoassay, tumor, qual Immunoassay, tumor, ca 15-3 Immunoassay, tumor, ca 19-9 Immunoassay, tumor, ca 125 Heterophile antibodies Heterophile antibodies Heterophile antibodies Immunoassay, tumor other Immunoassay,infectious agent Immunoassay,infectious agent Serum immunoelectrophoresis Other immunoelectrophoresis Immunoelectrophoresis assay Immunodiffusion Immunodiffusion ouchterlony Immune complex assay Immunofix e-phoresis, serum Immunfix e-phorsis/urine/csf Inhibin A Insulin antibodies Intrinsic factor antibody Islet cell antibody Leukocyte histamine release Leukocyte phagocytosis Lymphocyte transformation B cells, total count Mononuclear cell antigen Nk cells, total count T cells, total count T cell, absolute count/ratio T cell, absolute count Stem cells, total count Microsomal antibody Migration inhibitory factor Neutralization test, viral Nitroblue tetrazolium dye Particle agglutination test Particle agglutination test Rheumatoid factor test Rheumatoid factor, quant Tb test, cell immun measure Skin test, candida Skin test, nos antigen Coccidioidomycosis skin test Histoplasmosis skin test TB intradermal test Streptokinase, antibody Blood serology, qualitative Blood serology, quantitative Antinomyces antibody Adenovirus antibody Aspergillus antibody Bacterium antibody Bartonella antibody Blastomyces antibody Bordetella antibody Lyme disease antibody Lyme disease antibody Borrelia antibody Brucella antibody Campylobacter antibody Candida antibody Chlamydia antibody Chlamydia igm antibody Coccidioides antibody Q fever antibody Cryptococcus antibody CMV antibody CMV antibody, IgM Diphtheria antibody Encephalitis antibody Encephalitis antibody Encephalitis antibody Encephalitis antibody Enterovirus antibody Epstein-barr antibody Epstein-barr antibody Epstein-barr antibody Ehrlichia antibody Francisella tularensis Fungus antibody Giardia lamblia antibody Helicobacter pylori Helminth antibody Hemophilus influenza Htlv-i antibody Htlv-ii antibody HTLV/HIV confirmatory test Hepatitis, delta agent Herpes simplex test Herpes simplex test Herpes simplex type 2 Histoplasma HIV-1 HIV-2 HIV-1/HIV-2, single assay Hep b core antibody, total Hep b core antibody, igm Hep b surface antibody Hep be antibody Hep a antibody, total Hep a antibody, igm Influenza virus antibody Legionella antibody Leishmania antibody Leptospira antibody Listeria monocytogenes ab Lymph choriomeningitis ab Lympho venereum antibody Mucormycosis antibody Mumps antibody

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0433 0343 0433 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0341 0000 0341 0341 0341 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.2397 0.5142 0.2397 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0844 0.0000 0.0844 0.0844 0.0844 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

SI= 3 add tax code if nec. Effect 08/01/00

Verified w/ Angies schedule

X

Per Angie Not Allowed

X

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

46 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

Children's Hospital Outpatient Fee M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

Critical PDD Access Update to Hospital ACS Outpatient Fee M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

86738 86741 86744 86747 86750 86753 86756 86757 86759 86762 86765 86768 86771 86774 86777 86778 86781 86784 86787 86788 86789 86790 86793 86800 86803 86804 86805 86806 86807 86808 86812 86813 86816 86817 86821 86822

Mycoplasma antibody Neisseria meningitidis Nocardia antibody Parvovirus antibody Malaria antibody Protozoa antibody nos Respiratory virus antibody Rickettsia antibody Rotavirus antibody Rubella antibody Rubeola antibody Salmonella antibody Shigella antibody Tetanus antibody Toxoplasma antibody Toxoplasma antibody, igm Treponema pallidum, confirm Trichinella antibody Varicella-zoster antibody West nile virus ab, igm West nile virus antibody Virus antibody nos Yersinia antibody Thyroglobulin antibody Hepatitis c ab test Hep c ab test, confirm Lymphocytotoxicity assay Lymphocytotoxicity assay Cytotoxic antibody screening Cytotoxic antibody screening HLA typing, A, B, or C HLA typing, A, B, or C HLA typing, DR/DQ HLA typing, DR/DQ Lymphocyte culture, mixed Lymphocyte culture, primed

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

Added 1/1/07 to book Added 1/1/07 to book

86849 86850 86860 86870 86880 86885 86886 86890 86891 86900 86901 86903 86904 86905 86906 86910 86911 86920 86921 86922 86923 86927 86930 86931 86932 86940 86941 86945 86950 86960 86965 86970 86971 86972 86975 86976 86977 86978 86985

Immunology procedure RBC antibody screen RBC antibody elution RBC antibody identification Coombs test, direct Coombs test, indirect, qual Coombs test, indirect, titer Autologous blood process Autologous blood, op salvage Blood typing, ABO Blood typing, Rh (D) Blood typing, antigen screen Blood typing, patient serum Blood typing, RBC antigens Blood typing, Rh phenotype Blood typing, paternity test Blood typing, antigen system Compatibility test Compatibility test Compatibility test Compatibility test, electric Plasma, fresh frozen Frozen blood prep Frozen blood thaw Frozen blood freeze/thaw Hemolysins/agglutinins, auto Hemolysins/agglutinins Blood product/irradiation Leukacyte transfusion Vol reduction of blood/prod Pooling blood platelets RBC pretreatment RBC pretreatment RBC pretreatment RBC pretreatment, serum RBC pretreatment, serum RBC pretreatment, serum RBC pretreatment, serum Split blood or products

A X X X X X X X X X X X X X X E E X X X X X X X X A A X X X X X X X X X X X X

3 X X X X X X X X X X X X X X 3 3 X X X X X X X X 3 3 X X X X X X X X X X X X

0000 0345 0346 0346 0409 0409 0409 0347 0346 0409 0409 0345 0346 0345 0345 0000 0000 0346 0345 0346 0345 0345 0347 0347 0347 0000 0000 0345 0345 0345 0346 0345 0345 0346 0346 0345 0346 0346 0345

0.0000 0.2140 0.3346 0.3346 0.1190 0.1190 0.1190 0.7739 0.3346 0.1190 0.1190 0.2140 0.3346 0.2140 0.2140 0.0000 0.0000 0.3346 0.2140 0.3346 0.2140 0.2140 0.7739 0.7739 0.7739 0.0000 0.0000 0.2140 0.2140 0.2140 0.3346 0.2140 0.2140 0.3346 0.3346 0.2140 0.3346 0.3346 0.2140

M01 10.22 15.98 15.98 5.68 5.68 5.68 36.97 15.98 5.68 5.68 10.22 15.98 10.22 10.22 M01 M01 15.98 10.22 15.98 10.22 10.22 36.97 36.97 36.97 M01 M01 10.22 10.22 10.22 15.98 10.22 10.22 15.98 15.98 10.22 15.98 15.98 10.22

M01 23.31 36.44 36.44 12.96 12.96 12.96 84.29 36.44 12.96 12.96 23.31 36.44 23.31 23.31 M01 M01 36.44 23.31 36.44 23.31 23.31 84.29 84.29 84.29 M01 M01 23.31 23.31 23.31 36.44 23.31 23.31 36.44 36.44 23.31 36.44 36.44 23.31

M01 26.72 41.77 41.77 14.86 14.86 14.86 96.61 41.77 14.86 14.86 26.72 41.77 26.72 26.72 M01 M01 41.77 26.72 41.77 26.72 26.72 96.61 96.61 96.61 M01 M01 26.72 26.72 26.72 41.77 26.72 26.72 41.77 41.77 26.72 41.77 41.77 26.72

SI= 3, effect. 08/01/00 If needed add 282N Taxonomy

86999 87001 87003 87015 87040 87045 87046 87070 87071 87073 87075 87076 87077 87081 87084 87086 87088 87101 87102 87103 87106 87107 87109 87110 87116 87118 87140 87143 87147 87149 87152 87158 87164 87166 87168 87169 87172 87176 87177 87181 87184 87185 87186 87187 87188 87190 87197 87205 87206 87207 87209 87210 87220 87230 87250 87252 87253 87254 87255 87260 87265 87267 87269 87270 87271 87272 87273 87274 87275 87276 87277 87278 87279 87280 87281 87283 87285 87290 87299 87300 87301 87305 87320 87324

Transfusion procedure Small animal inoculation Small animal inoculation Specimen concentration Blood culture for bacteria Feces culture, bacteria Stool cultr, bacteria, each Culture, bacteria, other Culture bacteri aerobic othr Culture bacteria anaerobic Cultr bacteria, except blood Culture anaerobe ident, each Culture aerobic identify Culture screen only Culture of specimen by kit Urine culture/colony count Urine bacteria culture Skin fungi culture Fungus isolation culture Blood fungus culture Fungi identification, yeast Fungi identification, mold Mycoplasma Chlamydia culture Mycobacteria culture Mycobacteric identification Culture type immunofluoresc Culture typing, glc/hplc Culture type, immunologic Culture type, nucleic acid Culture type pulse field gel Culture typing, added method Dark field examination Dark field examination Macroscopic exam arthropod Macroscopic exam parasite Pinworm exam Tissue homogenization, cultr Ova and parasites smears Microbe susceptible, diffuse Microbe susceptible, disk Microbe susceptible, enzyme Microbe susceptible, mic Microbe susceptible, mlc Microbe suscept, macrobroth Microbe suscept, mycobacteri Bactericidal level, serum Smear, gram stain Smear, fluorescent/acid stai Smear, special stain Smear, complex stain Smear, wet mount, saline/ink Tissue exam for fungi Assay, toxin or antitoxin Virus inoculate, eggs/animal Virus inoculation, tissue Virus inoculate tissue, addl Virus inoculation, shell via Genet virus isolate, hsv Adenovirus ag, if Pertussis ag, if Enterovirus antibody, dfa Giardia ag, if Chlamydia trachomatis ag, if Cytomegalovirus dfa Cryptosporidium ag, if Herpes simplex 2, ag, if Herpes simplex 1, ag, if Influenza b, ag, if Influenza a, ag, if Legionella micdadei, ag, if Legion pneumophilia ag, if Parainfluenza, ag, if Respiratory syncytial ag, if Pneumocystis carinii, ag, if Rubeola, ag, if Treponema pallidum, ag, if Varicella zoster, ag, if Antibody detection, nos, if Ag detection, polyval, if Adenovirus ag, eia Aspergillus ag, eia Chylmd trach ag, eia Clostridium ag, eia

X A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A

X 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 1 3 3 3 3 3

0345 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.2140 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

10.22 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01

23.31 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01

26.72 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01

SI=X, effect. 05/01/06 If needed add 282N Taxonomy

Description Change

x

Added 1/1/07 to book

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

47 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 1 3 3 3 3 3 3 3 3 3 3 3 1 3 3 3 3 3

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01

Children's Hospital Outpatient Fee M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01

Critical PDD Access Update to Hospital ACS Outpatient Fee M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

87327 87328 87329 87332 87335 87336 87337 87338 87339 87340 87341 87350 87380 87385 87390 87391 87400 87420 87425 87427 87430 87449 87450 87451 87470 87471 87472 87475 87476 87477 87480 87481 87482 87485 87486 87487 87490 87491 87492 87495 87496 87497 87498 87500 87510 87511 87512 87515 87516 87517 87520 87521 87522 87525 87526 87527 87528 87529 87530 87531 87532 87533 87534 87535 87536 87537 87538 87539 87540 87541 87542 87550 87551 87552 87555 87556 87557 87560 87561 87562 87580 87581 87582 87590 87591 87592 87620 87621 87622 87640 87641 87650 87651 87652 87653 87660 87797 87798 87799 87800 87801 87802 87803 87804 87807 87808 87809 87810 87850 87880 87899 87900 87901 87902 87903 87904

Cryptococcus neoform ag, eia Cryptosporidium ag, eia Giardia ag, eia Cytomegalovirus ag, eia E coli 0157 ag, eia Entamoeb hist dispr, ag, eia Entamoeb hist group, ag, eia Hpylori, stool, eia H pylori ag, eia Hepatitis b surface ag, eia Hepatitis b surface, ag, eia Hepatitis be ag, eia Hepatitis delta ag, eia Histoplasma capsul ag, eia Hiv-1 ag, eia Hiv-2 ag, eia Influenza a/b, ag, eia Resp syncytial ag, eia Rotavirus ag, eia Shiga-like toxin ag, eia Strep a ag, eia Ag detect nos, eia, mult Ag detect nos, eia, single Ag detect polyval, eia, mult Bartonella, dna, dir probe Bartonella, dna, amp probe Bartonella, dna, quant Lyme dis, dna, dir probe Lyme dis, dna, amp probe Lyme dis, dna, quant Candida, dna, dir probe Candida, dna, amp probe Candida, dna, quant Chylmd pneum, dna, dir probe Chylmd pneum, dna, amp probe Chylmd pneum, dna, quant Chylmd trach, dna, dir probe Chylmd trach, dna, amp probe Chylmd trach, dna, quant Cytomeg, dna, dir probe Cytomeg, dna, amp probe Cytomeg, dna, quant Enterovirus, dna, amp probe Vanomycin, dna, amp probe Gardner vag, dna, dir probe Gardner vag, dna, amp probe Gardner vag, dna, quant Hepatitis b, dna, dir probe Hepatitis b, dna, amp probe Hepatitis b, dna, quant Hepatitis c, rna, dir probe Hepatitis c, rna, amp probe Hepatitis c, rna, quant Hepatitis g, dna, dir probe Hepatitis g, dna, amp probe Hepatitis g, dna, quant Hsv, dna, dir probe Hsv, dna, amp probe Hsv, dna, quant Hhv-6, dna, dir probe Hhv-6, dna, amp probe Hhv-6, dna, quant Hiv-1, dna, dir probe Hiv-1, dna, amp probe Hiv-1, dna, quant Hiv-2, dna, dir probe Hiv-2, dna, amp probe Hiv-2, dna, quant Legion pneumo, dna, dir prob Legion pneumo, dna, amp prob Legion pneumo, dna, quant Mycobacteria, dna, dir probe Mycobacteria, dna, amp probe Mycobacteria, dna, quant M.tuberculo, dna, dir probe M.tuberculo, dna, amp probe M.tuberculo, dna, quant M.avium-intra, dna, dir prob M.avium-intra, dna, amp prob M.avium-intra, dna, quant M.pneumon, dna, dir probe M.pneumon, dna, amp probe M.pneumon, dna, quant N.gonorrhoeae, dna, dir prob N.gonorrhoeae, dna, amp prob N.gonorrhoeae, dna, quant Hpv, dna, dir probe Hpv, dna, amp probe Hpv, dna, quant Staph a, dna, amp probe Mr-staph, dna, amp probe Strep a, dna, dir probe Strep a, dna, amp probe Strep a, dna, quant Strep b, dna, amp probe Trichomonas vagin, dir probe Detect agent nos, dna, dir Detect agent nos, dna, amp Detect agent nos, dna, quant Detect agnt mult, dna, direc Detect agnt mult, dna, ampli Strep b assay w/optic Clostridium toxin a w/optic Influenza assay w/optic Rsv assay w/optic Trichomonas assay w/optic Adenovirus assay w/optic Chylmd trach assay w/optic N. gonorrhoeae assay w/optic Strep a assay w/optic Agent nos assay w/optic Phenotype, infect agent drug Genotype, dna, hiv reverse t Genotype, dna, hepatitis C Phenotype, dna hiv w/culture Phenotype, dna hiv w/clt add

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

Added 1/1/07 to book Verified w/ Angies schedule

X

Added 1/1/07 to book Added 1/1/07 to book

Added 1/1/07 to book

Added 1/1/07 to book Verified w/ Angies schedule

X

87999 88000 88005 88007 88012 88014 88016 88020 88025 88027 88028 88029 88036 88037 88040 88045 88099 88104 88106 88107 88108 88112 88125 88130 88140 88141 88142 88143 88147 88148 88150 88152 88153 88154 88155 88160 88161 88162 88164 88165 88166 88167 88172 88173 88174

Microbiology procedure Autopsy (necropsy), gross Autopsy (necropsy), gross Autopsy (necropsy), gross Autopsy (necropsy), gross Autopsy (necropsy), gross Autopsy (necropsy), gross Autopsy (necropsy), complete Autopsy (necropsy), complete Autopsy (necropsy), complete Autopsy (necropsy), complete Autopsy (necropsy), complete Limited autopsy Limited autopsy Forensic autopsy (necropsy) Coroner’s autopsy (necropsy) Necropsy (autopsy) procedure Cytopathology, fluids Cytopathology, fluids Cytopathology, fluids Cytopath, concentrate tech Cytopath, cell enhance tech Forensic cytopathology Sex chromatin identification Sex chromatin identification Cytopath, c/v, interpret Cytopath, c/v, thin layer Cytopath c/v thin layer redo Cytopath, c/v, automated Cytopath, c/v, auto rescreen Cytopath, c/v, manual Cytopath, c/v, auto redo Cytopath, c/v, redo Cytopath, c/v, select Cytopath, c/v, index add-on Cytopath smear, other source Cytopath smear, other source Cytopath smear, other source Cytopath tbs, c/v, manual Cytopath tbs, c/v, redo Cytopath tbs, c/v, auto redo Cytopath tbs, c/v, select Cytopathology eval of fna Cytopath eval, fna, report Cytopath, c/v auto, in fluid

A E E E E E E E E E E E E E E E E X X X X X X A A N A A A A A A A A A X X X A A A A X X A

3 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 X X X X X X 3 3 N 3 3 3 3 3 3 3 3 3 X X X 3 3 3 3 X X 3

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0433 0433 0343 0343 0343 0433 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0433 0433 0343 0000 0000 0000 0000 0343 0343 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.2397 0.2397 0.5142 0.5142 0.5142 0.2397 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.2397 0.2397 0.5142 0.0000 0.0000 0.0000 0.0000 0.5142 0.5142 0.0000

M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 11.45 11.45 24.56 24.56 24.56 11.45 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 11.45 11.45 24.56 M01 M01 M01 M01 24.56 24.56 M01

M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 26.11 26.11 56.01 56.01 56.01 26.11 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 26.11 26.11 56.01 M01 M01 M01 M01 56.01 56.01 M01

M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 29.92 29.92 64.19 64.19 64.19 29.92 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 29.92 29.92 64.19 M01 M01 M01 M01 64.19 64.19 M01

SI= 3, effect. 08/01/00 If needed add 282N Taxonomy

change valid sex to F

x

change valid sex to F

x

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

48 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only A X X X X X X 3 X X X X X X

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee M01 24.56 11.45 11.45 11.45 11.45 24.56

Children's Hospital Outpatient Fee M01 56.01 26.11 26.11 26.11 26.11 56.01

Critical PDD Access Update to Hospital ACS Outpatient Fee M01 64.19 29.92 29.92 29.92 29.92 64.19

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule x

88175 88182 88184 88185 88187 88188 88189

Cytopath c/v auto fluid redo Cell marker study Flowcytometry/ tc, 1 marker Flowcytometry/tc, add-on Flowcytometry/read, 2-8 Flowcytometry/read, 9-15 Flowcytometry/read, 16 & >

0000 0343 0433 0433 0433 0433 0343

0.0000 0.5142 0.2397 0.2397 0.2397 0.2397 0.5142

change valid sex to F

88199 88230 88233 88235 88237 88239 88240 88241 88245 88248 88249 88261 88262 88263 88264 88267 88269 88271 88272 88273 88274 88275 88280 88283 88285 88289 88291 88299 88300 88302 88304 88305 88307 88309 88311 88312 88313 88314 88318 88319 88321 88323 88325 88329 88331 88332 88333 88334 88342 88346 88347 88348 88349 88355 88356 88358 88360 88361 88362 88365 88367 88368 88371 88372 88380 88381 88384 88385 88386

Cytopathology procedure Tissue culture, lymphocyte Tissue culture, skin/biopsy Tissue culture, placenta Tissue culture, bone marrow Tissue culture, tumor Cell cryopreserve/storage Frozen cell preparation Chromosome analysis, 20-25 Chromosome analysis, 50-100 Chromosome analysis, 100 Chromosome analysis, 5 Chromosome analysis, 15-20 Chromosome analysis, 45 Chromosome analysis, 20-25 Chromosome analys, placenta Chromosome analys, amniotic Cytogenetics, dna probe Cytogenetics, 3-5 Cytogenetics, 10-30 Cytogenetics, 25-99 Cytogenetics, 100-300 Chromosome karyotype study Chromosome banding study Chromosome count, additional Chromosome study, additional Cyto/molecular report Cytogenetic study Surgical path, gross Tissue exam by pathologist Tissue exam by pathologist Tissue exam by pathologist Tissue exam by pathologist Tissue exam by pathologist Decalcify tissue Special stains Special stains Histochemical stain Chemical histochemistry Enzyme histochemistry Microslide consultation Microslide consultation Comprehensive review of data Path consult introp Path consult intraop, 1 bloc Path consult intraop, add’l Intraop cyto path consult, 1 Intraop cyto path consult, 2 Immunohistochemistry Immunofluorescent study Immunofluorescent study Electron microscopy Scanning electron microscopy Analysis, skeletal muscle Analysis, nerve Analysis, tumor Tumor immunohistochem/manual Tumor immunohistochem/comput Nerve teasing preparations Insitu hybridization (fish) Insitu hybridization, auto Insitu hybridization, manual Protein, western blot tissue Protein analysis w/probe Microdissection, laser Microdissection, manual Eval molecular probes, 11-50 Eval molecul probes, 51-250 Eval molecul probes, 251-500

X A A A A A A A A A A A A A A A A A A A A A A A A A M X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X A A N N X X X

X 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 1 1 X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X 3 3 N N X X X

0342 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0342 0433 0433 0343 0343 0344 0344 0433 0433 0433 0433 0433 0433 0433 0343 0344 0433 0343 0433 0343 0433 0343 0343 0343 0661 0661 0343 0344 0344 0343 0344 0344 0344 0344 0343 0000 0000 0000 0000 0433 0343 0344

0.0969 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0969 0.2397 0.2397 0.5142 0.5142 0.8167 0.8167 0.2397 0.2397 0.2397 0.2397 0.2397 0.2397 0.2397 0.5142 0.8167 0.2397 0.5142 0.2397 0.5142 0.2397 0.5142 0.5142 0.5142 2.6949 2.6949 0.5142 0.8167 0.8167 0.5142 0.8167 0.8167 0.8167 0.8167 0.5142 0.0000 0.0000 0.0000 0.0000 0.2397 0.5142 0.8167

4.63 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 11.45 11.45 24.56 24.56 39.01 39.01 11.45 11.45 11.45 11.45 11.45 11.45 11.45 24.56 39.01 11.45 24.56 11.45 24.56 11.45 24.56 24.56 24.56 128.74 128.74 24.56 39.01 39.01 24.56 39.01 39.01 39.01 39.01 24.56 M01 M01 0.00 0.00 11.45 24.56 39.01

10.55 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 26.11 26.11 56.01 56.01 88.95 88.95 26.11 26.11 26.11 26.11 26.11 26.11 26.11 56.01 88.95 26.11 56.01 26.11 56.01 26.11 56.01 56.01 56.01 293.53 293.53 56.01 88.95 88.95 56.01 88.95 88.95 88.95 88.95 56.01 M01 M01 0.00 0.00 26.11 56.01 88.95

12.10 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 29.92 29.92 64.19 64.19 101.96 101.96 29.92 29.92 29.92 29.92 29.92 29.92 29.92 64.19 101.96 29.92 64.19 29.92 64.19 29.92 64.19 64.19 64.19 336.43 336.43 64.19 101.96 101.96 64.19 101.96 101.96 101.96 101.96 64.19 M01 M01 0.00 0.00 29.92 64.19 101.96

SI= X, effect. 05/01/06 If needed add 282N Taxonomy

Description Change Verified w/ Angies schedule

x X

88399 88400 89049 89050 89051 89055 89060 89100 89105 89125 89130 89132 89135 89136 89140 89141 89160 89190 89220 89225 89230 89235

Surgical pathology procedure Bilirubin total transcut Chct for mal hyperthermia Body fluid cell count Body fluid cell count Leukocyte assessment, fecal Exam,synovial fluid crystals Sample intestinal contents Sample intestinal contents Specimen fat stain Sample stomach contents Sample stomach contents Sample stomach contents Sample stomach contents Sample stomach contents Sample stomach contents Exam feces for meat fibers Nasal smear for eosinophils Sputum specimen collection Starch granules, feces Collect sweat for test Water load test

X A X A A A A X X A X X X X X X A A X A X A

X 3 X 3 3 3 3 X X 3 X X X X X X 3 3 X 3 X 3

0342 0000 0343 0000 0000 0000 0000 0360 0360 0000 0360 0360 0360 0360 0360 0360 0000 0000 0343 0000 0343 0000

0.0969 0.0000 0.5142 0.0000 0.0000 0.0000 0.0000 1.5330 1.5330 0.0000 1.5330 1.5330 1.5330 1.5330 1.5330 1.5330 0.0000 0.0000 0.5142 0.0000 0.5142 0.0000

4.63 M01 24.56 M01 M01 M01 M01 73.23 73.23 M01 73.23 73.23 73.23 73.23 73.23 73.23 M01 M01 24.56 M01 24.56 M01

10.55 M01 56.01 M01 M01 M01 M01 166.97 166.97 M01 166.97 166.97 166.97 166.97 166.97 166.97 M01 M01 56.01 M01 56.01 M01

12.10 M01 64.19 M01 M01 M01 M01 191.38 191.38 M01 191.38 191.38 191.38 191.38 191.38 191.38 M01 M01 64.19 M01 64.19 M01

SI= X, effect. 05/01/06 If needed add 282N Taxonomy

89240 89250 89251 89253 89254 89255 89257 89258 89259 89260 89261 89264 89268 89272 89280 89281 89290 89291 89300 89310 89320 89321 89322 89325 89329 89330 89331 89335 89342 89343 89344 89346 89352 89353 89354 89356 90281 90283 90284 90287 90288 90291 90296 90371 90375 90376 90378 90379 90384 90385 90386 90389 90393 90396 90399 90465 90466 90467 90468

Pathology lab procedure Cultr oocyte/embryo <4 days Cultr oocyte/embryo <4 days Embryo hatching Oocyte identification Prepare embryo for transfer Sperm identification Cryopreservation; embryo(s) Cryopreservation, sperm Sperm isolation, simple Sperm isolation, complex Identify sperm tissue Insemination of oocytes Extended culture of oocytes Assist oocyte fertilization Assist oocyte fertilization Biopsy, oocyte polar body Biopsy, oocyte polar body Semen analysis w/huhner Semen analysis w/count Semen anal vol/count/mot Semen anal, sperm detection Semen anal, strict criteria Sperm antibody test Sperm evaluation test Evaluation, cervical mucus Retrograde ejaculation anal Cryopreserve testicular tiss Storage/year; embryo(s) Storage/year; sperm/semen Storage/year; reprod tissue Storage/year; oocyte(s) Thawing cryopresrved; embryo Thawing cryopresrved; sperm Thaw cryoprsvrd; reprod tiss Thawing cryopresrved; oocyte Human ig, im Human ig, iv Human ig, sc Botulinum antitoxin Botulism ig, iv Cmv ig, iv Diphtheria antitoxin Hep b ig, im Rabies ig, im/sc Rabies ig, heat treated Rsv ig, im, 50mg Rsv ig, iv Rh ig, full-dose, im Rh ig, minidose, im Rh ig, iv Tetanus ig, im Vaccina ig, im Varicella-zoster ig, im Immune globulin Immune admin 1 inj, < 8 yrs Immune admin addl inj, < 8 y Immune admin o or n, < 8 yrs Immune admin o/n, addl < 8 y

X X X X X X X X X X X X X X X X X X A A A A A A A A A X X X X X X X X X E E E E E E N K K K E E E N E E N K E B B B B

X 1 1 1 1 1 1 1 1 1 1 X 1 1 1 1 1 1 3 3 3 3 3 1 1 1 3 1 1 1 1 1 1 1 1 1 1 1 1 1 3 1 N K K K 3 3 1 N 1 3 N K 1 B B B B

0342 0344 0344 0344 0344 0344 0344 0344 0344 0344 0344 0344 0344 0344 0344 0344 0344 0344 0000 0000 0000 0000 0000 0000 0000 0000 0000 0344 0344 0344 0344 0344 0344 0344 0344 0344 0000 0000 0000 0000 0000 0000 0000 1630 9133 9134 0000 0000 0000 0000 0000 0000 0000 9135 0000 0000 0000 0000 0000

0.0969 0.8167 0.8167 0.8167 0.8167 0.8167 0.8167 0.8167 0.8167 0.8167 0.8167 0.8167 0.8167 0.8167 0.8167 0.8167 0.8167 0.8167 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.8167 0.8167 0.8167 0.8167 0.8167 0.8167 0.8167 0.8167 0.8167 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 1.9046 1.0676 1.1599 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 1.9088 0.0000 0.0000 0.0000 0.0000 0.0000

* * *

*

4.63 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 39.01 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 M01 M01 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 90.98 51.00 55.41 M01 M01 0.00 0.00 0.00 M01 0.00 91.18 0.00 0.00 0.00 0.00 0.00

10.55 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 88.95 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 M01 M01 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 207.45 116.28 126.34 M01 M01 0.00 0.00 0.00 M01 0.00 207.91 0.00 0.00 0.00 0.00 0.00

12.10 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 101.96 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 M01 M01 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 237.77 133.28 144.80 M01 M01 0.00 0.00 0.00 M01 0.00 238.30 0.00 0.00 0.00 0.00 0.00

SI= X, effect. 05/01/06 If needed add 282N Taxonomy

Description Change Description Change Verified w/ Angies schedule

x x X

Verified w/ Angies schedule

X

X

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

49 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only S S S S N N N K B N N N N N N N N B E L L L L L E E E N L K K N E N N N B E N N N N N N N N N K N N N N N B N N N N N E N N L K K K B F F F F F E N S S S S S N S S S S S S S N S Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q S E E Q E N N N Q A T E E E E E E E E S B N S B B B B 3 3 3 3 1 N N K B 3 3 3 3 3 N 3 3 3 1 L L L L L 1 1 1 N 3 K K 3 3 N N N B 3 N 3 3 3 N N N N 3 K 3 N 3 1 3 3 N 3 N N N 3 N N L K 3 K B F 3 3 3 F 3 1 S S S S S N S S S S S S S N 1 Q Q Q Q Q Q Q Q Q Q Q Q Q Q 1 1 1 1 1 1 1 1 1 1 1 1 Q Q Q Q Q Q Q 1 S 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 S B N S B B B B

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee M01 M01 M01 M01 0.00 0.00 0.00 89.48 0.00 M01 M01 M01 M01 M01 0.00 M01 M01 M01 0.00

Children's Hospital Outpatient Fee M01 M01 M01 M01 0.00 0.00 0.00 204.03 0.00 M01 M01 M01 M01 M01 0.00 M01 M01 M01 0.00

Critical PDD Access Update to Hospital ACS Outpatient Fee M01 M01 M01 M01 0.00 0.00 0.00 233.85 0.00 M01 M01 M01 M01 M01 0.00 M01 M01 M01 0.00

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

90471 90472 90473 90474 90476 90477 90581 90585 90586 90632 90633 90634 90636 90645 90646 90647 90648 90649 90650 90655 90656 90657 90658 90660 90661 90662 90663 90665 90669 90675 90676 90680 90681 90690 90691 90692 90693 90696 90698 90700 90701 90702 90703 90704 90705 90706 90707 90708 90710 90712 90713 90714 90715 90716 90717 90718 90719 90720 90721 90723 90725 90727 90732 90733 90734 90735 90736 90740 90743 90744 90746 90747 90748 90749 90760 90761 90765 90766 90767 90768 90769 90770 90771 90772 90773 90774 90775 90776 90779 90801 90802 90804 90805 90806 90807 90808 90809 90810 90811 90812 90813 90814 90815 90816 90817 90818 90819 90821 90822 90823 90824 90826 90827 90828 90829 90845 90846 90847 90849 90853 90857 90862 90865 90870 90875 90876 90880 90882 90885 90887 90889 90899 90901 90911 90918 90919 90920 90921 90922 90923 90924 90925 90935 90937 90940 90945 90947 90989 90993 90997

Immunization admin Immunization admin, each add Immune admin oral/nasal Immune admin oral/nasal addl Adenovirus vaccine, type 4 Adenovirus vaccine, type 7 Anthrax vaccine, sc Bcg vaccine, percut Bcg vaccine, intravesical Hep a vaccine, adult im Hep a vacc, ped/adol, 2 dose Hep a vacc, ped/adol, 3 dose Hep a/hep b vacc, adult im Hib vaccine, hboc, im Hib vaccine, prp-d, im Hib vaccine, prp-omp, im Hib vaccine, prp-t, im H papilloma vacc 3 dose im Hpv typ bival 3 dose im Flu vaccine no preserv 6-35m Flu vaccine no preserv 3 & > Flu vaccine, 3 yrs, im Flu vaccine, 3 yrs & >, im Flu vaccine, nasal Flu vacc cell cult prsv free Flu vacc prsv free inc antig Flu vacc pandemic Lyme disease vaccine, im Pneumococcal vacc, ped <5 Rabies vaccine, im Rabies vaccine, id Rotovirus vaccine, oral Rotovirus vacc 2 dose oral Typhoid vaccine, oral Typhoid vaccine, im Typhoid vaccine, h-p, sc/id Typhoid vaccine, akd, sc Dtap-ipv vacc 4-6 yr im Dtap-hib-ip vaccine, im Dtap vaccine, < 7 yrs, im Dtp vaccine, im Dt vaccine < 7, im Tetanus vaccine, im Mumps vaccine, sc Measles vaccine, sc Rubella vaccine, sc Mmr vaccine, sc Measles-rubella vaccine, sc Mmrv vaccine, sc Oral poliovirus vaccine Poliovirus, ipv, sc Td vaccine no prsrv >/= 7 im Tdap vaccine >7 im Chicken pox vaccine, sc Yellow fever vaccine, sc Td vaccine > 7, im Diphtheria vaccine, im Dtp/hib vaccine, im Dtap/hib vaccine, im Dtap-hep b-ipv vaccine, im Cholera vaccine, injectable Plague vaccine, im Pneumococcal vaccine Meningococcal vaccine, sc Meningococcal vaccine, im Encephalitis vaccine, sc Zoster vacc, sc Hepb vacc, ill pat 3 dose im Hep b vacc, adol, 2 dose, im Hepb vacc ped/adol 3 dose im Hep b vaccine, adult, im Hepb vacc, ill pat 4 dose im Hep b/hib vaccine, im Vaccine toxoid Hydration iv infusion, init Hydrate iv infusion, add-on Ther/proph/diag iv inf, init Ther/proph/dg iv inf, add-on Tx/proph/dg addl seq iv inf Ther/diag concurrent inf Sc ther infusion, up to 1 hr Sc ther infusion, addl hr Sc ther infusion, reset pump Ther/proph/diag inj, sc/im Ther/proph/diag inj, ia Ther/proph/diag inj, iv push Tx/pro/dx inj new drug addon Tx/pro/dx inj same drug adon Ther/prop/diag inj/inf proc Psy dx interview Intac psy dx interview Psytx, office, 20-30 min Psytx, off, 20-30 min w/e&m Psytx, off, 45-50 min Psytx, off, 45-50 min w/e&m Psytx, office, 75-80 min Psytx, off, 75-80, w/e&m Intac psytx, off, 20-30 min Intac psytx, 20-30, w/e&m Intac psytx, off, 45-50 min Intac psytx, 45-50 min w/e&m Intac psytx, off, 75-80 min Intac psytx, 75-80 w/e&m Psytx, hosp, 20-30 min Psytx, hosp, 20-30 min w/e&m Psytx, hosp, 45-50 min Psytx, hosp, 45-50 min w/e&m Psytx, hosp, 75-80 min Psytx, hosp, 75-80 min w/e&m Intac psytx, hosp, 20-30 min Intac psytx, hsp 20-30 w/e&m Intac psytx, hosp, 45-50 min Intac psytx, hsp 45-50 w/e&m Intac psytx, hosp, 75-80 min Intac psytx, hsp 75-80 w/e&m Psychoanalysis Family psytx w/o patient Family psytx w/patient Multiple family group psytx Group psychotherapy Intac group psytx Medication management Narcosynthesis Electroconvulsive therapy Psychophysiological therapy Psychophysiological therapy Hypnotherapy Environmental manipulation Psy evaluation of records Consultation with family Preparation of report Psychiatric service/therapy Biofeedback train, any meth Biofeedback peri/uro/rectal ESRD related services, month ESRD related services, month ESRD related services, month ESRD related services, month ESRD related services, day Esrd related services, day Esrd related services, day Esrd related services, day Hemodialysis, one evaluation Hemodialysis, repeated eval Hemodialysis access study Dialysis, one evaluation Dialysis, repeated eval Dialysis training, complete Dialysis training, incompl Hemoperfusion

0437 0436 0436 0436 0000 0000 0000 9137 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 9139 9140 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 9141 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 9143 9145 9144 0000 0000 0000 0000 0000 0000 0000 0000 0440 0437 0440 0437 0437 0000 0440 0437 0438 0437 0438 0438 0438 0000 0436 0323 0323 0322 0322 0323 0323 0323 0323 0322 0322 0323 0323 0323 0323 0322 0322 0323 0323 0323 0323 0322 0322 0323 0323 0323 0323 0323 0324 0324 0325 0325 0325 0606 0323 0320 0000 0000 0323 0000 0000 0000 0000 0322 0000 0126 0000 0000 0000 0000 0000 0000 0000 0000 0170 0000 0000 0170 0000 0000 0000 0000

0.3945 0.2545 0.2545 0.2545 0.0000 0.0000 0.0000 1.8732 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 2.4068 1.8655 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 1.0422 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 1.3391 1.2753 1.5413 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 1.7998 0.3945 1.7998 0.3945 0.3945 0.0000 1.7998 0.3945 0.8041 0.3945 0.8041 0.8041 0.8041 0.0000 0.2545 1.6044 1.6044 1.1729 1.1729 1.6044 1.6044 1.6044 1.6044 1.1729 1.1729 1.6044 1.6044 1.6044 1.6044 1.1729 1.1729 1.6044 1.6044 1.6044 1.6044 1.1729 1.1729 1.6044 1.6044 1.6044 1.6044 1.6044 2.3616 2.3616 0.9913 0.9913 0.9913 1.3226 1.6044 5.7299 0.0000 0.0000 1.6044 0.0000 0.0000 0.0000 0.0000 1.1729 0.0000 1.0356 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 6.5383 0.0000 0.0000 6.5383 0.0000 0.0000 0.0000 0.0000

SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155)

*

X

APC by Report APC by Report APC by Report APC by Report APC by Report APC by Report APC by Report APC by Report APC by Report APC by Report APC by Report APC by Report APC by Report APC by Report APC by Report 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 114.97 262.15 300.47 89.11 203.19 232.89 M01 M01 M01 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 0.00 0.00 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 49.78 113.51 130.10 M01 M01 M01 0.00 0.00 0.00 M01 M01 M01 0.00 0.00 0.00 M01 M01 M01 M01 M01 M01 0.00 0.00 0.00 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 APC by Report APC by Report APC by Report 63.97 145.85 167.17 M01 M01 M01 73.63 167.88 192.41 0.00 0.00 0.00 SI change retro 4/1/06 (TR 1155)

X X X SI change 1/1/07 (TR 1155) X

* *

Not yet decided by Sheree

X

SI change 1/1/07 (TR 1155) Not yet decided by Sheree

X

*

SI change 1/1/07 (TR 1155)

SI change 1/1/07 (TR 1155)

SI change 1/1/07 (TR 1155)

X

SI change 1/1/07 (TR 1155)

X

* * *

APC by Report APC by Report APC by Report M01 M01 M01 M01 M01 M01 M01 M01 M01 APC by Report APC by Report APC by Report M01 M01 M01 0.00 0.00 0.00 85.98 196.03 224.69 18.85 42.97 49.25 85.98 196.03 224.69 18.85 42.97 49.25 18.85 42.97 49.25 0.00 0.00 0.00 85.98 196.03 224.69 18.85 42.97 49.25 38.41 87.58 100.38 18.85 42.97 49.25 38.41 87.58 100.38 38.41 87.58 100.38 38.41 0.00 0.00 76.64 76.64 56.03 56.03 76.64 76.64 76.64 76.64 56.03 56.03 76.64 76.64 76.64 76.64 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 76.64 112.81 112.81 47.35 47.35 47.35 63.18 0.00 273.72 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 312.33 0.00 0.00 312.33 0.00 0.00 0.00 0.00 87.58 0.00 0.00 174.75 174.75 127.75 127.75 174.75 174.75 174.75 174.75 127.75 127.75 174.75 174.75 174.75 174.75 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 174.75 257.23 257.23 107.97 107.97 107.97 144.06 0.00 624.10 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 712.15 0.00 0.00 712.15 0.00 0.00 0.00 0.00 100.38 0.00 0.00 200.29 200.29 146.42 146.42 200.29 200.29 200.29 200.29 146.42 146.42 200.29 200.29 200.29 200.29 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 200.29 294.82 294.82 123.75 123.75 123.75 165.11 0.00 715.32 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 816.24 0.00 0.00 816.24 0.00 0.00 0.00 0.00

SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) X X X SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) description change SI change 1/1/07 (TR 1155) X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X

x X

X

X X

SI change 1/1/07 (Addendum B)

SI change 1/1/07 (Addendum B)

SI change 1/1/07 (Addendum B)

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

50 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only B X X X X X X X X X X X X X X X X X T T T T N X X X V V V V E T T S S S S N S S S N S S S S S S S S S S S S S S S S S S S S E S S S E S S S S S E E E S S S S S E S S T N A A A T X X X A N N N N X X X X X X N X E X X X X X E E X X X X X X X X X X X X X X X X S S S X X E E E E E E X A X X X X A A A A A A A A B A E A E X N X 1 X X X X X X X X X X X X X X X X X T T T T N X X 1 V V V V 3 T T S S S S N S S S N S S S S S S S S S S S S S S S S S S S S 3 S S S 3 S S S S S 3 3 3 S S S S 1 3 S 1 T N 3 3 3 T X X X 3 N N N N X X X X X X N X 3 X X X X X 1 1 X X X X X X X X X X X X X X X X S S S X X 3 3 3 3 3 3 X 1 X X X X 1 1 1 1 1 3 3 3 B 3 1 3 1 X N X

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 0.00 187.62 187.62 187.62 187.62 187.62 187.62 187.62 187.62 187.62 187.62 187.62 73.23 187.62 73.23 73.23 73.23 73.23 455.21 406.19 49.47 95.91 0.00 73.23 73.23 0.00 47.60 63.18 40.07 47.60 M01 656.61 656.61 28.20 41.54 41.54 41.54 0.00 28.20 41.54 41.54 0.00 41.54 28.20 28.20 41.54 28.20 28.20 41.54 104.09 104.09 104.09 41.54 28.20 41.54 28.20 104.09 28.20 41.54 41.54 104.09 104.09 M01 41.54 41.54 28.20 M01 28.20 41.54 28.20 28.20 41.54 M01 M01 M01 41.54 28.20 28.20 28.20 0.00 M01 28.20 0.00 119.43 0.00 M01 M01 M01 39.29 38.54 68.37 68.37 M01 0.00 0.00 0.00 0.00 38.54 38.54 68.37 38.54 38.54 68.37 0.00 68.37 M01 21.45 59.95 21.45 21.45 59.95 0.00 0.00 21.45 21.45 21.45 21.45 21.45 21.45 21.45 21.45 21.45 84.19 21.45 21.45 84.19 59.95 59.95 21.45 128.24 128.24 55.17 38.54 68.37 M01 M01 M01 M01 M01 M01 21.45 0.00 84.19 84.19 84.19 84.19 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 0.00 M01 0.00 M01 0.00 59.95 0.00 59.95

Children's Hospital Outpatient Fee 0.00 427.79 427.79 427.79 427.79 427.79 427.79 427.79 427.79 427.79 427.79 427.79 166.97 427.79 166.97 166.97 166.97 166.97 1,037.92 926.15 112.80 218.68 0.00 166.97 166.97 0.00 108.53 144.06 91.36 108.53 M01 1,497.14 1,497.14 64.30 94.72 94.72 94.72 0.00 64.30 94.72 94.72 0.00 94.72 64.30 64.30 94.72 64.30 64.30 94.72 237.34 237.34 237.34 94.72 64.30 94.72 64.30 237.34 64.30 94.72 94.72 237.34 237.34 M01 94.72 94.72 64.30 M01 64.30 94.72 64.30 64.30 94.72 M01 M01 M01 94.72 64.30 64.30 64.30 0.00 M01 64.30 0.00 272.32 0.00 M01 M01 M01 89.58 87.87 155.89 155.89 M01 0.00 0.00 0.00 0.00 87.87 87.87 155.89 87.87 87.87 155.89 0.00 155.89 M01 48.91 136.68 48.91 48.91 136.68 0.00 0.00 48.91 48.91 48.91 48.91 48.91 48.91 48.91 48.91 48.91 191.96 48.91 48.91 191.96 136.68 136.68 48.91 292.41 292.41 125.80 87.87 155.89 M01 M01 M01 M01 M01 M01 48.91 0.00 191.96 191.96 191.96 191.96 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 0.00 M01 0.00 M01 0.00 136.68 0.00 136.68

Critical PDD Access Update to Hospital ACS Outpatient Fee 0.00 490.32 490.32 490.32 490.32 490.32 490.32 490.32 490.32 490.32 490.32 490.32 191.38 490.32 191.38 191.38 191.38 191.38 1,189.63 1,061.51 129.28 250.64 0.00 191.38 191.38 0.00 124.39 165.11 104.72 124.39 M01 1,715.96 1,715.96 73.69 108.56 108.56 108.56 0.00 73.69 108.56 108.56 0.00 108.56 73.69 73.69 108.56 73.69 73.69 108.56 272.03 272.03 272.03 108.56 73.69 108.56 73.69 272.03 73.69 108.56 108.56 272.03 272.03 M01 108.56 108.56 73.69 M01 73.69 108.56 73.69 73.69 108.56 M01 M01 M01 108.56 73.69 73.69 73.69 0.00 M01 73.69 0.00 312.12 0.00 M01 M01 M01 102.67 100.71 178.67 178.67 M01 0.00 0.00 0.00 0.00 100.71 100.71 178.67 100.71 100.71 178.67 0.00 178.67 M01 56.05 156.66 56.05 56.05 156.66 0.00 0.00 56.05 56.05 56.05 56.05 56.05 56.05 56.05 56.05 56.05 220.02 56.05 56.05 220.02 156.66 156.66 56.05 335.15 335.15 144.19 100.71 178.67 M01 M01 M01 M01 M01 M01 56.05 0.00 220.02 220.02 220.02 220.02 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 0.00 M01 0.00 M01 0.00 156.66 0.00 156.66

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

90999 91000 91010 91011 91012 91020 91022 91030 91034 91035 91037 91038 91040 91052 91055 91065 91100 91105 91110 91111 91120 91122 91123 91132 91133 91299 92002 92004 92012 92014 92015 92018 92019 92020 92025 92060 92065 92070 92081 92082 92083 92100 92120 92130 92135 92136 92140 92225 92226 92230 92235 92240 92250 92260 92265 92270 92275 92283 92284 92285 92286 92287 92310 92311 92312 92313 92314 92315 92316 92317 92325 92326 92340 92341 92342 92352 92353 92354 92355 92358 92370 92371 92499 92502 92504 92506 92507 92508 92511 92512 92516 92520 92526 92531 92532 92533 92534 92541 92542 92543 92544 92545 92546 92547 92548 92551 92552 92553 92555 92556 92557 92559 92560 92561 92562 92563 92564 92565 92567 92568 92569 92571 92572 92575 92576 92577 92579 92582 92583 92584 92585 92586 92587 92588 92590 92591 92592 92593 92594 92595 92596 92597 92601 92602 92603 92604 92605 92606 92607 92608 92609 92610 92611 92612 92613 92614 92615 92616 92617 92620 92621 92625

Dialysis procedure Esophageal intubation Esophagus motility study Esophagus motility study Esophagus motility study Gastric motility Duodenal motility study Acid perfusion of esophagus Gastroesophageal reflux test G-esoph reflx tst w/electrod Esoph imped function test Esoph imped funct test > 1h Esoph balloon distension tst Gastric analysis test Gastric intubation for smear Breath hydrogen test Pass intestine bleeding tube Gastric intubation treatment Gi tract capsule endoscopy Esophageal capsule endoscopy Rectal sensation test Anal pressure record Irrigate fecal impaction Electrogastrography Electrogastrography w/test Gastroenterology procedure Eye exam, new patient Eye exam, new patient Eye exam established pat Eye exam & treatment Refraction New eye exam & treatment Eye exam & treatment Special eye evaluation Corneal topography Special eye evaluation Orthoptic/pleoptic training Fitting of contact lens Visual field examination(s) Visual field examination(s) Visual field examination(s) Serial tonometry exam(s) Tonography & eye evaluation Water provocation tonography Ophth dx imaging post seg Ophthalmic biometry Glaucoma provocative tests Special eye exam, initial Special eye exam, subsequent Eye exam with photos Eye exam with photos Icg angiography Eye exam with photos Ophthalmoscopy/dynamometry Eye muscle evaluation Electro-oculography Electroretinography Color vision examination Dark adaptation eye exam Eye photography Internal eye photography Internal eye photography Contact lens fitting Contact lens fitting Contact lens fitting Contact lens fitting Prescription of contact lens Prescription of contact lens Prescription of contact lens Prescription of contact lens Modification of contact lens Replacement of contact lens Fitting of spectacles Fitting of spectacles Fitting of spectacles Special spectacles fitting Special spectacles fitting Special spectacles fitting Special spectacles fitting Eye prosthesis service Repair & adjust spectacles Repair & adjust spectacles Eye service or procedure Ear and throat examination Ear microscopy examination Speech/hearing evaluation Speech/hearing therapy Speech/hearing therapy Nasopharyngoscopy Nasal function studies Facial nerve function test Laryngeal function studies Oral function therapy Spontaneous nystagmus study Positional nystagmus test Caloric vestibular test Optokinetic nystagmus test Spontaneous nystagmus test Positional nystagmus test Caloric vestibular test Optokinetic nystagmus test Oscillating tracking test Sinusoidal rotational test Supplemental electrical test Posturography Pure tone hearing test, air Pure tone audiometry, air Audiometry, air & bone Speech threshold audiometry Speech audiometry, complete Comprehensive hearing test Group audiometric testing Bekesy audiometry, screen Bekesy audiometry, diagnosis Loudness balance test Tone decay hearing test Sisi hearing test Stenger test, pure tone Tympanometry Acoustic reflex testing Acoustic reflex decay test Filtered speech hearing test Staggered spondaic word test Sensorineural acuity test Synthetic sentence test Stenger test, speech Visual audiometry (vra) Conditioning play audiometry Select picture audiometry Electrocochleography Auditor evoke potent, compre Auditor evoke potent, limit Evoked auditory test Evoked auditory test Hearing aid exam, one ear Hearing aid exam, both ears Hearing aid check, one ear Hearing aid check, both ears Electro hearng aid test, one Electro hearng aid tst, both Ear protector evaluation Oral speech device eval Cochlear implt f/up exam < 7 Reprogram cochlear implt < 7 Cochlear implt f/up exam 7 > Reprogram cochlear implt 7 > Eval for nonspeech device rx Non-speech device service Ex for speech device rx, 1hr Ex for speech device rx addl Use of speech device service Evaluate swallowing function Motion fluoroscopy/swallow Endoscopy swallow tst (fees) Endoscopy swallow tst (fees) Laryngoscopic sensory test Eval laryngoscopy sense tst Fees w/laryngeal sense test Interprt fees/laryngeal test Auditory function, 60 min Auditory function, + 15 min Tinnitus assessment

0000 0361 0361 0361 0361 0361 0361 0361 0361 0361 0361 0361 0360 0361 0360 0360 0360 0360 0142 0141 0126 0164 0000 0360 0360 0360 0605 0606 0604 0605 0000 0699 0699 0230 0698 0698 0698 0000 0230 0698 0698 0000 0698 0230 0230 0698 0230 0230 0698 0231 0231 0231 0698 0230 0698 0230 0231 0230 0698 0698 0231 0231 0000 0698 0698 0230 0000 0230 0698 0230 0230 0698 0000 0000 0000 0698 0230 0230 0230 0230 0000 0230 0230 0251 0000 0000 0000 0000 0071 0363 0660 0660 0000 0000 0000 0000 0000 0363 0363 0660 0363 0363 0660 0000 0660 0000 0364 0365 0364 0364 0365 0000 0000 0364 0364 0364 0364 0364 0364 0364 0364 0364 0366 0364 0364 0366 0365 0365 0364 0216 0216 0218 0363 0660 0000 0000 0000 0000 0000 0000 0364 0000 0366 0366 0366 0366 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0365 0000 0365

0.0000 3.9276 3.9276 3.9276 3.9276 3.9276 3.9276 3.9276 3.9276 3.9276 3.9276 3.9276 1.5330 3.9276 1.5330 1.5330 1.5330 1.5330 9.5292 8.5030 1.0356 2.0077 0.0000 1.5330 1.5330 1.5330 0.9964 1.3226 0.8388 0.9964 0.0000 13.7453 13.7453 0.5903 0.8696 0.8696 0.8696 0.0000 0.5903 0.8696 0.8696 0.0000 0.8696 0.5903 0.5903 0.8696 0.5903 0.5903 0.8696 2.1790 2.1790 2.1790 0.8696 0.5903 0.8696 0.5903 2.1790 0.5903 0.8696 0.8696 2.1790 2.1790 0.0000 0.8696 0.8696 0.5903 0.0000 0.5903 0.8696 0.5903 0.5903 0.8696 0.0000 0.0000 0.0000 0.8696 0.5903 0.5903 0.5903 0.5903 0.0000 0.5903 0.5903 2.5002 0.0000 0.0000 0.0000 0.0000 0.8224 0.8067 1.4312 1.4312 0.0000 0.0000 0.0000 0.0000 0.0000 0.8067 0.8067 1.4312 0.8067 0.8067 1.4312 0.0000 1.4312 0.0000 0.4490 1.2549 0.4490 0.4490 1.2549 0.0000 0.0000 0.4490 0.4490 0.4490 0.4490 0.4490 0.4490 0.4490 0.4490 0.4490 1.7624 0.4490 0.4490 1.7624 1.2549 1.2549 0.4490 2.6846 2.6846 1.1550 0.8067 1.4312 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.4490 0.0000 1.7624 1.7624 1.7624 1.7624 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 1.2549 0.0000 1.2549

SI change 1/1/07 (TR 1155)

Added 1/1/07 to book

Added 1/1/07 to book

description change

x

SI change 1/1/07 (TR 1155)

X X X X X X X X

X X X X X X

X

X

SI change 1/1/07 (Addendum B)

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

51 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only X N E E X X S S S S C C T T C T N N T T T T T T T C C T T T T B S B N B B B X B X X B S B B X X B B X X B B X B B X S B X S S S S S S N S S N S N N N S T T T T T T T T T T T T T T T T N N N N N N N N N N N N N T T S S S N S S N S S S Q Q N N N T N N N S Q Q Q S N E S B X B S S S S S S S S X S S S S S E E N E X X B S S X S S X N 3 3 X 1 S S S S C C T T C T N N T T T T T T T C C T T T T B S B N B B B X B X X B S B B X X B B X X B B X B B X S B X S S S S S S N S S N S N N N S T T T T T T T T T T T T T T T T N N N N N N N N N N N N N T T S S S N S S N S S S Q Q N N N T N N N S Q Q Q S N 3 S B X B S S S S S S S S X S S S S S 1 3 N 1 X X B S S 1 S S

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 59.95 0.00 M01 M01 59.95 0.00 117.47 117.47 260.36 260.36 0.00 0.00 1,851.91 700.19 0.00 118.58 0.00 0.00 4,252.29 4,252.29 2,168.02 2,168.02 2,168.02 2,168.02 2,168.02 0.00 0.00 4,180.53 4,180.53 2,168.02 2,168.02 0.00 18.59 0.00 0.00 0.00 0.00 0.00 122.04 0.00 122.04 122.04 0.00 18.59 0.00 0.00 47.84 47.84 0.00 0.00 47.84 47.84 0.00 0.00 47.84 0.00 0.00 47.84 73.15 0.00 30.14 304.54 159.56 304.54 159.56 392.50 392.50 0.00 392.50 392.50 0.00 392.50 0.00 0.00 0.00 304.54 1,859.23 700.19 700.19 1,859.23 1,859.23 1,859.23 1,859.23 1,859.23 1,859.23 1,859.23 1,859.23 1,859.23 1,859.23 1,859.23 1,859.23 1,859.23 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 6,325.36 6,325.36 457.80 457.80 457.80 0.00 457.80 457.80 0.00 457.80 457.80 457.80 2,259.28 2,259.28 0.00 0.00 0.00 2,259.28 0.00 0.00 0.00 457.80 2,259.28 4,435.75 4,435.75 200.51 0.00 M01 18.59 0.00 44.20 0.00 16.74 16.74 16.74 16.74 16.74 16.74 16.74 16.74 44.20 28.40 28.40 28.40 28.40 28.40 0.00 M01 0.00 0.00 47.84 47.84 0.00 27.16 27.16 0.00 70.17 113.65

Children's Hospital Outpatient Fee 136.68 0.00 M01 M01 136.68 0.00 267.83 267.83 593.64 593.64 0.00 0.00 4,222.53 1,596.51 0.00 270.38 0.00 0.00 9,695.61 9,695.61 4,943.28 4,943.28 4,943.28 4,943.28 4,943.28 0.00 0.00 9,531.99 9,531.99 4,943.28 4,943.28 0.00 42.39 0.00 0.00 0.00 0.00 0.00 278.26 0.00 278.26 278.26 0.00 42.39 0.00 0.00 109.08 109.08 0.00 0.00 109.08 109.08 0.00 0.00 109.08 0.00 0.00 109.08 166.79 0.00 68.73 694.38 363.80 694.38 363.80 894.94 894.94 0.00 894.94 894.94 0.00 894.94 0.00 0.00 0.00 694.38 4,239.21 1,596.51 1,596.51 4,239.21 4,239.21 4,239.21 4,239.21 4,239.21 4,239.21 4,239.21 4,239.21 4,239.21 4,239.21 4,239.21 4,239.21 4,239.21 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 14,422.41 14,422.41 1,043.82 1,043.82 1,043.82 0.00 1,043.82 1,043.82 0.00 1,043.82 1,043.82 1,043.82 5,151.36 5,151.36 0.00 0.00 0.00 5,151.36 0.00 0.00 0.00 1,043.82 5,151.36 10,113.92 10,113.92 457.17 0.00 M01 42.39 0.00 100.78 0.00 38.17 38.17 38.17 38.17 38.17 38.17 38.17 38.17 100.78 64.76 64.76 64.76 64.76 64.76 0.00 M01 0.00 0.00 109.08 109.08 0.00 61.92 61.92 0.00 159.99 259.14

Critical PDD Access Update to Hospital ACS Outpatient Fee 156.66 0.00 M01 M01 156.66 0.00 306.98 306.98 680.40 680.40 0.00 0.00 4,839.71 1,829.85 0.00 309.90 0.00 0.00 11,112.74 11,112.74 5,665.80 5,665.80 5,665.80 5,665.80 5,665.80 0.00 0.00 10,925.21 10,925.21 5,665.80 5,665.80 0.00 48.59 0.00 0.00 0.00 0.00 0.00 318.93 0.00 318.93 318.93 0.00 48.59 0.00 0.00 125.03 125.03 0.00 0.00 125.03 125.03 0.00 0.00 125.03 0.00 0.00 125.03 191.17 0.00 78.77 795.87 416.98 795.87 416.98 1,025.75 1,025.75 0.00 1,025.75 1,025.75 0.00 1,025.75 0.00 0.00 0.00 795.87 4,858.82 1,829.85 1,829.85 4,858.82 4,858.82 4,858.82 4,858.82 4,858.82 4,858.82 4,858.82 4,858.82 4,858.82 4,858.82 4,858.82 4,858.82 4,858.82 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 16,530.43 16,530.43 1,196.39 1,196.39 1,196.39 0.00 1,196.39 1,196.39 0.00 1,196.39 1,196.39 1,196.39 5,904.30 5,904.30 0.00 0.00 0.00 5,904.30 0.00 0.00 0.00 1,196.39 5,904.30 11,592.19 11,592.19 523.99 0.00 M01 48.59 0.00 115.51 0.00 43.74 43.74 43.74 43.74 43.74 43.74 43.74 43.74 115.51 74.23 74.23 74.23 74.23 74.23 0.00 M01 0.00 0.00 125.03 125.03 0.00 70.97 70.97 0.00 183.38 297.02

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

92626 92627 92630 92633 92640 92700 92950 92953 92960 92961 92970 92971 92973 92974 92975 92977 92978 92979 92980 92981 92982 92984 92986 92987 92990 92992 92993 92995 92996 92997 92998 93000 93005 93010 93012 93014 93015 93016 93017 93018 93024 93025 93040 93041 93042 93224 93225 93226 93227 93230 93231 93232 93233 93235 93236 93237 93268 93270 93271 93272 93278 93303 93304 93307 93308 93312 93313 93314 93315 93316 93317 93318 93320 93321 93325 93350 93501 93503 93505 93508 93510 93511 93514 93524 93526 93527 93528 93529 93530 93531 93532 93533 93539 93540 93541 93542 93543 93544 93545 93555 93556 93561 93562 93571 93572 93580 93581 93600 93602 93603 93609 93610 93612 93613 93615 93616 93618 93619 93620 93621 93622 93623 93624 93631 93640 93641 93642 93650 93651 93652 93660 93662 93668 93701 93720 93721 93722 93724 93727 93731 93732 93733 93734 93735 93736 93740 93741 93742 93743 93744 93745 93760 93762 93770 93784 93786 93788 93790 93797 93798 93799 93875 93880

Eval aud rehab status Eval aud status rehab add-on Aud rehab pre-ling hear loss Aud rehab postling hear loss Aud brainstem implt programg Ent procedure/service Heart/lung resuscitation cpr Temporary external pacing Cardioversion electric, ext Cardioversion, electric, int Cardioassist, internal Cardioassist, external Percut coronary thrombectomy Cath place, cardio brachytx Dissolve clot, heart vessel Dissolve clot, heart vessel Intravasc us, heart add-on Intravasc us, heart add-on Insert intracoronary stent Insert intracoronary stent Coronary artery dilation Coronary artery dilation Revision of aortic valve Revision of mitral valve Revision of pulmonary valve Revision of heart chamber Revision of heart chamber Coronary atherectomy Coronary atherectomy add-on Pul art balloon repr, percut Pul art balloon repr, percut Electrocardiogram, complete Electrocardiogram, tracing Electrocardiogram report Transmission of ecg Report on transmitted ecg Cardiovascular stress test Cardiovascular stress test Cardiovascular stress test Cardiovascular stress test Cardiac drug stress test Microvolt t-wave assess Rhythm ECG with report Rhythm ECG, tracing Rhythm ECG, report ECG monitor/report, 24 hrs ECG monitor/record, 24 hrs ECG monitor/report, 24 hrs ECG monitor/review, 24 hrs ECG monitor/report, 24 hrs Ecg monitor/record, 24 hrs ECG monitor/report, 24 hrs ECG monitor/review, 24 hrs ECG monitor/report, 24 hrs ECG monitor/report, 24 hrs ECG monitor/review, 24 hrs ECG record/review ECG recording Ecg/monitoring and analysis Ecg/review, interpret only ECG/signal-averaged Echo transthoracic Echo transthoracic Echo exam of heart Echo exam of heart Echo transesophageal Echo transesophageal Echo transesophageal Echo transesophageal Echo transesophageal Echo transesophageal Echo transesophageal intraop Doppler echo exam, heart Doppler echo exam, heart Doppler color flow add-on Echo transthoracic Right heart catheterization Insert/place heart catheter Biopsy of heart lining Cath placement, angiography Left heart catheterization Left heart catheterization Left heart catheterization Left heart catheterization Rt & Lt heart catheters Rt & Lt heart catheters Rt & Lt heart catheters Rt, lt heart catheterization Rt heart cath, congenital R & l heart cath, congenital R & l heart cath, congenital R & l heart cath, congenital Injection, cardiac cath Injection, cardiac cath Injection for lung angiogram Injection for heart x-rays Injection for heart x-rays Injection for aortography Inject for coronary x-rays Imaging, cardiac cath Imaging, cardiac cath Cardiac output measurement Cardiac output measurement Heart flow reserve measure Heart flow reserve measure Transcath closure of asd Transcath closure of vsd Bundle of His recording Intra-atrial recording Right ventricular recording Map tachycardia, add-on Intra-atrial pacing Intraventricular pacing Electrophys map 3d, add-on Esophageal recording Esophageal recording Heart rhythm pacing Electrophysiology evaluation Electrophysiology evaluation Electrophysiology evaluation Electrophysiology evaluation Stimulation, pacing heart Electrophysiologic study Heart pacing, mapping Evaluation heart device Electrophysiology evaluation Electrophysiology evaluation Ablate heart dysrhythm focus Ablate heart dysrhythm focus Ablate heart dysrhythm focus Tilt table evaluation Intracardiac ecg (ice) Peripheral vascular rehab Bioimpedance, thoracic Total body plethysmography Plethysmography tracing Plethysmography report Analyze pacemaker system Analyze ilr system Analyze pacemaker system Analyze pacemaker system Telephone analy, pacemaker Analyze pacemaker system Analyze pacemaker system Telephonic analy, pacemaker Temperature gradient studies Analyze ht pace device sngl Analyze ht pace device sngl Analyze ht pace device dual Analyze ht pace device dual Set-up cardiovert-defibrill Cephalic thermogram Peripheral thermogram Measure venous pressure Ambulatory BP monitoring Ambulatory BP recording Ambulatory BP analysis Review/report BP recording Cardiac rehab Cardiac rehab/monitor Cardiovascular procedure Extracranial study Extracranial study

0365 0000 0000 0000 0365 0364 0094 0094 0679 0679 0000 0000 0088 0103 0000 0676 0000 0000 0104 0104 0083 0083 0083 0083 0083 0000 0000 0082 0082 0083 0083 0000 0099 0000 0000 0000 0000 0000 0100 0000 0100 0100 0000 0099 0000 0000 0097 0097 0000 0000 0097 0097 0000 0000 0097 0000 0000 0097 0663 0000 0340 0269 0697 0269 0697 0270 0270 0000 0270 0270 0000 0270 0000 0000 0000 0269 0080 0103 0103 0080 0080 0080 0080 0080 0080 0080 0080 0080 0080 0080 0080 0080 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0434 0434 0084 0084 0084 0000 0084 0084 0000 0084 0084 0084 0085 0085 0000 0000 0000 0085 0000 0000 0000 0084 0085 0086 0086 0101 0000 0000 0099 0000 0368 0000 0690 0690 0690 0690 0690 0690 0690 0690 0368 0689 0689 0689 0689 0689 0000 0000 0000 0000 0097 0097 0000 0095 0095 0097 0096 0267

1.2549 0.0000 0.0000 0.0000 1.2549 0.4490 2.4590 2.4590 5.4502 5.4502 0.0000 0.0000 38.7673 14.6576 0.0000 2.4824 0.0000 0.0000 89.0159 89.0159 45.3845 45.3845 45.3845 45.3845 45.3845 0.0000 0.0000 87.5137 87.5137 45.3845 45.3845 0.0000 0.3892 0.0000 0.0000 0.0000 0.0000 0.0000 2.5547 0.0000 2.5547 2.5547 0.0000 0.3892 0.0000 0.0000 1.0015 1.0015 0.0000 0.0000 1.0015 1.0015 0.0000 0.0000 1.0015 0.0000 0.0000 1.0015 1.5313 0.0000 0.6310 6.3751 3.3401 6.3751 3.3401 8.2165 8.2165 0.0000 8.2165 8.2165 0.0000 8.2165 0.0000 0.0000 0.0000 6.3751 38.9204 14.6576 14.6576 38.9204 38.9204 38.9204 38.9204 38.9204 38.9204 38.9204 38.9204 38.9204 38.9204 38.9204 38.9204 38.9204 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 132.4129 132.4129 9.5834 9.5834 9.5834 0.0000 9.5834 9.5834 0.0000 9.5834 9.5834 9.5834 47.2949 47.2949 0.0000 0.0000 0.0000 47.2949 0.0000 0.0000 0.0000 9.5834 47.2949 92.8564 92.8564 4.1973 0.0000 0.0000 0.3892 0.0000 0.9253 0.0000 0.3504 0.3504 0.3504 0.3504 0.3504 0.3504 0.3504 0.3504 0.9253 0.5946 0.5946 0.5946 0.5946 0.5946 0.0000 0.0000 0.0000 0.0000 1.0015 1.0015 0.0000 0.5685 0.5685 1.0015 1.4689 2.3792

Added 1/1/07 to book

X X

X X

X X X

Description Change

x

X X

X X X X X X X X X X X X X X X X SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) X X X X

Ensure that max units is 24 Ensure that max units is 24 SI change 1/1/07 (TR 1155)

x x

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

52 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only S S S S S S S S S S S S S S S S S S S S S S X S S S B B X X X A X X X X X X X X X X X X X X X S X X S S S S S S S S S X X X X X X N N Q X X B X X B X X X X X X X X X X X X X X X X S S E E E E E E E S S S S S S S S X X V B S S S S S S S S S S S S S N B A A A A A A S S S S S S S S S S S S N N S S S S N S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S S X S S S 1 1 X 1 1 1 X X X X X X X X X X X X X X X S X X S S S S S S S S S X X X X X X N N Q X X B X X B 1 X X X X X X X X X X X X X X X S S 1 1 1 1 1 1 1 S S S S S S S S X 1 V B S S S S S S S S S S S S S N B 3 3 3 3 3 3 S S S S S S S S S S S S N N S S S S N S S S S S S S S S S S S

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 113.65 113.65 45.72 72.10 72.10 72.10 70.17 70.17 70.17 113.65 72.10 113.65 72.10 70.17 113.65 72.10 113.65 113.65 113.65 72.10 113.65 113.65 47.84 72.10 118.39 118.39 0.00 0.00 44.20 0.00 0.00 0.00 44.20 131.61 27.12 27.12 44.20 27.12 44.20 44.20 27.12 27.12 44.20 27.12 44.20 44.20 27.12 18.52 44.20 131.61 18.52 63.83 63.83 63.83 63.83 118.39 18.52 18.52 18.52 44.20 44.20 27.12 44.20 44.20 44.20 0.00 0.00 47.84 27.12 131.61 0.00 47.84 47.84 0.00 0.00 13.25 13.25 27.12 13.25 13.25 13.25 13.25 13.25 13.25 49.82 49.82 13.25 131.61 131.61 187.62 12.16 18.85 0.00 0.00 0.00 0.00 0.00 0.00 0.00 18.85 18.85 18.85 18.85 18.85 18.85 18.85 18.85 49.82 0.00 79.32 0.00 538.95 109.78 538.95 538.95 538.95 538.95 109.78 109.78 109.78 109.78 109.78 128.24 109.78 0.00 0.00 M01 M01 M01 M01 M01 M01 55.17 55.17 55.17 55.17 55.17 55.17 55.17 55.17 55.17 55.17 27.73 55.17 0.00 0.00 27.73 27.73 27.73 27.73 0.00 55.17 55.17 55.17 128.24 128.24 128.24 55.17 55.17 128.24 27.73 27.73 27.73

Children's Hospital Outpatient Fee 259.14 259.14 104.24 164.40 164.40 164.40 159.99 159.99 159.99 259.14 164.40 259.14 164.40 159.99 259.14 164.40 259.14 259.14 259.14 164.40 259.14 259.14 109.08 164.40 269.94 269.94 0.00 0.00 100.78 0.00 0.00 0.00 100.78 300.07 61.83 61.83 100.78 61.83 100.78 100.78 61.83 61.83 100.78 61.83 100.78 100.78 61.83 42.23 100.78 300.07 42.23 145.54 145.54 145.54 145.54 269.94 42.23 42.23 42.23 100.78 100.78 61.83 100.78 100.78 100.78 0.00 0.00 109.08 61.83 300.07 0.00 109.08 109.08 0.00 0.00 30.20 30.20 61.83 30.20 30.20 30.20 30.20 30.20 30.20 113.60 113.60 30.20 300.07 300.07 427.79 27.72 42.97 0.00 0.00 0.00 0.00 0.00 0.00 0.00 42.97 42.97 42.97 42.97 42.97 42.97 42.97 42.97 113.60 0.00 180.85 0.00 1,228.86 250.30 1,228.86 1,228.86 1,228.86 1,228.86 250.30 250.30 250.30 250.30 250.30 292.41 250.30 0.00 0.00 M01 M01 M01 M01 M01 M01 125.80 125.80 125.80 125.80 125.80 125.80 125.80 125.80 125.80 125.80 63.22 125.80 0.00 0.00 63.22 63.22 63.22 63.22 0.00 125.80 125.80 125.80 292.41 292.41 292.41 125.80 125.80 292.41 63.22 63.22 63.22

Critical PDD Access Update to Hospital ACS Outpatient Fee 297.02 297.02 119.47 188.43 188.43 188.43 183.38 183.38 183.38 297.02 188.43 297.02 188.43 183.38 297.02 188.43 297.02 297.02 297.02 188.43 297.02 297.02 125.03 188.43 309.39 309.39 0.00 0.00 115.51 0.00 0.00 0.00 115.51 343.93 70.87 70.87 115.51 70.87 115.51 115.51 70.87 70.87 115.51 70.87 115.51 115.51 70.87 48.40 115.51 343.93 48.40 166.81 166.81 166.81 166.81 309.39 48.40 48.40 48.40 115.51 115.51 70.87 115.51 115.51 115.51 0.00 0.00 125.03 70.87 343.93 0.00 125.03 125.03 0.00 0.00 34.62 34.62 70.87 34.62 34.62 34.62 34.62 34.62 34.62 130.21 130.21 34.62 343.93 343.93 490.32 31.77 49.25 0.00 0.00 0.00 0.00 0.00 0.00 0.00 49.25 49.25 49.25 49.25 49.25 49.25 49.25 49.25 130.21 0.00 207.28 0.00 1,408.47 286.88 1,408.47 1,408.47 1,408.47 1,408.47 286.88 286.88 286.88 286.88 286.88 335.15 286.88 0.00 0.00 M01 M01 M01 M01 M01 M01 144.19 144.19 144.19 144.19 144.19 144.19 144.19 144.19 144.19 144.19 72.46 144.19 0.00 0.00 72.46 72.46 72.46 72.46 0.00 144.19 144.19 144.19 335.15 335.15 335.15 144.19 144.19 335.15 72.46 72.46 72.46

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

93882 93886 93888 93890 93892 93893 93922 93923 93924 93925 93926 93930 93931 93965 93970 93971 93975 93976 93978 93979 93980 93981 93982 93990 94002 94003 94004 94005 94010 94014 94015 94016 94060 94070 94150 94200 94240 94250 94260 94350 94360 94370 94375 94400 94450 94452 94453 94610 94620 94621 94640 94642 94644 94645 94660 94662 94664 94667 94668 94680 94681 94690 94720 94725 94750 94760 94761 94762 94770 94772 94774 94775 94776 94777 94799 95004 95010 95012 95015 95024 95027 95028 95044 95052 95056 95060 95065 95070 95071 95075 95115 95117 95120 95125 95130 95131 95132 95133 95134 95144 95145 95146 95147 95148 95149 95165 95170 95180 95199 95250 95251 95805 95806 95807 95808 95810 95811 95812 95813 95816 95819 95822 95824 95827 95829 95830 95831 95832 95833 95834 95851 95852 95857 95860 95861 95863 95864 95865 95866 95867 95868 95869 95870 95872 95873 95874 95875 95900 95903 95904 95920 95921 95922 95923 95925 95926 95927 95928 95929 95930 95933 95934 95936

Extracranial study Intracranial study Intracranial study Tcd, vasoreactivity study Tcd, emboli detect w/o inj Tcd, emboli detect w/inj Extremity study Extremity study Extremity study Lower extremity study Lower extremity study Upper extremity study Upper extremity study Extremity study Extremity study Extremity study Vascular study Vascular study Vascular study Vascular study Penile vascular study Penile vascular study Aneurysm pressure sens study Doppler flow testing Vent mgmt inpat, init day Vent mgmt inpat, subq day Vent mgmt nf per day Home vent mgmt supervision Breathing capacity test Patient recorded spirometry Patient recorded spirometry Review patient spirometry Evaluation of wheezing Evaluation of wheezing Vital capacity test Lung function test (MBC/MVV) Residual lung capacity Expired gas collection Thoracic gas volume Lung nitrogen washout curve Measure airflow resistance Breath airway closing volume Respiratory flow volume loop CO2 breathing response curve Hypoxia response curve Hast w/report Hast w/oxygen titrate Surfactant admin thru tube Pulmonary stress test/simple Pulm stress test/complex Airway inhalation treatment Aerosol inhalation treatment Cbt, 1st hour Cbt, each addl hour Pos airway pressure, CPAP Neg press ventilation, cnp Evaluate pt use of inhaler Chest wall manipulation Chest wall manipulation Exhaled air analysis, o2 Exhaled air analysis, o2/co2 Exhaled air analysis Monoxide diffusing capacity Membrane diffusion capacity Pulmonary compliance study Measure blood oxygen level Measure blood oxygen level Measure blood oxygen level Exhaled carbon dioxide test Breath recording, infant Ped home apnea rec, compl Ped home apnea rec, hk-up Ped home apnea rec, downld Ped home apnea rec, report Pulmonary service/procedure Percut allergy skin tests Percut allergy titrate test Exhaled nitric oxide meas Id allergy titrate-drug/bug Id allergy test, drug/bug Id allergy titrate-airborne Id allergy test-delayed type Allergy patch tests Photo patch test Photosensitivity tests Eye allergy tests Nose allergy test Bronchial allergy tests Bronchial allergy tests Ingestion challenge test Immunotherapy, one injection Immunotherapy injections Immunotherapy, one injection Immunotherapy, many antigens Immunotherapy, insect venom Immunotherapy, insect venoms Immunotherapy, insect venoms Immunotherapy, insect venoms Immunotherapy, insect venoms Antigen therapy services Antigen therapy services Antigen therapy services Antigen therapy services Antigen therapy services Antigen therapy services Antigen therapy services Antigen therapy services Rapid desensitization Allergy immunology services Glucose monitoring, cont Gluc monitor, cont, phys i&r Multiple sleep latency test Sleep study, unattended Sleep study, attended Polysomnography, 1-3 Polysomnography, 4 or more Polysomnography w/cpap Eeg, 41-60 minutes Eeg, over 1 hour Eeg, awake and drowsy Eeg, awake and asleep Eeg, coma or sleep only Eeg, cerebral death only Eeg, all night recording Surgery electrocorticogram Insert electrodes for EEG Limb muscle testing, manual Hand muscle testing, manual Body muscle testing, manual Body muscle testing, manual Range of motion measurements Range of motion measurements Tensilon test Muscle test, one limb Muscle test, 2 limbs Muscle test, 3 limbs Muscle test, 4 limbs Muscle test, larynx Muscle test, hemidiaphragm Muscle test cran nerv unilat Muscle test cran nerve bilat Muscle test, thor paraspinal Muscle test, nonparaspinal Muscle test, one fiber Guide nerv destr, elec stim Guide nerv destr, needle emg Limb exercise test Motor nerve conduction test Motor nerve conduction test Sense nerve conduction test Intraop nerve test add-on Autonomic nerv function test Autonomic nerv function test Autonomic nerv function test Somatosensory testing Somatosensory testing Somatosensory testing C motor evoked, uppr limbs C motor evoked, lwr limbs Visual evoked potential test Blink reflex test H-reflex test H-reflex test

0267 0267 0265 0266 0266 0266 0096 0096 0096 0267 0266 0267 0266 0096 0267 0266 0267 0267 0267 0266 0267 0267 0097 0266 0079 0079 0000 0000 0368 0367 0367 0000 0368 0369 0367 0367 0368 0367 0368 0368 0367 0367 0368 0367 0368 0368 0367 0077 0368 0369 0077 0078 0078 0078 0078 0079 0077 0077 0077 0368 0368 0367 0368 0368 0368 0000 0000 0097 0367 0369 0000 0097 0097 0000 0367 0381 0381 0367 0381 0381 0381 0381 0381 0381 0370 0370 0381 0369 0369 0361 0436 0437 0000 0000 0000 0000 0000 0000 0000 0437 0437 0437 0437 0437 0437 0437 0437 0370 0381 0607 0000 0209 0213 0209 0209 0209 0209 0213 0213 0213 0213 0213 0216 0213 0000 0000 0000 0000 0000 0000 0000 0000 0218 0218 0218 0218 0218 0218 0218 0218 0218 0218 0215 0218 0000 0000 0215 0215 0215 0215 0000 0218 0218 0218 0216 0216 0216 0218 0218 0216 0215 0215 0215

2.3792 2.3792 0.9570 1.5094 1.5094 1.5094 1.4689 1.4689 1.4689 2.3792 1.5094 2.3792 1.5094 1.4689 2.3792 1.5094 2.3792 2.3792 2.3792 1.5094 2.3792 2.3792 1.0015 1.5094 2.4783 2.4783 0.0000 0.0000 0.9253 0.5677 0.5677 0.0000 0.9253 2.7550 0.5677 0.5677 0.9253 0.5677 0.9253 0.9253 0.5677 0.5677 0.9253 0.5677 0.9253 0.9253 0.5677 0.3877 0.9253 2.7550 0.3877 1.3362 1.3362 1.3362 1.3362 2.4783 0.3877 0.3877 0.3877 0.9253 0.9253 0.5677 0.9253 0.9253 0.9253 0.0000 0.0000 1.0015 0.5677 2.7550 0.0000 1.0015 1.0015 0.0000 0.5677 0.2773 0.2773 0.5677 0.2773 0.2773 0.2773 0.2773 0.2773 0.2773 1.0430 1.0430 0.2773 2.7550 2.7550 3.9276 0.2545 0.3945 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.3945 0.3945 0.3945 0.3945 0.3945 0.3945 0.3945 0.3945 1.0430 0.2773 1.6604 0.0000 11.2822 2.2980 11.2822 11.2822 11.2822 11.2822 2.2980 2.2980 2.2980 2.2980 2.2980 2.6846 2.2980 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 1.1550 1.1550 1.1550 1.1550 1.1550 1.1550 1.1550 1.1550 1.1550 1.1550 0.5804 1.1550 0.0000 0.0000 0.5804 0.5804 0.5804 0.5804 0.0000 1.1550 1.1550 1.1550 2.6846 2.6846 2.6846 1.1550 1.1550 2.6846 0.5804 0.5804 0.5804

X Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book

Added 1/1/07 to book

Added 1/1/07 to book Added 1/1/07 to book

SI change 1/1/07 (TR 1155)

Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book

Added 1/1/07 to book

SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) SI = 1 effective 01/01/06 SI = 1 effective 01/01/06 SI = 1 effective 01/01/06 SI = 1 effective 01/01/06 SI = 1 effective 01/01/06 SI = 1 effective 01/01/06 SI = 1 effective 01/01/06 SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155)

X X X X X X X

X

X

X X

X

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

53 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only S S S S S N S N S S S S S S S S S S S S S S N S S T T S S S S S B N B Q Q Q A Q Q Q Q Q Q A Q Q Q Q Q E S S S S S S S S S S S S S S S S S S S Q S S T T T S N N S S S T T T T A A A A E E A A E A A A A A A A A A A A A A A A A A A A A A A A A A A A A T T T T T A A A A A A A A A E E E E S S S S S S S S E E E E E E E E E E B B E S S S S S N S N S S S S S S S S S S S S S S N S S T T 1 S 1 S 1 B N 1 Q Q Q 1 Q Q Q Q Q Q 1 1 1 1 1 1 1 S S S S S S S S S S S S S S S S S S S Q S 1 T T T S N N S S S 1 1 1 1 3 3 3 3 1 1 3 3 3 3 3 3 3 3 3 3 3 3 3 3 1 3 3 3 3 3 1 3 3 3 3 3 1 1 3 1 1 T T T T T 3 3 3 3 3 1 1 1 1 1 1 1 1 S S S S S 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 55.17 538.95 538.95 538.95 55.17 0.00 538.95 0.00 109.78 128.24 128.24 2,947.24 792.56 792.56 55.17 87.78 73.15 73.15 73.15 87.78 87.78 73.15 0.00 55.17 87.78 112.47 112.47 0.00 128.24 0.00 55.17 0.00 0.00 0.00 0.00 125.01 125.01 59.46 0.00 59.46 125.01 125.01 125.01 125.01 59.46 0.00 0.00 0.00 0.00 0.00 0.00 0.00 38.41 38.41 38.41 38.41 79.03 79.03 112.00 38.41 112.00 38.41 79.03 112.00 38.41 112.00 112.00 112.00 112.00 85.98 85.98 27.18 38.41 0.00 37.88 69.72 69.72 22.96 0.00 0.00 22.96 22.96 124.42 0.00 0.00 0.00 0.00 M01 M01 M01 M01 0.00 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 0.00 0.00 M01 0.00 0.00 69.72 69.72 69.72 37.88 69.72 M01 M01 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 21.41 21.41 21.41 21.41 21.41 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Children's Hospital Outpatient Fee 125.80 1,228.86 1,228.86 1,228.86 125.80 0.00 1,228.86 0.00 250.30 292.41 292.41 6,719.98 1,807.10 1,807.10 125.80 200.15 166.79 166.79 166.79 200.15 200.15 166.79 0.00 125.80 200.15 256.44 256.44 0.00 292.41 0.00 125.80 0.00 0.00 0.00 0.00 285.03 285.03 135.58 0.00 135.58 285.03 285.03 285.03 285.03 135.58 0.00 0.00 0.00 0.00 0.00 0.00 0.00 87.58 87.58 87.58 87.58 180.20 180.20 255.37 87.58 255.37 87.58 180.20 255.37 87.58 255.37 255.37 255.37 255.37 196.03 196.03 61.96 87.58 0.00 86.37 158.97 158.97 52.35 0.00 0.00 52.35 52.35 283.68 0.00 0.00 0.00 0.00 M01 M01 M01 M01 0.00 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 0.00 0.00 M01 0.00 0.00 158.97 158.97 158.97 86.37 158.97 M01 M01 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 48.82 48.82 48.82 48.82 48.82 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Critical PDD Access Update to Hospital ACS Outpatient Fee 144.19 1,408.47 1,408.47 1,408.47 144.19 0.00 1,408.47 0.00 286.88 335.15 335.15 7,702.19 2,071.23 2,071.23 144.19 229.41 191.17 191.17 191.17 229.41 229.41 191.17 0.00 144.19 229.41 293.92 293.92 0.00 335.15 0.00 144.19 0.00 0.00 0.00 0.00 326.69 326.69 155.40 0.00 155.40 326.69 326.69 326.69 326.69 155.40 0.00 0.00 0.00 0.00 0.00 0.00 0.00 100.38 100.38 100.38 100.38 206.54 206.54 292.70 100.38 292.70 100.38 206.54 292.70 100.38 292.70 292.70 292.70 292.70 224.69 224.69 71.02 100.38 0.00 99.00 182.20 182.20 60.00 0.00 0.00 60.00 60.00 325.15 0.00 0.00 0.00 0.00 M01 M01 M01 M01 0.00 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 0.00 0.00 M01 0.00 0.00 182.20 182.20 182.20 99.00 182.20 M01 M01 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 55.95 55.95 55.95 55.95 55.95 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

95937 95950 95951 95953 95954 95955 95956 95957 95958 95961 95962 95965 95966 95967 95970 95971 95972 95973 95974 95975 95978 95979 95980 95981 95982 95990 95991 95999 96000 96001 96002 96003 96004 96020 96040 96101 96102 96103 96105 96110 96111 96116 96118 96119 96120 96125 96150 96151 96152 96153 96154 96155 96401 96402 96405 96406 96409 96411 96413 96415 96416 96417 96420 96422 96423 96425 96440 96445 96450 96521 96522 96523 96542 96549 96567 96570 96571 96900 96902 96904 96910 96912 96913 96920 96921 96922 96999 97001 97002 97003 97004 97005 97006 97010 97012 97014 97016 97018 97022 97024 97026 97028 97032 97033 97034 97035 97036 97039 97110 97112 97113 97116 97124 97139 97140 97150 97530 97532 97533 97535 97537 97542 97545 97546 97597 97598 97602 97605 97606 97750 97755 97760 97761 97762 97799 97802 97803 97804 97810 97811 97813 97814 98925 98926 98927 98928 98929 98940 98941 98942 98943 98960 98961 98962 98966 98967 98968 98969 99000 99001 99002 99024 99026

Neuromuscular junction test Ambulatory eeg monitoring EEG monitoring/videorecord EEG monitoring/computer EEG monitoring/giving drugs EEG during surgery Eeg monitoring, cable/radio EEG digital analysis EEG monitoring/function test Electrode stimulation, brain Electrode stim, brain add-on Meg, spontaneous Meg, evoked, single Meg, evoked, each add’l Analyze neurostim, no prog Analyze neurostim, simple Analyze neurostim, complex Analyze neurostim, complex Cranial neurostim, complex Cranial neurostim, complex Analyze neurostim brain/1h Analyz neurostim brain addon Io anal gast n-stim init Io anal gast n-stim subsq Io ga n-stim subsq w/reprog Spin/brain pump refil & main Spin/brain pump refil & main Neurological procedure Motion analysis, video/3d Motion test w/ft press meas Dynamic surface emg Dynamic fine wire emg Phys review of motion tests Functional brain mapping Genetic counseling, 30 min Psycho testing by psych/phys Psycho testing by technician Psycho testing admin by comp Assessment of aphasia Developmental test, lim Developmental test, extend Neurobehavioral status exam Neuropsych tst by psych/phys Neuropsych testing by tech Neuropsych tst admin w/comp Cognitive test by hc pro Assess hlth/behave, init Assess hlth/behave, subseq Intervene hlth/behave, indiv Intervene hlth/behave, group Interv hlth/behav, fam w/pt Interv hlth/behav fam no pt Chemo, anti-neopl, sq/im Chemo hormon antineopl sq/im Intralesional chemo admin Intralesional chemo admin Chemo, iv push, sngl drug Chemo, iv push, addl drug Chemo, iv infusion, 1 hr Chemo, iv infusion, addl hr Chemo prolong infuse w/pump Chemo iv infus each addl seq Chemotherapy, push technique Chemotherapy,infusion method Chemo, infuse method add-on Chemotherapy,infusion method Chemotherapy, intracavitary Chemotherapy, intracavitary Chemotherapy, into CNS Refill/maint, portable pump Refill/maint pump/resvr syst Irrig drug delivery device Chemotherapy injection Chemotherapy, unspecified Photodynamic tx, skin Photodynamic tx, 30 min Photodynamic tx, addl 15 min Ultraviolet light therapy Trichogram Whole body photography Photochemotherapy with UV-B Photochemotherapy with UV-A Photochemotherapy, UV-A or B Laser tx, skin < 250 sq cm Laser tx, skin 250-500 sq cm Laser tx, skin > 500 sq cm Dermatological procedure Pt evaluation Pt re-evaluation Ot evaluation Ot re-evaluation Athletic train eval Athletic train reeval Hot or cold packs therapy Mechanical traction therapy Electric stimulation therapy Vasopneumatic device therapy Paraffin bath therapy Whirlpool therapy Diathermy treatment Infrared therapy Ultraviolet therapy Electrical stimulation Electric current therapy Contrast bath therapy Ultrasound therapy Hydrotherapy Physical therapy treatment Therapeutic exercises Neuromuscular reeducation Aquatic therapy/exercises Gait training therapy Massage therapy Physical medicine procedure Manual therapy Group therapeutic procedures Therapeutic activities Cognitive skills development Sensory integration Self care mngment training Community/work reintegration Wheelchair mngment training Work hardening Work hardening add-on Active wound care/20 cm or < Active wound care > 20 cm Wound(s) care non-selective Neg press wound tx, < 50 cm Neg press wound tx, > 50 cm Physical performance test Assistive technology assess Orthotic mgmt and training Prosthetic training C/o for orthotic/prosth use Physical medicine procedure Medical nutrition, indiv, in Med nutrition, indiv, subseq Medical nutrition, group Acupunct w/o stimul 15 min Acupunct w/o stimul addl 15m Acupunct w/stimul 15 min Acupunct w/stimul addl 15m Osteopathic manipulation Osteopathic manipulation Osteopathic manipulation Osteopathic manipulation Osteopathic manipulation Chiropractic manipulation Chiropractic manipulation Chiropractic manipulation Chiropractic manipulation Self-mgmt educ & train, 1 pt Self-mgmt educ/train, 2-4 pt Self-mgmt educ/train, 5-8 pt Hc pro phone call 5-10 min Hc pro phone call 11-20 min Hc pro phone call 21-30 min Online service by hc pro Specimen handling Specimen handling Device handling Postop follow-up visit In-hospital on call service

0218 0209 0209 0209 0218 0000 0209 0000 0213 0216 0216 0067 0065 0065 0218 0692 0663 0663 0663 0692 0692 0663 0000 0218 0692 0125 0125 0215 0216 0216 0218 0215 0000 0000 0000 0382 0382 0373 0000 0373 0382 0382 0382 0382 0373 0000 0432 0432 0432 0432 0432 0000 0438 0438 0438 0438 0439 0439 0441 0438 0441 0438 0439 0441 0438 0441 0441 0441 0441 0440 0440 0624 0438 0436 0013 0015 0015 0001 0000 0000 0001 0001 0683 0015 0015 0015 0012 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0015 0015 0015 0013 0015 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0060 0060 0060 0060 0060 0060 0060 0060 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

1.1550 11.2822 11.2822 11.2822 1.1550 0.0000 11.2822 0.0000 2.2980 2.6846 2.6846 61.6965 16.5911 16.5911 1.1550 1.8376 1.5313 1.5313 1.5313 1.8376 1.8376 1.5313 0.0000 1.1550 1.8376 2.3544 2.3544 0.5804 2.6846 2.6846 1.1550 0.5804 0.0000 0.0000 0.0000 2.6169 2.6169 1.2448 0.0000 1.2448 2.6169 2.6169 2.6169 2.6169 1.2448 0.0000 0.3128 0.3128 0.3128 0.3128 0.3128 0.0000 0.8041 0.8041 0.8041 0.8041 1.6544 1.6544 2.3446 0.8041 2.3446 0.8041 1.6544 2.3446 0.8041 2.3446 2.3446 2.3446 2.3446 1.7998 1.7998 0.5689 0.8041 0.2545 0.7930 1.4595 1.4595 0.4806 0.0000 0.0000 0.4806 0.4806 2.6045 1.4595 1.4595 1.4595 0.2963 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 1.4595 1.4595 1.4595 0.7930 1.4595 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.4482 0.4482 0.4482 0.4482 0.4482 0.4482 0.4482 0.4482 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

X X

X X X

Added 1/1/07 to book Added 1/1/07 to book

X X X X X X X X X X X X X X X X

Drug admin Drug admin SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) Drug admin Drug admin SI change 1/1/07 (TR 1155) Drug admin Drug admin Drug admin Drug admin SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) Drug admin Drug admin

Added 1/1/07 to book

X

X X X X

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

54 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only E B B B B B B B B E N B B B N B B B B N N N N N N T E E E N B N N C C C X B V V V V Q V V V V Q B B B B B B B B B B B B B B B B B B B B C C C C C V V V Q Q B N N Q N C C C C C C N B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B N N C C N N B 1 B B B 1 B 1 B 1 1 1 1 B 1 1 1 1 1 1 N N N N N N T 1 1 1 N B N N 1 1 1 X 1 V V V V Q V V V V Q B B B B B B B B B B B B B B B B B B B B C C C C C V V V Q Q B 1 1 Q 1 C C C C C C N B B B B B B B B B B B B B B B B B B B 1 1 B B B B B B B B B 1 1 C C 1 1 B

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 6.25 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 27.18 0.00 40.07 47.60 63.18 79.32 103.85 40.07 47.60 47.60 63.18 79.32 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 38.07 62.76 99.12 159.44 236.63 0.00 0.00 0.00 349.51 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Children's Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 14.26 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 61.96 0.00 91.36 108.53 144.06 180.85 236.79 91.36 108.53 108.53 144.06 180.85 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 86.81 143.09 226.01 363.54 539.54 0.00 0.00 0.00 796.92 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Critical PDD Access Update to Hospital ACS Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 16.34 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 71.02 0.00 104.72 124.39 165.11 207.28 271.40 104.72 124.39 124.39 165.11 207.28 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 99.50 164.00 259.04 416.68 618.39 0.00 0.00 0.00 913.40 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 11/30/07

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

99027 99050 99051 99053 99056 99058 99060 99070 99071 99075 99078 99080 99082 99090 99091 99100 99116 99135 99140 99143 99144 99145 99148 99149 99150 99170 99172 99173 99174 99175 99183 99185 99186 99190 99191 99192 99195 99199 99201 99202 99203 99204 99205 99211 99212 99213 99214 99215 99217 99218 99219 99220 99221 99222 99223 99231 99232 99233 99234 99235 99236 99238 99239 99241 99242 99243 99244 99245 99251 99252 99253 99254 99255 99281 99282 99283 99284 99285 99288 99289 99290 99291 99292 99293 99294 99295 99296 99298 99299 99300 99304 99305 99306 99307 99308 99309 99310 99315 99316 99318 99324 99325 99326 99327 99328 99334 99335 99336 99337 99339 99340 99341 99342 99343 99344 99345 99347 99348 99349 99350 99354 99355 99356 99357 99358 99359 99360

Out-of-hosp on call service Medical services after hrs Med serv, eve/wkend/holiday Med serv 10pm-8am, 24 hr fac Non-office medical services Office emergency care Out of office emerg med serv Special supplies Patient education materials Medical testimony Group health education Special reports or forms Unusual physician travel Computer data analysis Collect/review data from pt Special anesthesia service Anesthesia with hypothermia Special anesthesia procedure Emergency anesthesia Mod cs by same phys, < 5 yrs Mod cs by same phys, 5 yrs + Mod cs by same phys add-on Mod cs diff phys < 5 yrs Mod cs diff phys 5 yrs + Mod cs diff phys add-on Anogenital exam, child Ocular function screen Visual acuity screen Ocular photoscreening Induction of vomiting Hyperbaric oxygen therapy Regional hypothermia Total body hypothermia Special pump services Special pump services Special pump services Phlebotomy Special service/proc/report Office/outpatient visit, new Office/outpatient visit, new Office/outpatient visit, new Office/outpatient visit, new Office/outpatient visit, new Office/outpatient visit, est Office/outpatient visit, est Office/outpatient visit, est Office/outpatient visit, est Office/outpatient visit, est Observation care discharge Observation care Observation care Observation care Initial hospital care Initial hospital care Initial hospital care Subsequent hospital care Subsequent hospital care Subsequent hospital care Observ/hosp same date Observ/hosp same date Observ/hosp same date Hospital discharge day Hospital discharge day Office consultation Office consultation Office consultation Office consultation Office consultation Initial inpatient consult Initial inpatient consult Initial inpatient consult Initial inpatient consult Initial inpatient consult Emergency dept visit Emergency dept visit Emergency dept visit Emergency dept visit Emergency dept visit Direct advanced life support Ped crit care transport Ped crit care transport addl Critical care, first hour Critical care, add’l 30 min Ped critical care, initial Ped critical care, subseq Neonate crit care, initial Neonate critical care subseq Ic for lbw infant < 1500 gm Ic, lbw infant 1500-2500 gm Ic, infant pbw 2501-5000 gm Nursing facility care, init Nursing facility care, init Nursing facility care, init Nursing fac care, subseq Nursing fac care, subseq Nursing fac care, subseq Nursing fac care, subseq Nursing fac discharge day Nursing fac discharge day Annual nursing fac assessmnt Domicil/r-home visit new pat Domicil/r-home visit new pat Domicil/r-home visit new pat Domicil/r-home visit new pat Domicil/r-home visit new pat Domicil/r-home visit est pat Domicil/r-home visit est pat Domicil/r-home visit est pat Domicil/r-home visit est pat Domicil/r-home care supervis Domicil/r-home care supervis Home visit, new patient Home visit, new patient Home visit, new patient Home visit, new patient Home visit, new patient Home visit, est patient Home visit, est patient Home visit, est patient Home visit, est patient Prolonged service, office Prolonged service, office Prolonged service, inpatient Prolonged service, inpatient Prolonged serv, w/o contact Prolonged serv, w/o contact Physician standby services

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0191 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0624 0000 0604 0605 0606 0607 0608 0604 0605 0605 0606 0607 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0609 0613 0614 0615 0616 0000 0000 0000 0617 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.1309 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.5689 0.0000 0.8388 0.9964 1.3226 1.6604 2.1740 0.8388 0.9964 0.9964 1.3226 1.6604 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.7970 1.3137 2.0750 3.3377 4.9535 0.0000 0.0000 0.0000 7.3166 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

Factor Code = N so SI needs to be 1

X

X

X

SI change 1/1/07 (Addendum B) SI change 1/1/07 (Addendum B) SI change 1/1/07 (Addendum B) SI change 1/1/07 (Addendum B) SI change 1/1/07 (Addendum B) SI change 1/1/07 (Addendum B)

SI change 1/1/07 (Addendum B) SI change 1/1/07 (Addendum B) X X X X X

X X

X

99363 99364 99366 99367 99368

Anticoag mgmt, init Anticoag mgmt, subseq Team conf w/pat by hc pro Team conf w/o pat by phys Team conf w/o pat by hc pro

B B N N N

1 1 N N N

0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000

0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00

Added 1/1/07 to book Added 1/1/07 to book X X X

99374 99375 99377 99378 99379 99380 99381 99382 99383 99384 99385 99386 99387 99391 99392 99393

Home health care supervision Home health care supervision Hospice care supervision Hospice care supervision Nursing fac care supervision Nursing fac care supervision Prev visit, new, infant Prev visit, new, age 1-4 Prev visit, new, age 5-11 Prev visit, new, age 12-17 Prev visit, new, age 18-39 Prev visit, new, age 40-64 Prev visit, new, 65 & over Prev visit, est, infant Prev visit, est, age 1-4 Prev visit, est, age 5-11

B E B E B B E E E E E E E E E E

B 1 B 1 B B 1 1 1 1 1 1 1 1 1 1

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

55 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only E E E E E E E E X X E E E E E E V N C B N S E E E E E B B C B E E E E E E E E E E E E E E E E E E M M M M M T T A A T N A A N N A N A T T C C C C C C 1 1 1 1 1 1 1 1 X X 1 1 1 1 1 3 V 1 C B 1 S 1 1 1 1 1 1 1 C 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 7.87 7.87 0.00 0.00 0.00 0.00 0.00 M01 47.60 0.00 0.00 0.00 0.00 117.47 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Children's Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 17.95 17.95 0.00 0.00 0.00 0.00 0.00 M01 108.53 0.00 0.00 0.00 0.00 267.83 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Critical PDD Access Update to Hospital ACS Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 20.57 20.57 0.00 0.00 0.00 0.00 0.00 M01 124.39 0.00 0.00 0.00 0.00 306.98 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

99394 99395 99396 99397 99401 99402 99403 99404 99406 99407 99408 99409 99411 99412 99420 99429 99431 99432 99433 99435 99436 99440 99441 99442 99443 99444 99450 99455 99456 99477 99499 99500 99501 99502 99503 99504 99505 99506 99507 99509 99510 99511 99512 99600 99601 99602 99605 99606 99607 0001F 0005F 0012F 0014F 0015F 0016T 0017T 0019T 0026T 0027T 0028T 0029T 0030T 0031T 0032T 0041T 0042T 0043T 0046T 0047T 0048T 0049T 0050T 0051T 0052T 0053T

Prev visit, est, age 12-17 Prev visit, est, age 18-39 Prev visit, est, age 40-64 Prev visit, est, 65 & over Preventive counseling, indiv Preventive counseling, indiv Preventive counseling, indiv Preventive counseling, indiv Behav chng smoking 3-10 min Behav chng smoking < 10 min Audit/dast, 15-30 min Audit/dast, over 30 min Preventive counseling, group Preventive counseling, group Health risk assessment test Unlisted preventive service Initial care, normal newborn Newborn care, not in hosp Normal newborn care/hospital Newborn discharge day hosp Attendance, birth Newborn resuscitation Phone e/m by phys 5-10 min Phone e/m by phys 11-20 min Phone e/m by phys 21-30 min Online e/m by phys Life/disability evaluation Disability examination Disability examination Init day hosp neonate care Unlisted e&m service Home visit, prenatal Home visit, postnatal Home visit, nb care Home visit, resp therapy Home visit mech ventilator Home visit, stoma care Home visit, im injection Home visit, cath maintain Home visit day life activity Home visit, sing/m/fam couns Home visit, fecal/enema mgmt Home visit for hemodialysis Home visit nos Home infusion/visit, 2 hrs Home infusion, each addtl hr Mtms by pharm, np, 15 min Mtms by pharm, est, 15 min Mtms by pharm, addl 15 min Heart failure composite Osteoarthritis composite Cap bacterial assess Comp preop assess cat surg Melan follow-up complete Thermotx choroid vasc lesion Photocoagulat macular drusen Extracorp shock wave tx, ms Measure remnant lipoproteins Endoscopic epidural lysis Dexa body composition study Magnetic tx for incontinence Antiprothrombin antibody Speculoscopy Speculoscopy w/direct sample Detect ur infect agnt w/cpas Ct perfusion w/contrast, cbf Co expired gas analysis Cath lavage, mammary duct(s Cath lavage, mammary duct(s) Implant ventricular device External circulation assist Removal circulation assist Implant total heart system Replace component heart syst Replace component heart syst

0000 0000 0000 0000 0000 0000 0000 0000 0031 0031 0000 0000 0000 0000 0000 0000 0605 0000 0000 0000 0000 0094 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0235 0235 0000 0000 0220 0000 0000 0000 0000 0000 0000 0000 0000 0021 0021 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.1648 0.1648 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.9964 0.0000 0.0000 0.0000 0.0000 2.4590 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 4.1331 4.1331 0.0000 0.0000 18.0518 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 16.1001 16.1001 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

Verified with Sheree sched Verified with Sheree sched

X X X X

SI change 1/1/07 (Addendum B)

X X X X

X

X X X

Added 1/1/07 to book X X

0058T 0059T 0060T 0061T 0062T 0063T 0064T 0066T 0067T 0068T 0069T 0070T 0071T 0072T 0073T 0075T 0076T 0077T 0078T 0079T 0080T 0081T 0084T 0085T 0086T 0087T 0088T 0089T 0090T 0092T 0093T 0095T 0096T 0098T 0099T 0100T 0101T 0102T 0103T 0104T 0105T 0106T 0107T 0108T 0109T 0110T 0111T

Cryopreservation, ovary tiss Cryopreservation, oocyte Electrical impedance scan Destruction of tumor, breast Rep intradisc annulus;1 lev Rep intradisc annulus;>1lev Spectroscop eval expired gas Ct colonography;screen Ct colonography;dx Interp/rept heart sound Analysis only heart sound Interp only heart sound U/s leiomyomata ablate <200 U/s leiomyomata ablate >200 Delivery, comp imrt Perq stent/chest vert art S&i stent/chest vert art Cereb therm perfusion probe Endovasc aort repr w/device Endovasc visc extnsn repr Endovasc aort repr rad s&i Endovasc visc extnsn s&i Temp prostate urethral stent Breath test heart reject L ventricle fill pressure Sperm eval hyaluronan Rf tongue base vol reduxn Actigraphy testing, 3-day Cervical artific disc Artific disc addl Cervical artific diskectomy Artific diskectomy addl Rev cervical artific disc Rev artific disc addl Implant corneal ring Prosth retina receive&gen Extracorp shockwv tx,hi enrg Extracorp shockwv tx,anesth Holotranscobalamin At rest cardio gas rebreathe Exerc cardio gas rebreathe Touch quant sensory test Vibrate quant sensory test Cool quant sensory test Heat quant sensory test Nos quant sensory test Rbc membranes fatty acids

X X B B T T X E S B N B S S S C C C C C C C T X N X T S C C C C C C T T T T A A A X X X X X A

1 1 1 1 1 1 1 1 1 1 1 B 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 T 1 1 1 1 1 1 1 1 1 1 1 1

0344 0344 0000 0000 0050 0050 0367 0000 0332 0000 0000 0000 0067 0067 0412 0000 0000 0000 0000 0000 0000 0000 0164 0340 0000 0344 0253 0218 0000 0000 0000 0000 0000 0000 0233 0672 0050 0050 0000 0000 0000 0341 0341 0341 0341 0341 0000

0.8167 0.8167 0.0000 0.0000 29.1900 29.1900 0.5677 0.0000 3.0109 0.0000 0.0000 0.0000 61.6965 61.6965 5.4582 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 2.0077 0.6310 0.0000 0.8167 16.3288 1.1550 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 16.1710 37.2078 29.1900 29.1900 0.0000 0.0000 0.0000 0.0844 0.0844 0.0844 0.0844 0.0844 0.0000

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 772.49 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1,761.35 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2,018.79 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 SI change retro 1/1/06 (TR 1155)

SI change 1/1/07 (TR 1155) X X

0123T 0124T 0126T 0130T

Scleral fistulization Conjunctival drug placement Chd risk imt study Chron care drug investigatn

T T Q B

1 1 1 1

0234 0232 0340 0000

23.1758 5.1169 0.6310 0.0000

0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00

X

0137T 0140T 0141T 0142T 0143T 0144T 0145T 0146T 0147T 0148T 0149T 0150T 0151T

Prostate saturation sampling Exhaled breath condensate ph Perq islet transplant Open islet transplant Laparoscopic islet transplnt CT heart wo dye; qual calc CT heart w/wo dye funct CCTA w/wo dye CCTA w/wo, quan calcium CCTA w/wo, strxr CCTA w/wo, strxr quan calc CCTA w/wo, disease strxr CT heart funct add-on

T A E E E S S S S S S S S

1 1 1 1 1 1 1 1 1 1 1 1 1

0184 0000 0000 0000 0000 0282 0383 0383 0383 0383 0383 0383 0282

11.0338 0.0000 0.0000 0.0000 0.0000 1.5839 4.7005 4.7005 4.7005 4.7005 4.7005 4.7005 1.5839

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0155T 0156T 0157T 0158T 0159T 0160T 0161T 0162T

Lap impl gast curve electrd Lap remv gast curve electrd Open impl gast curve electrd Open remv gast curve electrd Cad breast mri Tcranial magn stim tx plan Tcranial magn stim tx deliv Anal program gast neurostim

T T C C N S S S

1 1 1 1 1 1 1 1

0130 0130 0000 0000 0000 0216 0216 0692

34.3958 34.3958 0.0000 0.0000 0.0000 2.6846 2.6846 1.8376

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

56 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only C C C C C T C T 1 1 1 1 1 1 1 1

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Children's Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Critical PDD Access Update to Hospital ACS Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

0163T 0164T 0165T 0166T 0167T 0168T 0169T 0170T

Lumb artif diskectomy addl Remove lumb artif disc addl Revise lumb artif disc addl Tcath vsd close w/o bypass Tcath vsd close w bypass Rhinophototx light app bilat Place stereo cath brain Anorectal fistula plug rpr

0000 0000 0000 0000 0000 0251 0000 0150

0.0000 0.0000 0.0000 0.0000 0.0000 2.5002 0.0000 30.1606

0171T

Lumbar spine proces distract

T

1

0050

29.1900

0.00

0.00

0.00

Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to Medicare's Addendum B but not added to book Added 1/1/07 to Medicare's Addendum B but not added to book Description Change Added 1/1/07 to Medicare's Addendum B but not added to book Added 1/1/07 to Medicare's Addendum B but not added to book Added 1/1/07 to Medicare's Addendum B but not added to book Added 1/1/07 to Medicare's Addendum B but not added to book Added 1/1/07 to Medicare's Addendum B but not added to book Description Change Description Change Description Change Description Change

0172T

Lumbar spine process addl

T

1

0050

29.1900

0.00

0.00

0.00

x

0173T

Iop monit io pressure

N

1

0000

0.0000

0.00

0.00

0.00

0174T

Cad cxr with interp

N

1

0000

0.0000

0.00

0.00

0.00

0175T

Cad cxr remote

N

1

0000

0.0000

0.00

0.00

0.00

0176T

Aqu canal dilat w/o retent

T

1

0673

39.7101

0.00

0.00

0.00

0177T 0178T 0179T 0180T 0181T 0182T 0183T 0184T 0185T 0186T 0187T 0500F 0501F 0502F 0503F

Aqu canal dilat w retent 64 Lead ecg w I&R 64 Lead ecg w tracing 64 Lead ecg w I&R only Corneal hysteresis Hdr elect brachytherapy Wound ultrasound Exc rectal tumor endoscopic Comptr probability analysis Suprachoroidal drug delivery Ophthalmic dx image anterior Initial prenatal care visit Prenatal flow sheet Subsequent prenatal care Postpartum care visit

T B X B S S T C N T S M M M M

1 1 1 1 1 1 T C N T S 1 1 1 1

0673 0000 0100 0000 0230 1519 0015 0000 0000 0236 0230 0000 0000 0000 0000

39.7101 0.0000 2.5547 0.0000 0.5903 27.4751 1.4595 0.0000 0.0000 18.2350 0.5903 0.0000 0.0000 0.0000 0.0000

*

0.00 0.00 0.00 0.00 0.00 0.00 69.72 0.00 0.00 871.09 28.20 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 158.97 0.00 0.00 1,986.16 64.30 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 182.20 0.00 0.00 2,276.46 73.69 0.00 0.00 0.00 0.00

x x x x X X X X X

0505F

Hemodialysis plan doc'd

M

1

0000

0.0000

0.00

0.00

0.00

0507F 0509F 0513F 0514F 0516F 0517F 0518F 0519F 0520F 0521F 1000F 1002F 1003F 1004F 1005F 1006F 1007F 1008F 1015F 1018F 1019F 1022F 1026F 1030F 1034F 1035F 1036F 1038F 1039F

Periton dialysis plan doc'd Urine Incon Plan Doc'd Elev BP plan of care doc'd Care plan Hgb doc'd ESA pt Anemia plan of care doc'd Glaucoma plan of care doc'd Fall plan of care doc'd Plan'd chemo doc'd b/4 txmnt Tissue dose done w/in 5 days Plan of care 4 pain doc'd Tobacco use assessed Assess anginal symptom/level Level of activity assess Clin symp vol ovrld assess Asthma symptoms evaluate Osteoarthritis assess Anti-inflm/anlgsc otc assess Gi/renal risk assess Copd symptoms assess Assess dyspnea not present Assess dyspnea present Pneumo imm status assess Co-morbid condition assess Influenza imm status assess Current tobacco smoker Smokeless tobacco user Tobacco non-user Persistent asthma Intermittent asthma

M M M M M M M M M M M M M M M M M M M M M M M M M M M M M

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Added 1/1/07 to Medicare's Addendum B but not added to book Added 1/1/07 to Medicare's Addendum B but not added to book add to fee schedule SI=1 X X X X X X X X

Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to Medicare's Addendum B but not added to book Description Change Added 1/1/07 to Medicare's Addendum B but not added to book Added 1/1/07 to Medicare's Addendum B but not added to book add to fee schedule SI=1 Description Change add to fee schedule SI=1

1040F

Dsm-IV info MDD doc'd

M

1

0000

0.0000

0.00

0.00

0.00

x

1050F

History of mole changes

M

1

0000

0.0000

0.00

0.00

0.00

1055F 1060F 1061F 1065F 1066F 1070F 1071F 1090F 1091F 1100F 1101F 1110F 1111F 1116F 1118F 1119F 1121F 1123F 1124F 1125F 1126F 1127F 1128F 2000F 2001F 2002F 2004F 2010F 2014F 2018F

Visual funct status assess Doc Perm/cont/parox atr Fib Doc Lack Perm+cont+parox fib Ischm Stroke symp lt3 hrsb/4 Ischm Stroke symp ge3 hrsb/4 Alarm Symp assessed -absent Alarm Symp assessed-1+prsnt Pres/absn ruine incon assess Urine incon characterized Pt falls assess-doc'd ge2+/yr Pt falls assess-doc'd le1/y Pt lft inpt fac w/in 60 days Dschrg med/current med merge Auric/peri pain assessed GERD symps assessed 12 month Init. Eval for condition Subs. Eval for condition ACP discuss/dscn mkr doc'd ACP discuss-no dscnmkr doc'd Amnt Pain noted; pain prsnt Amnt Pain noted; none prsnt New episode for condition Subs. episode for condition Blood pressure, measured Weight recorded Clin sign vol ovrld assess Initial exam involved joints Vital signs recorded Mental status assess Hydration status assess

M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

x

add to fee schedule SI=1 add to fee schedule SI=1 add to fee schedule SI=1 add to fee schedule SI=1

add to fee schedule SI=1 add to fee schedule SI=1 SI = 1 effective 10/01/07

X X X X X X X X X X x

Description Change

2019F

Dilated macul exam done

M

1

0000

0.0000

0.00

0.00

0.00

2020F

Dilated fundus eval done

M

1

0000

0.0000

0.00

0.00

0.00

2021F 2022F 2024F 2026F 2027F 2028F 2029F 2030F 2031F 2035F 3006F 3011F 3014F 3017F 3020F 3021F 3022F 3023F 3025F 3027F 3028F 3035F 3037F 3040F 3042F 3044F

Dilat macul+exam done Dil retina exam interp rev 7 field photo interp doc rev Eye image valid to dx rev Optic nerve head eval done Foot exam performed Complete phys skin exam done H2O stat docÆd, normal H2O stat docÆd, dehydrated Tymp memb motion exam'd Cxr doc rev Lipid panel doc rev Screen mammo doc rev Colorectal ca screen doc rev Lvf assess Lvef mod/sever deprs syst Lvef >=40% systolic Spirom doc rev Spirom fev/fvc<70% w copd Spirom fev/fvc=>70%/ w/o copd O2 saturation doc rev O2 saturation <=88% /pao<=55 O2 saturation> 88% /pao>55 Fev<40% predicted value Fev>=40% predicted value Hg a 1 c level 1t 7.0%

M M M M M M M M M M M M M M M M M M M M M M M M M M

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to Medicare's Addendum B but not added to book Added 1/1/07 to Medicare's Addendum B but not added to book Added 1/1/07 to Medicare's Addendum B but not added to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Add to OCE 1/1/07 (TR 1155) Added 1/1/07 to book Add to OCE 1/1/07 (TR 1155) Add to OCE 1/1/07 (TR 1155) Add to OCE 1/1/07 (TR 1155) effective 10/01/07 Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Description Change Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Description Change Added 1/1/07 to book Added 1/1/07 to book Description Change Added 1/1/07 to book Description Change Added 1/1/07 to book Added 1/1/07 to book Description Change Description Change

X

X

x

x x

x x

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

57 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee

Children's Hospital Outpatient Fee

Critical PDD Access Update to Hospital ACS Outpatient Fee

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

3045F 3046F

HG a1c level 7.0-9.0% Hemoglobin a1c level > 9.0%

M M

1 1

0000 0000

0.0000 0.0000

0.00 0.00

0.00 0.00

0.00 0.00

Added 1/1/07 to Medicare's Addendum B but not added to book Added 1/1/07 to book Added 1/1/07 to book description Change Added 1/1/07 to book description Change Added 1/1/07 to book description Change Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Add to OCE 1/1/07 (TR 1155)

3048F 3049F 3050F 3060F 3061F 3062F 3066F 3072F 3073F 3074F 3075F

Ldl-c <100 mg/dl Ldl-c 100-129 mg/dl Ldl-c> = 130 mg/dl Pos microalbuminuria rev Neg microalbuminuria rev Pos macroalbuminuria rev Nephropathy doc tx Low risk for retinopathy Pre-surg eye measures doc’d Syst bp lt 130 mm hg Syst bp ge 130-139 mm hg

M M M M M M M M M M M

1 1 1 1 1 1 1 1 1 1 1

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

x x x

3077F 3078F 3079F 3080F 3082F 3083F 3084F 3085F 3088F 3089F 3090F 3091F 3092F 3093F 3095F 3096F 3100F

Syst bp> = 140 mm hg6 it Diast bp < 80 mm hg Diast bp 80-89 mm hg Diast bp> = 90 mm hg Kt/v lt 1.2 Kt/v ge 1.2 and <1.7 Kt/v ge 1.7 Suicide risk assessed MDD, mild MDD, moderate MDD, severe; w/o psych Mdd, severe; w/ psych MDD, in remission Doc new diag 1st/addl mdd Central dexa results doc’d Central dexa ordered Image test ref carot diam

M M M M M M M M M M M M M M M M M

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Added 1/1/07 to book description Change Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book description Change Add to OCE 1/1/07 (TR 1155) Description change Add to OCE 1/1/07 (TR 1155) Description change Add to OCE 1/1/07 (TR 1155) Description change Add to OCE 1/1/07 (TR 1155) Add to OCE 1/1/07 (TR 1155) Description change Add to OCE 1/1/07 (TR 1155) Description change Add to OCE 1/1/07 (TR 1155) Description change Add to OCE 1/1/07 (TR 1155) Add to OCE 1/1/07 (TR 1155) Description change Add to OCE 1/1/07 (TR 1155) Description change Add to OCE 1/1/07 (TR 1155) Add to OCE 1/1/07 (TR 1155)

x

x x x x

x x x

x x

3110F 3111F 3112F 3120F 3130F 3132F 3140F 3141F 3142F 3150F 3155F 3160F 3170F 3200F 3210F 3215F 3216F 3218F 3220F 3230F 3260F 3265F 3266F 3268F 3269F 3270F 3271F 3272F 3273F 3274F 3278F 3279F 3280F 3281F 3284F 3285F 3288F 3290F 3291F 3292F 3300F 3301F 3302F 3303F 3304F 3305F 3306F 3307F 3308F 3309F 3310F 3311F 3312F 3313F 3314F 3315F 3316F 3317F 3318F 3319F 3320F 3325F 4000F 4001F 4002F 4003F 4005F 4006F 4009F 4011F 4012F 4014F 4015F 4016F 4017F 4018F 4019F 4025F 4030F 4033F 4035F 4037F 4040F 4041F 4042F 4043F 4044F 4045F 4046F 4047F 4048F 4049F 4050F 4051F 4052F 4053F 4054F 4055F

Pres/absn hmrgh/lesion doc'd Ct/mri brain done w/in 24hrs Ct/mri brain done gt 24hrs 12-lead ecg performed Upper gi endoscopy performed Doc ref upper gi endoscopy Upper gi endo shows barrtt's Upper gi endo not barrtt's Barium swallow test ordered Forceps esoph biopsy done Cytogen test marrow b/4 tx Doc fe+stores b/4 epo thx Flow cyto done b/4 tx Barium swallow test not req Grp a strep test performed Pt immunity to hep A doc'd Pt immunity to hep B doc'd Rna tstng hep c doc'd-done Hep C quant rna tstng doc'd Note hring tst w/in 6 mon Pt cat/pn cat/hist grd doc'd RNA tstng HepC vir ord/doc'd HepC gn tstng doc'd b/4txmnt PSA/T/G1Sc doc'd b/4 txmnt Bone scn b/4 txmnt/aftr Dx No bone scn b/4 txmnt/aftrDx Low risk, prostate cancer Med. risk, prostate cancer High risk, prostate cancer Prost Cncr rsk not lw/md/hgh Serum lvls CA/iPTH/lpd ord Hgb lvl >/=13 g/dL Hgb lvl 11-12.9 g/dL Hgb lvl <11 g/dL IOP down >15% of pre-svc lvl IOP down <15% of pre-svc lvl Fall risk assessment doc'd Pt=D(Rh)- and unsensitized Pt=D(Rh)+or sensitized HIV tstng asked/doc'd/revw'd AJCC stage doc'd b/4 thxpy Cancer stage doc'd, metast AJCC stage 0 doc'd AJCC stage IA doc'd AJCC stage IB doc'd AJCC stage IC doc'd AJCC stage IIA doc'd AJCC stage IIB doc'd AJCC stage IIC doc'd AJCC stage IIIA doc'd AJCC stage IIIB doc'd AJCC stage IIIC doc'd AJCC stage IVA doc'd AJCC stage IVB doc'd AJCC stage IVC doc'd ER +or PR +breast cancer ER- or PR- breast cancer Path rpt malig cancer doc'd Path rpt malig cancer doc'd X-ray/CT/Ultrsnd et al ord'd No Xray/CT/ et al ord'd Preop asses 4 cataract surg Tobacco use txmnt counseling Tobacco use txmnt, pharmacol Statin therapy, rx Pt ed write/oral, pts w/ hf Pharm thx for op rx’d Beta-blocker therapy, rx ACE/ARB inhibitor therapy Rx Oral antiplatelet tx, rx Warfarin therapy rx Written discharge instr prvd Persist asthma medicine ctrl Anti-inflm/anlgsc agent rx Gi prophylaxis for nsaid rx Therapy exercise joint rx Doc recpt counsl vit d/calc+ Inhaled broncholidator rx Oxygen therapy rx Pulmonary rehab rec Influenza imm rec Influenza imm order/admin Pneumoc imm order/admin Doc order cefazolin/cefurox doc antibio not given Doc order given stop antibio Doc order given vte prophylx Empiric antibiotic rx Doc antibio given b/4 surg Doc antibio given b/4 surg Doc antibio given b/4 surg Doc order given stop antibio Ht care plan doc Referred for an AV fistula Hemodialysis via AV fistula Hemodialysis via av graft Hemodialysis via catheter Pt. rcvng periton dialysis

M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

add to fee schedule SI=1 Description Change Description Change Description Change Description Change

x x x x

X

effective 10/01/07 effective 10/01/07 effective 10/01/07 effective 10/01/07 effective 10/01/07 effective 10/01/07

X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X

Add to OCE 1/1/07 (TR 1155)

Add to OCE 1/1/07 (TR 1155) Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book add to fee schedule SI=1 add to fee schedule SI=1 add to fee schedule SI=1 add to fee schedule SI=1 Added 1/1/07 to book add to fee schedule SI=1 add to fee schedule SI=1 add to fee schedule SI=1 add to fee schedule SI=1 Added 1/1/07 to book Add to OCE 1/1/07 (TR 1155) Description Change Add to OCE 1/1/07 (TR 1155) Description Change Add to OCE 1/1/07 (TR 1155) Add to OCE 1/1/07 (TR 1155) Add to OCE 1/1/07 (TR 1155)

x x

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

58 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee

Children's Hospital Outpatient Fee

Critical PDD Access Update to Hospital ACS Outpatient Fee

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

4056F 4058F 4060F 4062F 4064F 4065F 4066F 4067F 4070F 4073F 4075F 4077F 4079F 4084F 4090F 4095F 4100F 4110F 4115F 4120F 4124F 4130F 4131F 4132F 4133F 4134F 4135F 4136F 4150F 4151F 4152F 4153F 4154F 4155F 4156F 4157F 4158F 4159F 4163F 4164F 4165F 4167F 4168F 4169F 4171F 4172F 4174F 4175F 4176F 4177F 4178F 4179F 4180F 4181F 4182F 4185F 4186F 4187F 4188F 4189F 4190F 4191F 4200F 4201F 4210F 4220F 4221F 4230F

Approp. oral rehyd. recommÆd Ped gastro ed given, caregvr Psych svcs provided Pt referral psych docÆd Antidepressant rx Antipsychotic rx Ect provided Pt referral for ect docÆd Dvt prophylx recv'd day 2 Oral Antiplat thx rx dischrg Anticoag thx rx at dischrg Doc t-pa admin considered Doc rehab svcs considered Aspirin recv'd w/in 24 hrs Pt rcvng epo thxpy Pt not rcvng epo thxpy Biphos thxpy vein ord/rec'vd Int. mam art used for cabg Beta blckr admin w/in 24 hrs Anitbiot rx'd/given Anitbiot not rx'd/given Topical prep rx, AOE Syst antimicrobial thx rx No syst antimicrobial thx rx Antihist/decong rx/recom No antihist/decong rx/recom Systemic corticosteroids rx Syst corticosteroids not rx Pt recvng antivir txmnt hepc Pt not recvng antiv hep c Doc'd pegintf/rib thxy consd Combo pegintf/rib rx Hep A vac series recommended Hep A vac series prev recvd Hep B vac series recommended Hep B vac series prev recvd Pt edu re: alcoh drnkng done Contrcp talk b/4 antiv txmnt Pt couns. 4 txmnt opt, prost Adjv hrmnl thxpy Rx'd 3D-CRT/IMRT received Hd Bed tilted, 1st day vent Pt care, ICU&vent w/in 24hrs No pt care ICU/vent in 24hrs Pt. rcvng ESA thxpy Pt. not rcvng ESA thxpy Couns., potent. Glauc impct Vis of >=20/40 w/in 90 days Talk re UV light, pt/crgvr Talk pt/crgvr re: AREDS,prev AntiD glbln rcv'd w/in 26wks Tamoxifen/AI prescribed Adjv thxpyRx'd/rcv'd Stg3A-C Conformal rad'n thxpy rcv'd No conformal rad'n thxpy Continuous PPI or H2RA rcv'd No Cont. PPI or H2RA rcv'd Anti rheum DrugthxpyRx'd/gvn Approp ACE/ARB tstng done Approp dogoxin tstng done Approp diuretic tstng done Approp anticonvuls tstng External beam to prost only Extrnl beam other than prost ACE/ARB thxpy for >= 6 mons Digoxin thxpy for >= 6 mons Diuretic thxpy for >= 6 mons Anticonv thxpy for >= 6 mons

M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Add to OCE 1/1/07 (TR 1155) Add to OCE 1/1/07 (TR 1155) Add to OCE 1/1/07 (TR 1155) Add to OCE 1/1/07 (TR 1155) Add to OCE 1/1/07 (TR 1155) Add to OCE 1/1/07 (TR 1155) Add to OCE 1/1/07 (TR 1155) Add to OCE 1/1/07 (TR 1155) add to fee schedule SI=1 add to fee schedule SI=1 add to fee schedule SI=1 add to fee schedule SI=1 add to fee schedule SI=1 add to fee schedule SI=1

effective 10/01/07 effective 10/01/07 effective 10/01/07 effective 10/01/07 effective 10/01/07 effective 10/01/07 effective 10/01/07 effective 10/01/07 effective 10/01/07 effective 10/01/07 effective 10/01/07 effective 10/01/07 effective 10/01/07 effective 10/01/07 effective 10/01/07 effective 10/01/07 effective 10/01/07

X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X

5005F

Pt counsld on exam for moles

M

1

0000

0.0000

0.00

0.00

0.00

5010F

Macul+fndngs to dr mng dm

M

1

0000

0.0000

0.00

0.00

0.00

5015F 5020F 5050F 6005F 6010F 6015F 6020F 6030F 7010F A0021 A0080 A0090 A0100 A0110 A0120 A0130 A0140 A0160 A0170 A0180 A0190 A0200 A0210 A0225 A0380 A0382 A0384 A0390 A0392 A0394 A0396 A0398 A0420 A0422 A0424 A0425 A0426 A0427 A0428 A0429 A0430 A0431 A0432 A0433 A0434 A0435 A0436 A0888 A0998 A0999 A4206 A4207 A4208 A4209 A4210 A4211 A4212 A4213 A4215 A4216 A4217 A4218 A4220 A4221 A4222 A4223 A4230 A4231 A4232 A4233 A4234 A4235 A4236 A4244 A4245 A4246 A4247

Doc fx & test/txmnt for op Txmnts 2 main Dr by 1 mon Plan 2 main Dr. by 1 month Care level rationale doc dysphag test done b/4 eating Dysphag test done b/4 eating NPO (nothing-mouth) ordered Max sterile barriers follw'd Pt info into recall system Outside state ambulance serv Noninterest escort in non er Interest escort in non er Nonemergency transport taxi Nonemergency transport bus Noner transport mini-bus Noner transport wheelch van Nonemergency transport air Noner transport case worker Transport parking fees/tolls Noner transport lodgng recip Noner transport meals recip Noner transport lodgng escrt Noner transport meals escort Neonatal emergency transport Basic life support mileage Basic support routine suppls Bls defibrillation supplies Advanced life support mileag Als defibrillation supplies Als IV drug therapy supplies Als esophageal intub suppls Als routine disposble suppls Ambulance waiting 1/2 hr Ambulance 02 life sustaining Extra ambulance attendant Ground mileage Als 1 ALS1-emergency bls BLS-emergency Fixed wing air transport Rotary wing air transport PI volunteer ambulance co als 2 Specialty care transport Fixed wing air mileage Rotary wing air mileage Noncovered ambulance mileage Ambulance response/treatment Unlisted ambulance service 1 CC sterile syringe&needle 2 CC sterile syringe&needle 3 CC sterile syringe&needle 5+ CC sterile syringe&needle Nonneedle injection device Supp for self-adm injections Non coring needle or stylet 20+ CC syringe only Sterile needle Sterile water/saline, 10 ml Sterile water/saline, 500 ml Sterile saline or water Infusion pump refill kit Maint drug infus cath per wk Infusion supplies with pump Infusion supplies w/o pump Infus insulin pump non needl Infusion insulin pump needle Syringe w/needle insulin 3cc Alkalin batt for glucose mon J-cell batt for glucose mon Lithium batt for glucose mon Silvr oxide batt glucose mon Alcohol or peroxide per pint Alcohol wipes per box Betadine/phisohex solution Betadine/iodine swabs/wipes

M M M M M M M M M E E E E E E E E E E E E E E E E A A E A A A A A A A A A A A A A A A A A A A E E A E E E E E E B E E A A N N Y Y E Y Y E Y Y Y Y E E E E

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 3 3 3 3 1 1 B 3 3 3 3 N N Y Y Y Y Y Y Y Y Y Y 3 3 3 3

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 M01 0.00 0.00 0.00 M01 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 M01

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 M01 0.00 0.00 0.00 M01 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 M01

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 M01 0.00 0.00 0.00 M01 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 M01

Added 1/1/07 to Medicare's Addendum B but not added to book Added 1/1/07 to Medicare's Addendum B but not added to book Added 1/1/07 to Medicare's Addendum B but not added to book X X Added 1/1/07 to book add to fee schedule SI=1 add to fee schedule SI=1 Description change add to fee schedule SI=1

x X X

X X

X

SI change 1/1/07 (TR 1155)

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

59 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only N E E Y Y Y Y Y Y E N N Y E E E E N A E E E E E E B N N N N A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A E A A A A A A A A A A A A A A A A E A A A A A A A E E E E E B E Y Y Y Y N N A E E E E Y 1 3 1 Y Y Y Y Y Y 3 1 1 Y 3 3 3 3 1 3 3 3 3 3 3 3 1 N N N N 3 3 3 3 3 3 3 3 3 3 3 1 3 3 3 3 3 3 1 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 1 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 1 1 3 1 3 3 3 3 1 B 3 Y Y Y Y N N 3 1 1 1 1 Y

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 M01 0.00 M01 M01 M01 M01 0.00 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00 0.00

Children's Hospital Outpatient Fee 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 M01 0.00 M01 M01 M01 M01 0.00 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00 0.00

Critical PDD Access Update to Hospital ACS Outpatient Fee 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 M01 0.00 M01 M01 M01 M01 0.00 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00 0.00 11/30/07

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

A4248 A4250 A4252 A4253 A4255 A4256 A4257 A4258 A4259 A4261 A4262 A4263 A4265 A4266 A4267 A4268 A4269 A4270 A4280 A4281 A4282 A4283 A4284 A4285 A4286 A4290 A4300 A4301 A4305 A4306 A4310 A4311 A4312 A4313 A4314 A4315 A4316 A4320 A4321 A4322 A4326 A4327 A4328 A4330 A4331 A4332 A4333 A4334 A4335 A4338 A4340 A4344 A4346 A4349 A4351 A4352 A4353 A4354 A4355 A4356 A4357 A4358 A4361 A4362 A4363 A4364 A4365 A4366 A4367 A4368 A4369 A4371 A4372 A4373 A4375 A4376 A4377 A4378 A4379 A4380 A4381 A4382 A4383 A4384 A4385 A4387 A4388 A4389 A4390 A4391 A4392 A4393 A4394 A4395 A4396 A4397 A4398 A4399 A4400 A4402 A4404 A4405 A4406 A4407 A4408 A4409 A4410 A4411 A4412 A4413 A4414 A4415 A4416 A4417 A4418 A4419 A4420 A4421 A4422 A4423 A4424 A4425 A4426 A4427 A4428 A4429 A4430 A4431 A4432 A4433 A4434 A4450 A4452 A4455 A4458 A4461 A4463 A4465 A4470 A4480 A4481 A4483 A4490 A4495 A4500 A4510 A4520 A4550 A4554 A4556 A4557 A4558 A4559 A4561 A4562 A4565 A4570 A4575 A4580 A4590 A4595

Chlorhexidine antisept Urine reagent strips/tablets Blood ketone test or strip Blood glucose/reagent strips Glucose monitor platforms Calibrator solution/chips Replace Lensshield Cartridge Lancet device each Lancets per box Cervical cap contraceptive Temporary tear duct plug Permanent tear duct plug Paraffin Diaphragm Male condom Female condom Spermicide Disposable endoscope sheath Brst prsths adhsv attchmnt Replacement breastpump tube Replacement breastpump adpt Replacement breastpump cap Replcmnt breast pump shield Replcmnt breast pump bottle Replcmnt breastpump lok ring Sacral nerve stim test lead Cath impl vasc access portal Implantable access syst perc Drug delivery system >=50 ML Drug delivery system <=5 ML Insert tray w/o bag/cath Catheter w/o bag 2-way latex Cath w/o bag 2-way silicone Catheter w/bag 3-way Cath w/drainage 2-way latex Cath w/drainage 2-way silcne Cath w/drainage 3-way Irrigation tray Cath therapeutic irrig agent Irrigation syringe Male external catheter Fem urinary collect dev cup Fem urinary collect pouch Stool collection pouch Extension drainage tubing Lube sterile packet Urinary cath anchor device Urinary cath leg strap Incontinence supply Indwelling catheter latex Indwelling catheter special Cath indw foley 2 way silicn Cath indw foley 3 way Disposable male external cat Straight tip urine catheter Coude tip urinary catheter Intermittent urinary cath Cath insertion tray w/bag Bladder irrigation tubing Ext ureth clmp or compr dvc Bedside drainage bag Urinary leg or abdomen bag Ostomy face plate Solid skin barrier Ostomy clamp, replacement Adhesive, liquid or equal Adhesive remover wipes Ostomy vent Ostomy belt Ostomy filter Skin barrier liquid per oz Skin barrier powder per oz Skin barrier solid 4x4 equiv Skin barrier with flange Drainable plastic pch w fcpl Drainable rubber pch w fcplt Drainable plstic pch w/o fp Drainable rubber pch w/o fp Urinary plastic pouch w fcpl Urinary rubber pouch w fcplt Urinary plastic pouch w/o fp Urinary hvy plstc pch w/o fp Urinary rubber pouch w/o fp Ostomy faceplt/silicone ring Ost skn barrier sld ext wear Ost clsd pouch w att st barr Drainable pch w ex wear barr Drainable pch w st wear barr Drainable pch ex wear convex Urinary pouch w ex wear barr Urinary pouch w st wear barr Urine pch w ex wear bar conv Ostomy pouch liq deodorant Ostomy pouch solid deodorant Peristomal hernia supprt blt Irrigation supply sleeve Ostomy irrigation bag Ostomy irrig cone/cath w brs Ostomy irrigation set Lubricant per ounce Ostomy ring each Nonpectin based ostomy paste Pectin based ostomy paste Ext wear ost skn barr <=4sq” Ext wear ost skn barr >4sq” Ost skn barr w flng <=4 sq” Ost skn barr w flng >4sq” Ost skn barr extnd =4sq Ost pouch drain high output 2 pc drainable ost pouch Ostomy sknbarr w flng <=4sq” Ostomy skn barr w flng >4sq” Ost pch clsd w barrier/filtr Ost pch w bar/bltinconv/fltr Ost pch clsd w/o bar w filtr Ost pch for bar w flange/flt Ost pch clsd for bar w lk fl Ostomy supply misc Ost pouch absorbent material Ost pch for bar w lk fl/fltr Ost pch drain w bar & filter Ost pch drain for barrier fl Ost pch drain 2 piece system Ost pch drain/barr lk flng/f Urine ost pouch w faucet/tap Urine ost pouch w bltinconv Ost urine pch w b/bltin conv Ost pch urine w barrier/tapv Os pch urine w bar/fange/tap Urine ost pch bar w lock fln Ost pch urine w lock flng/ft Non-waterproof tape Waterproof tape Adhesive remover per ounce Reusable enema bag Surgicl dress hold non-reuse Surgical dress holder reuse Non-elastic extremity binder Gravlee jet washer Vabra aspirator Tracheostoma filter Moisture exchanger Above knee surgical stocking Thigh length surg stocking Below knee surgical stocking Full length surg stocking Incontinence garment anytype Surgical trays Disposable underpads Electrodes, pair Lead wires, pair Conductive paste or gel Coupling gel or paste Pessary rubber, any type Pessary, non rubber,any type Slings Splint Hyperbaric o2 chamber disps Cast supplies (plaster) Special casting material TENS suppl 2 lead per month

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

X

SI=Y effective 01/01/08

x

change valid sex to F change valid sex to F change valid sex to F change valid sex to F change valid sex to F change valid sex to F

x x x x x x

SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155)

Factor Code = N so SI needs to be 1

Added 1/1/07 to book Added 1/1/07 to book

SI = Y effective 01/01/08

x

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

60 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee

Children's Hospital Outpatient Fee

Critical PDD Access Update to Hospital ACS Outpatient Fee

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

A4600 A4601 A4604 A4605 A4606 A4608 A4611 A4612 A4613 A4614 A4615 A4616 A4617 A4618 A4619 A4620 A4623 A4624 A4625 A4626 A4627 A4628 A4629 A4630 A4633 A4634 A4635 A4636 A4637 A4638 A4639 A4640 A4641 A4642 A4648 A4649 A4650 A4651 A4652 A4653 A4657 A4660 A4663 A4670 A4671 A4672 A4673 A4674 A4680 A4690 A4706 A4707 A4708 A4709 A4714 A4719 A4720 A4721 A4722 A4723 A4724 A4725 A4726 A4728 A4730 A4736 A4737 A4740 A4750 A4755 A4760 A4765 A4766 A4770 A4771 A4772 A4773 A4774 A4802 A4860 A4870 A4890 A4911 A4913 A4918 A4927 A4928 A4929 A4930 A4931 A4932 A5051 A5052 A5053 A5054 A5055 A5061 A5062 A5063 A5071 A5072 A5073 A5081 A5082 A5083 A5093 A5102 A5105 A5112 A5113 A5114 A5120 A5121 A5122 A5126 A5131 A5200 A5500 A5501 A5503 A5504 A5505 A5506 A5507 A5508 A5510 A5512 A5513 A6000 A6010 A6011 A6021 A6022 A6023 A6024 A6025 A6154 A6196 A6197 A6198 A6199 A6200 A6201 A6202 A6203 A6204 A6205 A6206 A6207 A6208 A6209 A6210 A6211 A6212 A6213 A6214 A6215 A6216 A6217 A6218

Sleeve, inter limb comp dev Lith ion batt, non-pros use Tubing with heating element Trach suction cath close sys Oxygen probe used w oximeter Transtracheal oxygen cath Heavy duty battery Battery cables Battery charger Hand-held PEFR meter Cannula nasal Tubing (oxygen) per foot Mouth piece Breathing circuits Face tent Variable concentration mask Tracheostomy inner cannula Tracheal suction tube Trach care kit for new trach Tracheostomy cleaning brush Spacer bag/reservoir Oropharyngeal suction cath Tracheostomy care kit Repl bat t.e.n.s. own by pt Uvl replacement bulb Replacement bulb th lightbox Underarm crutch pad Handgrip for cane etc Repl tip cane/crutch/walker Repl batt pulse gen sys Infrared ht sys replcmnt pad Alternating pressure pad Diagnostic imaging agent Satumomab pendetide per dose Implantable tissue marker Surgical supplies Implant radiation dosimeter Calibrated microcap tube Microcapillary tube sealant PD catheter anchor belt Syringe w/wo needle Sphyg/bp app w cuff and stet Dialysis blood pressure cuff Automatic bp monitor, dial Disposable cycler set Drainage ext line, dialysis Ext line w easy lock connect Chem/antisept solution, 8oz Activated carbon filter, ea Dialyzer, each Bicarbonate conc sol per gal Bicarbonate conc pow per pac Acetate conc sol per gallon Acid conc sol per gallon Treated water per gallon "Y set" tubing Dialysat sol fld vol > 249cc Dialysat sol fld vol > 999cc Dialys sol fld vol > 1999cc Dialys sol fld vol > 2999cc Dialys sol fld vol > 3999cc Dialys sol fld vol > 4999cc Dialys sol fld vol > 5999cc Dialysate solution, non-dex Fistula cannulation set, ea Topical anesthetic, per gram Inj anesthetic per 10 ml Shunt accessory Art or venous blood tubing Comb art/venous blood tubing Dialysate sol test kit, each Dialysate conc pow per pack Dialysate conc sol add 10 ml Blood collection tube/vacuum Serum clotting time tube Blood glucose test strips Occult blood test strips Ammonia test strips Protamine sulfate per 50 mg Disposable catheter tips Plumb/elec wk hm hemo equip Repair/maint cont hemo equip Drain bag/bottle Misc dialysis supplies noc Venous pressure clamp Non-sterile gloves Surgical mask Tourniquet for dialysis, ea Sterile, gloves per pair Reusable oral thermometer Reusable rectal thermometer Pouch clsd w barr attached Clsd ostomy pouch w/o barr Clsd ostomy pouch faceplate Clsd ostomy pouch w/flange Stoma cap Pouch drainable w barrier at Drnble ostomy pouch w/o barr Drain ostomy pouch w/flange Urinary pouch w/barrier Urinary pouch w/o barrier Urinary pouch on barr w/flng Continent stoma plug Continent stoma catheter Stoma absorptive cover Ostomy accessory convex inse Bedside drain btl w/wo tube Urinary suspensory Urinary leg bag Latex leg strap Foam/fabric leg strap Skin barrier, wipe or swab Solid skin barrier 6x6 Solid skin barrier 8x8 Disk/foam pad +or- adhesive Appliance cleaner Percutaneous catheter anchor Diab shoe for density insert Diabetic custom molded shoe Diabetic shoe w/roller/rockr Diabetic shoe with wedge Diab shoe w/metatarsal bar Diabetic shoe w/off set heel Modification diabetic shoe Diabetic deluxe shoe Compression form shoe insert Multi den insert direct form Multi den insert custom mold Wound warming wound cover Collagen based wound filler Collagen gel/paste wound fil Collagen dressing <=16 sq in Collagen drsg>6<=48 sq in Collagen dressing >48 sq in Collagen dsg wound filler Silicone gel sheet, each Wound pouch each Alginate dressing <=16 sq in Alginate drsg >16 <=48 sq in alginate dressing > 48 sq in Alginate drsg wound filler Compos drsg <=16 no border Compos drsg >16<=48 no bdr Compos drsg >48 no border Composite drsg <= 16 sq in Composite drsg >16<=48 sq in Composite drsg > 48 sq in Contact layer <= 16 sq in Contact layer >16<= 48 sq in Contact layer > 48 sq in Foam drsg <=16 sq in w/o bdr Foam drg >16<=48 sq in w/o b Foam drg > 48 sq in w/o brdr Foam drg <=16 sq in w/border Foam drg >16<=48 sq in w/bdr Foam drg > 48 sq in w/border Foam dressing wound filler Non-sterile gauze<=16 sq in Non-sterile gauze>16<=48 sq Non-sterile gauze > 48 sq in

Y Y Y Y A Y Y Y Y N Y Y Y Y Y Y A Y A A E Y A Y Y A Y Y Y Y Y Y N N N A N A A A A A A E B B B B A A A A A A A A A A A A A A A B A A A A A A A A A A A A A A A A A A A A A A A A A A E A A A A A A A A A A A A A A A A A A A A A A A A A A Y Y Y Y Y Y Y Y E Y Y E A A A A A A E A A A A A E E E A A A A A A A A A A A A A A A A

1 1 Y Y 3 Y Y Y Y N Y Y Y Y Y Y 3 Y 3 3 3 Y 3 Y Y 1 Y Y Y 1 Y Y N N N 1 N 1 1 1 1 3 3 3 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 3 3 1 1 1 1 1 1 1 1 3 1 1 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 1 3 3 3 3 3 3 3 3 3 3 3 1 Y Y Y Y Y Y Y Y 1 Y Y 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 1 3

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 M01 M01 M01 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01

0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 M01 M01 M01 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01

0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 M01 M01 M01 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01

11/30/07 11/30/07

Factor Code = N so SI needs to be 1 Factor Code = N so SI needs to be 1

SI change 1/1/07 (TR 1155)

SI = Y effective 01/01/08

x

SI = Y effective 01/01/08

x

X X X

Per Angie Not Allowed

X

SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155)

11/30/07

Factor Code = N so SI needs to be 1

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

61 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A E E A A A A A A A A A A A A A A A A A A A A A A A A A A A A A B E A A E E E E E E E E E E E E E Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y A A A A Y Y Y A A A A A A A A A A A A A A A A A Y Y Y Y Y B E 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 1 1 3 3 3 3 3 3 1 3 1 3 3 3 3 3 3 3 3 3 1 1 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 B 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y 1 Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y 1 1 1 1 1 1 Y 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 Y Y Y Y Y 1 1

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 M01 M01 M01 M01 M01 M01 0.00 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Children's Hospital Outpatient Fee M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 M01 M01 M01 M01 M01 M01 0.00 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Critical PDD Access Update to Hospital ACS Outpatient Fee M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 M01 M01 M01 M01 M01 M01 0.00 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 11/30/07 11/30/07

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

A6219 A6220 A6221 A6222 A6223 A6224 A6228 A6229 A6230 A6231 A6232 A6233 A6234 A6235 A6236 A6237 A6238 A6239 A6240 A6241 A6242 A6243 A6244 A6245 A6246 A6247 A6248 A6250 A6251 A6252 A6253 A6254 A6255 A6256 A6257 A6258 A6259 A6260 A6261 A6262 A6266 A6402 A6403 A6404 A6407 A6410 A6411 A6412 A6413 A6441 A6442 A6443 A6444 A6445 A6446 A6447 A6448 A6449 A6450 A6451 A6452 A6453 A6454 A6455 A6456 A6457 A6501 A6502 A6503 A6504 A6505 A6506 A6507 A6508 A6509 A6510 A6511 A6512 A6513 A6530 A6531 A6532 A6533 A6534 A6535 A6536 A6537 A6538 A6539 A6540 A6541 A6542 A6543 A6544 A6549 A6550 A7000 A7001 A7002 A7003 A7004 A7005 A7006 A7007 A7008 A7009 A7010 A7011 A7012 A7013 A7014 A7015 A7016 A7017 A7018 A7025 A7026 A7027 A7028 A7029 A7030 A7031 A7032 A7033 A7034 A7035 A7036 A7037 A7038 A7039 A7040 A7041 A7042 A7043 A7044 A7045 A7046 A7501 A7502 A7503 A7504 A7505 A7506 A7507 A7508 A7509 A7520 A7521 A7522 A7523 A7524 A7525 A7526 A7527 A8000 A8001 A8002 A8003 A8004 A9150 A9152

Gauze <= 16 sq in w/border Gauze >16 <=48 sq in w/bordr Gauze > 48 sq in w/border Gauze <=16 in no w/sal w/o b Gauze >16<=48 no w/sal w/o b Gauze > 48 in no w/sal w/o b Gauze <= 16 sq in water/sal Gauze >16<=48 sq in watr/sal Gauze > 48 sq in water/salne Hydrogel dsg<=16 sq in Hydrogel dsg>16<=48 sq in Hydrogel dressing >48 sq in Hydrocolld drg <=16 w/o bdr Hydrocolld drg >16<=48 w/o b Hydrocolld drg > 48 in w/o b Hydrocolld drg <=16 in w/bdr Hydrocolld drg >16<=48 w/bdr Hydrocolld drg > 48 in w/bdr Hydrocolld drg filler paste Hydrocolloid drg filler dry Hydrogel drg <=16 in w/o bdr Hydrogel drg >16<=48 w/o bdr Hydrogel drg >48 in w/o bdr Hydrogel drg <= 16 in w/bdr Hydrogel drg >16<=48 in w/b Hydrogel drg > 48 sq in w/b Hydrogel drsg gel filler Skin seal protect moisturizr Absorpt drg <=16 sq in w/o b Absorpt drg >16 <=48 w/o bdr Absorpt drg > 48 sq in w/o b Absorpt drg <=16 sq in w/bdr Absorpt drg >16<=48 in w/bdr Absorpt drg > 48 sq in w/bdr Transparent film <= 16 sq in Transparent film >16<=48 in Transparent film > 48 sq in Wound cleanser any type/size Wound filler gel/paste /oz Wound filler dry form / gram Impreg gauze no h20/sal/yard Sterile gauze <= 16 sq in Sterile gauze>16 <= 48 sq in Sterile gauze > 48 sq in Packing strips, non-impreg Sterile eye pad Non-sterile eye pad Occlusive eye patch Adhesive bandage, first-aid Pad band w>=3” <5”/yd Conform band n/s w<3”/yd Conform band n/s w>=3”<5”/yd Conform band n/s w>=5”/yd Conform band s w <3”/yd Conform band s w>=3” <5”/yd Conform band s w >=5”/yd Lt compres band <3”/yd Lt compres band >=3” <5”/yd Lt compres band >=5”/yd Mod compres band w>=3”<5”/yd High compres band w>=3”<5”yd Self-adher band w <3”/yd Self-adher band w>=3” <5”/yd Self-adher band >=5”/yd Zinc paste band w >=3”<5”/yd Tubular dressing Compres burngarment bodysuit Compres burngarment chinstrp Compres burngarment facehood Cmprsburngarment glove-wrist Cmprsburngarment glove-elbow Cmprsburngrmnt glove-axilla Cmprs burngarment foot-knee Cmprs burngarment foot-thigh Compres burn garment jacket Compres burn garment leotard Compres burn garment panty Compres burn garment, noc Compress burn mask face/neck Compression stocking BK18-30 Compression stocking BK30-40 Compression stocking BK40-50 Gc stocking thighlngth 18-30 Gc stocking thighlngth 30-40 Gc stocking thighlngth 40-50 Gc stocking full lngth 18-30 Gc stocking full lngth 30-40 Gc stocking full lngth 40-50 Gc stocking waistlngth 18-30 Gc stocking waistlngth 30-40 Gc stocking waistlngth 40-50 Gc stocking custom made Gc stocking lymphedema Gc stocking garter belt G compression stocking Neg pres wound ther drsg set Disposable canister for pump Nondisposable pump canister Tubing used w suction pump Nebulizer administration set Disposable nebulizer sml vol Nondisposable nebulizer set Filtered nebulizer admin set Lg vol nebulizer disposable Disposable nebulizer prefill Nebulizer reservoir bottle Disposable corrugated tubing Nondispos corrugated tubing Nebulizer water collec devic Disposable compressor filter Compressor nondispos filter Aerosol mask used w nebulize Nebulizer dome & mouthpiece Nebulizer not used w oxygen Water distilled w/nebulizer Replace chest compress vest Replace chst cmprss sys hose Combination oral/nasal mask Repl oral cushion combo mask Repl nasal pillow comb mask CPAP full face mask Replacement facemask interfa Replacement nasal cushion Replacement nasal pillows Nasal application device Pos airway press headgear Pos airway press chinstrap Pos airway pressure tubing Pos airway pressure filter Filter, non disposable w pap One way chest drain valve Water seal drain container Implanted pleural catheter Vacuum drainagebottle/tubing PAP oral interface Repl exhalation port for PAP Repl water chamber, PAP dev Tracheostoma valve w diaphra Replacement diaphragm/fplate HMES filter holder or cap Tracheostoma HMES filter HMES or trach valve housing HMES/trachvalve adhesivedisk Integrated filter & holder Housing & Integrated Adhesiv Heat & moisture exchange sys Trach/laryn tube non-cuffed Trach/laryn tube cuffed Trach/laryn tube stainless Tracheostomy shower protect Tracheostoma stent/stud/bttn Tracheostomy mask Tracheostomy tube collar Trach/laryn tube plug/stop Soft protect helmet prefab Hard protect helmet prefab Soft protect helmet custom Hard protect helmet custom Repl soft interface, helmet Misc/exper non-prescript dru Single vitamin nos

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

X

Factor Code = N so SI needs to be 1 Factor Code = N so SI needs to be 1

X X X

Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

62 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only E B E E E E E E E E E E E E E N N N N N N N N N N N N H N N N H N N H N N N N N N N N N N H N H N N N N N N N N N N N N N N N N H H N N N N N N N N N N N H H N N B 1 B 1 1 1 3 1 1 1 1 1 1 1 1 1 N N 1 1 N N 1 1 N N 1 1 3 1 1 1 1 1 N 1 N N 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 N 1 1 1 1 1 1 1 1 1 1 1 1 1 N N N N N N N N 1 1 1 1 1

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Children's Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Critical PDD Access Update to Hospital ACS Outpatient Fee 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

A9153 A9155 A9180 A9270 A9274 A9275 A9276 A9277 A9278 A9279 A9280 A9281 A9282 A9283 A9300 A9500 A9501 A9502 A9503 A9504 A9505 A9507 A9508 A9509 A9510 A9512 A9516 A9517 A9521 A9524 A9526 A9527 A9528 A9529 A9530 A9531 A9532 A9535 A9536 A9537 A9538 A9539 A9540 A9541 A9542 A9543 A9544 A9545 A9546 A9547 A9548 A9550 A9551 A9552 A9553 A9554 A9555 A9556 A9557 A9558 A9559 A9560 A9561 A9562 A9563 A9564 A9566 A9567 A9568 A9569 A9570 A9571 A9572 A9576 A9577 A9578 A9579 A9600 A9605 A9698 A9699 A9700

Multi-vitamin nos Artificial saliva Lice treatment, topical Non-covered item or service Ext amb insulin delivery sys Disp home glucose monitor Disposable sensor, CGM sys External transmitter, CGM External receiver, CGM sys Monitoring feature/deviceNOC Alert device, noc Reaching/grabbing device Wig any type Foot press off load supp dev Exercise equipment Technetium TC 99m sestamibi Technetium TC-99m teboroxime Technetium TC99M tetrofosmin Technetium TC 99m medronate Technetium tc 99m apcitide Thallous chloride TL 201/mci Indium/111 capromab pendetid Iobenguane sulfate I-131 Iodine I-123 sod iodide mil Technetium TC99m Disofenin Technetiumtc99mpertechnetate Iodine I-123 sod iodide mic Th I131 so iodide cap millic Technetiumtc-99m exametazine Iodinated I-131 serumalbumin Ammonia N-13, per dose Iodine I-125 sodium iodide Dx I131 so iodide cap millic Dx I131 so iodide sol millic Th I131 so iodide sol millic Dx I131 so iodide microcurie I-125 serum albumin micro Injection, methylene blue Tc99m depreotide Tc99m mebrofenin Tc99m pyrophosphate Tc99m pentetate Tc99m MAA Tc99m sulfur colloid In111 ibritumomab, dx Y90 ibritumomab, rx I131 tositumomab, dx I131 tositumomab, rx Co57/58 In111 oxyquinoline In111 pentetate Tc99m gluceptate Tc99m succimer F18 fdg Cr51 chromate I125 iothalamate, dx Rb82 rubidium Ga67 gallium Tc99m bicisate Xe133 xenon 10mci Co57 cyano Tc99m labeled rbc Tc99m oxidronate Tc99m mertiatide P32 Na phosphate P32 chromic phosphate Tc99m fanolesomab Technetium TC-99m aerosol Technetium tc99m arcitumomab Technetium TC-99m auto WBC Indium In-111 auto WBC Indium IN-111 auto platelet Indium In-111 pentetreotide Inj prohance multipack Inj multihance Inj multihance multipack Gad-base MR contrast NOS,1ml Strontium-89 chloride Samarium sm153 lexidronamm Non-rad contrast materialNOC Noc therapeutic radiopharm Echocardiography Contrast

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 1064 0000 0000 0000 2632 0000 0000 1150 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 1643 0000 1645 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 1675 1676 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0701 0702 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

X

X X X X Added 1/1/07 to book

X X X X SI change 1/1/07 (TR 1155) X X X X SI change 1/1/07 (TR 1155) Description Change APC Priced OPPS Covered Only X x X X X X SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) X

Added 1/1/07 to book

SI change 1/1/07 (TR 1155)

X

X X SI change 1/1/07 (TR 1155) X X X X X X X X X X SI change 1/1/07 (TR 1155) X X X

SI change 1/1/07 (TR 1155)

Added 1/1/07 to book

X X X X X X X X X X X

A9900

Supply/accessory/service

Y

1

0000

0.0000

0.00

0.00

0.00

SI change 1/1/01 (TR 1155) but Medicare's Addendum B indicates different SI SI change 1/1/07 (TR 1155) but Medicare's Addendum B indicates different SI - not covered for WY hosp SI change retro 8/1/00 (TR 1155) SI = Y effective 01/01/08 SI = Y effective 01/01/08 SI = Y effective 01/01/08 SI = Y effective 01/01/08 SI = Y effective 01/01/08 SI = Y effective 01/01/08

A9901 A9999

Delivery/set up/dispensing DME supply or accessory, nos

A Y

1 1

0000 0000

0.0000 0.0000

0.00 0.00

0.00 0.00

0.00 0.00

B4034 B4035 B4036 B4081 B4082 B4083 B4087 B4088 B4100 B4102 B4103 B4104 B4149 B4150 B4152 B4153 B4154 B4155 B4157 B4158 B4159 B4160 B4161 B4162 B4164 B4168 B4172 B4176 B4178 B4180 B4185 B4189 B4193 B4197 B4199 B4216 B4220 B4222 B4224 B5000 B5100 B5200 B9000 B9002 B9004 B9006 B9998 B9999 C1300 C1713 C1714 C1715 C1716 C1717 C1719 C1721 C1722 C1724 C1725 C1726 C1727 C1728 C1729 C1730

Enter feed supkit syr by day Enteral feed supp pump per d Enteral feed sup kit grav by Enteral ng tubing w/ stylet Enteral ng tubing w/o stylet Enteral stomach tube levine Gastro/jejuno tube, std Gastro/jejuno tube, low-pro Food thickener oral EF adult fluids and electro EF ped fluid and electrolyte Additive for enteral formula EF blenderized foods EF complet w/intact nutrient EF calorie dense>/=1.5Kcal EF hydrolyzed/amino acids EF spec metabolic noninherit EF incomplete/modular EF special metabolic inherit EF ped complete intact nut EF ped complete soy based EF ped caloric dense>/=0.7kc EF ped hydrolyzed/amino acid EF ped specmetabolic inherit Parenteral 50% dextrose solu Parenteral sol amino acid 3. Parenteral sol amino acid 5. Parenteral sol amino acid 7Parenteral sol amino acid > Parenteral sol carb > 50% Parenteral sol 10 gm lipids Parenteral sol amino acid & Parenteral sol 52-73 gm prot Parenteral sol 74-100 gm pro Parenteral sol > 100gm prote Parenteral nutrition additiv Parenteral supply kit premix Parenteral supply kit homemi Parenteral administration ki Parenteral sol renal-amirosy Parenteral sol hepatic-fream Parenteral sol stres-brnch c Enter infusion pump w/o alrm Enteral infusion pump w/ ala Parenteral infus pump portab Parenteral infus pump statio Enteral supp not otherwise c Parenteral supp not othrws c HYPERBARIC Oxygen Anchor/screw bn/bn,tis/bn Cath, trans atherectomy, dir Brachytherapy needle Brachytx non-str, Gold 198 Brachytx, non-str, HDR Ir-192 Brachytx, NS, Non-HDRIr-192 AICD, dual chamber AICD, single chamber Cath, trans atherec,rotation Cath, translumin non-laser Cath, bal dil, non-vascular Cath, bal tis dis, non-vas Cath, brachytx seed adm Cath, drainage Cath, EP, 19 or few elect

Y Y Y Y Y Y A A E Y Y E Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y B Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y S N N N H H H N N N N N N N N N

Y Y Y Y Y Y 1 1 1 Y Y 1 Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y B Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y 1 S N N N 1 1 1 N N N N N N N N N

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0659 0000 0000 0000 1716 1717 1719 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 1.5579 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 74.42 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 169.69 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 194.49 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

x x x x x x X X

SI = Y effective 01/01/08 SI = Y effective 01/01/08 SI = Y effective 01/01/08 SI = Y effective 01/01/08 SI = Y effective 01/01/08 SI = Y effective 01/01/08 SI = Y effective 01/01/08 SI = Y effective 01/01/08 SI = Y effective 01/01/08 SI = Y effective 01/01/08 SI = Y effective 01/01/08 SI = Y effective 01/01/08 SI = Y effective 01/01/08 SI = Y effective 01/01/08 SI = Y effective 01/01/08 SI = Y effective 01/01/08 SI = Y effective 01/01/08 SI = Y effective 01/01/08 SI = Y effective 01/01/08 SI = Y effective 01/01/08 SI = Y effective 01/01/08 SI = Y effective 01/01/09 SI = Y effective 01/01/10 SI = Y effective 01/01/11 SI = Y effective 01/01/12 SI = Y effective 01/01/13 SI = Y effective 01/01/14 SI = Y effective 01/01/15 SI = Y effective 01/01/16 SI = Y effective 01/01/17 SI = Y effective 01/01/18 SI = Y effective 01/01/19 SI = Y effective 01/01/20 SI = Y effective 01/01/21 SI = Y effective 01/01/22 SI = Y effective 01/01/08

x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

63 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N H N N N N N N N N N N N N N N N N N N N N N N N N N N H N N N N N N N N N N N N N H H H B H H H H H H H H S S S S S S S S S S S S S S S S S S S S S S S S S S S K N K N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N 1 1 1 N N 1 N N 1 N N N N N N N H N N N N 1 N N N N N 1 N N N N N N N N N N N N N N N 1 N N N N N 1 N N N N N N N 1 1 1 1 1 1 1 1 1 1 1 1 S S S S S S S S S S S S S S S S S S S S S S S S S S S 1 N K

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Children's Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Critical PDD Access Update to Hospital ACS Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

C1731 C1732 C1733 C1750 C1751 C1752 C1753 C1754 C1755 C1756 C1757 C1758 C1759 C1760 C1762 C1763 C1764 C1765 C1766 C1767 C1768 C1769 C1770 C1771 C1772 C1773 C1776 C1777 C1778 C1779 C1780 C1781 C1782 C1783 C1784 C1785 C1786 C1787 C1788 C1789 C1813 C1814 C1815 C1816 C1817 C1818 C1819 C1820 C1821 C1874 C1875 C1876 C1877 C1878 C1879 C1880 C1881 C1882 C1883 C1884 C1885 C1887 C1888 C1891 C1892 C1893 C1894 C1895 C1896 C1897 C1898 C1899 C1900 C2614 C2615 C2616 C2617 C2618 C2619 C2620 C2621 C2622 C2625 C2626 C2627 C2628 C2629 C2630 C2631 C2634 C2635 C2636 C2637 C2638 C2639 C2640 C2641 C2642 C2643 C2698 C2699 C8900 C8901 C8902 C8903 C8904 C8905 C8906 C8907 C8908 C8909 C8910 C8911 C8912 C8913 C8914 C8918 C8919 C8920 C8921 C8922 C8923 C8924 C8925 C8926 C8927 C8928 C8957 C9003 C9113 C9121

Cath, EP, 20 or more elec Cath, EP, diag/abl, 3D/vect Cath, EP, othr than cool-tip Cath, hemodialysis,long-term Cath, inf, per/cent/midline Cath,hemodialysis,short-term Cath, intravas ultrasound Catheter, intradiscal Catheter, intraspinal Cath, pacing, transesoph Cath, thrombectomy/embolect Catheter, ureteral Cath, intra echocardiography Closure dev, vasc Conn tiss, human(inc fascia) Conn tiss, non-human Event recorder, cardiac Adhesion barrier Intro/sheath,strble,non-peel Generator, neuro non-recharg Graft, vascular Guide wire Imaging coil, MR, insertable Rep dev, urinary, w/sling Infusion pump, programmable Ret dev, insertable Joint device (implantable) Lead, AICD, endo single coil Lead, neurostimulator Lead, pmkr, transvenous VDD Lens, intraocular (new tech) Mesh (implantable) Morcellator Ocular imp, aqueous drain de Ocular dev, intraop, det ret Pmkr, dual, rate-resp Pmkr, single, rate-resp Patient progr, neurostim Port, indwelling, imp Prosthesis, breast, imp Prosthesis, penile, inflatab Retinal tamp, silicone oil Pros, urinary sph, imp Receiver/transmitter, neuro Septal defect imp sys Integrated keratoprosthesis Tissue local excision Generator neuro rechg bat sys Interspinous implant Stent, coated/cov w/del sys Stent, coated/cov w/o del sy Stent, non-coa/non-cov w/del Stent, non-coat/cov w/o del Matrl for vocal cord Tissue marker, implantable Vena cava filter Dialysis access system AICD, other than sing/dual Adapt/ext, pacing/neuro lead Embolization Protect syst Cath, translumin angio laser Catheter, guiding Endovas non-cardiac abl cath Infusion pump,non-prog, perm Intro/sheath,fixed,peel-away Intro/sheath, fixed,non-peel Intro/sheath, non-laser Lead, AICD, endo dual coil Lead, AICD, non sing/dual Lead, neurostim test kit Lead, pmkr, other than trans Lead, pmkr/AICD combination Lead, coronary venous Probe, perc lumb disc Sealant, pulmonary, liquid Brachytx, non-str, Yttrium-90 Stent, non-cor, tem w/o del Probe, cryoablation Pmkr, dual, non rate-resp Pmkr, single, non rate-resp Pmkr, other than sing/dual Prosthesis, penile, non-inf Stent, non-cor, tem w/del sy Infusion pump, non-prog,temp Cath, suprapubic/cystoscopic Catheter, occlusion Intro/sheath, laser Cath, EP, cool-tip Rep dev, urinary, w/o sling Brachytx, non-str, HA, I-125 Brachytx, non-str, HA, P-103 Brachytx linear, non-str, P-103 Brachy, non-str, Ytterbuim-169 Brachytx, stranded, I-125 Brachytx, non-stranded, I-125 Brachytx, stranded, P-103 Brachytx, non-stranded, P-103 Brachytx, stranded, C-131 Brachytx, non-stranded, C-131 Brachytx, stranded, NOS Brachytx, non-stranded, NOS MRA w/cont, abd MRA w/o cont, abd MRA w/o fol w/cont, abd MRI w/cont, breast, uni MRI w/o cont, breast, uni MRI w/o fol w/cont, brst, un MRI w/cont, breast, bi MRI w/o cont, breast, bi MRI w/o fol w/cont, breast, MRA w/cont, chest MRA w/o cont, chest MRA w/o fol w/cont, chest MRA w/cont, lwr ext MRA w/o cont, lwr ext MRA w/o fol w/cont, lwr ext MRA w/cont, pelvis MRA w/o cont, pelvis MRA w/o fol w/cont, pelvis Comp transtho echo w/contr Limit transtho echo w/contr 2D com transtho echo w/contr 2D lim transtho echo w/contr 2D TEE w/contrast, int/rept Cong TEE w/contr, int/rept TEE w/contrast; monitor 2D transtho w/contr; stress Prolonged IV inf, req pump Palivizumab, per 50 mg Inj pantoprazole sodium, via Injection, argatroban

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 1821 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 2616 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 2634 2635 2636 0000 2638 2639 2640 2641 2642 2643 2698 2699 0284 0336 0337 0284 0336 0337 0284 0336 0337 0284 0336 0337 0284 0336 0337 0284 0336 0337 0128 0128 0128 0128 0128 0128 0128 0128 0441 9003 0000 9121

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 6.2350 5.3933 8.2463 6.2350 5.3933 8.2463 6.2350 5.3933 8.2463 6.2350 5.3933 8.2463 6.2350 5.3933 8.2463 6.2350 5.3933 8.2463 8.4896 8.4896 8.4896 8.4896 8.4896 8.4896 8.4896 8.4896 2.3446 12.7276 0.0000 0.3052

X Added 1/1/07 to book

APC by Report APC by Report APC by Report 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 297.85 257.64 393.93 297.85 257.64 393.93 297.85 257.64 393.93 297.85 257.64 393.93 297.85 257.64 393.93 297.85 257.64 393.93 405.55 405.55 405.55 405.55 405.55 405.55 405.55 405.55 112.00 0.00 0.00 14.58 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 679.12 587.44 898.19 679.12 587.44 898.19 679.12 587.44 898.19 679.12 587.44 898.19 679.12 587.44 898.19 679.12 587.44 898.19 924.69 924.69 924.69 924.69 924.69 924.69 924.69 924.69 255.37 0.00 0.00 33.24 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 778.38 673.30 1,029.47 778.38 673.30 1,029.47 778.38 673.30 1,029.47 778.38 673.30 1,029.47 778.38 673.30 1,029.47 778.38 673.30 1,029.47 1,059.84 1,059.84 1,059.84 1,059.84 1,059.84 1,059.84 1,059.84 1,059.84 292.70 0.00 0.00 38.10

X

X X X X X X X X

* *

C9237 C9238 C9239 C9240

Inj, lanreotide acetate Inj, levetiracetam Inj, temsirolimus Injection, ixabepilone

K K G K

K K G K

9237 9238 1168 9240

0.3788 0.0071 0.7520 1.0133

* * * *

18.10 0.34 35.92 48.40

41.26 0.77 81.91 110.37

47.29 0.88 93.88 126.50

X X X X

C9352 C9353 C9354 C9355 C9399 C9716 C9723 C9724 C9725 C9726 C9727 C9728 D0120 D0140 D0145 D0150 D0160 D0170 D0180

Neuragen nerve guide, per cm Neurawrap nerve protector,cm Veritas collagen matrix, cm2 Neuromatrix nerve cuff, cm Unclassified drugs or biolog Radiofrequency energy to anu Dyn IR Perf Img EPS gast cardia plic Place endorectal app Rxt breast appl place/remov Insert palate implants Place device/marker, non pro Periodic oral evaluation Limit oral eval problm focus Oral evaluation, pt < 3yrs Comprehensve oral evaluation Extensv oral eval prob focus Re-eval,est pt,problem focus Comp periodontal evaluation

G G G G A T S T S S S T E E E S E E E

G G G G 3 1 1 1 1 S 1 1 1 1 1 1 1 1 1

9350 1169 9354 9355 0000 0150 1502 0422 1507 1508 1510 0156 0000 0000 0000 0330 0000 0000 0000

8.1118 6.9002 0.1848 3.5680 0.0000 30.1606 1.1775 25.3233 8.6350 10.2050 13.3451 3.0469 0.0000 0.0000 0.0000 9.1677 0.0000 0.0000 0.0000

* * * *

* * * *

387.50 329.62 8.83 170.44 M01 0.00 0.00 0.00 0.00 487.49 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

883.53 751.57 20.13 388.63 M01 0.00 0.00 0.00 0.00 1,111.53 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

1,012.67 861.42 23.07 445.43 M01 0.00 0.00 0.00 0.00 1,274.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

X X X X SI change 1/1/07 (TR 1155)

Description Change

x

Added 1/1/07 to book

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

64 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only E E E S S S S S E S S E E E E E E E E E E E E B B E B S E B B B B B B B B B B B B B B E B B E E E E 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 B 1 1 1 1

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Children's Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Critical PDD Access Update to Hospital ACS Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

D0210 D0220 D0230 D0240 D0250 D0260 D0270 D0272 D0273 D0274 D0277 D0290 D0310 D0320 D0321 D0322 D0330 D0340 D0350 D0360 D0362 D0363 D0415 D0416 D0421 D0425 D0431 D0460 D0470 D0472 D0473 D0474 D0475 D0476 D0477 D0478 D0479 D0480 D0481 D0482 D0483 D0484 D0485 D0486 D0502 D0999 D1110 D1120 D1203 D1204

Intraor complete film series Intraoral periapical first f Intraoral periapical ea add Intraoral occlusal film Extraoral first film Extraoral ea additional film Dental bitewing single film Dental bitewings two films Bitewings - three films Dental bitewings four films Vert bitewings-sev to eight Dental film skull/facial bon Dental saliography Dental tmj arthrogram incl i Dental other tmj films Dental tomographic survey Dental panoramic film Dental cephalometric film Oral/facial photo images Cone beam ct Cone beam, two dimensional Cone beam, three dimensional Collection of microorganisms Viral culture Gen tst suscept oral disease Caries susceptibility test Diag tst detect mucos abnorm Pulp vitality test Diagnostic casts Gross exam, prep & report Micro exam, prep & report Micro w exam of surg margins Decalcification procedure Spec stains for microorganis Spec stains not for microorg Immunohistochemical stains Tissue in-situ hybridization Cytopath smear prep & report Electron microscopy diagnost Direct immunofluorescence Indirect immunofluorescence Consult slides prep elsewher Consult inc prep of slides Accession of brush biopsy Other oral pathology procedu Unspecified diagnostic proce Dental prophylaxis adult Dental prophylaxis child Topical fluor w/o prophy chi Topical fluor w/o prophy adu

0000 0000 0000 0330 0330 0330 0330 0330 0000 0330 0330 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0330 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 9.1677 9.1677 9.1677 9.1677 9.1677 0.0000 9.1677 9.1677 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 9.1677 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

Added 1/1/07 to book

Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book

Added 1/1/07 to book

D1206 D1310 D1320 D1330 D1351 D1510 D1515 D1520 D1525 D1550 D1555 D2140 D2150 D2160 D2161 D2330 D2331 D2332 D2335 D2390 D2391 D2392 D2393 D2394 D2410 D2420 D2430 D2510 D2520 D2530 D2542 D2543 D2544 D2610 D2620 D2630 D2642 D2643 D2644 D2650 D2651 D2652 D2662 D2663 D2664 D2710 D2712 D2720 D2721 D2722 D2740 D2750 D2751 D2752 D2780 D2781 D2782 D2783 D2790 D2791 D2792 D2794 D2799 D2910 D2915 D2920 D2930 D2931 D2932 D2933 D2934 D2940 D2950 D2951 D2952 D2953 D2954 D2955 D2957 D2960 D2961 D2962 D2970 D2971 D2975 D2980 D2999 D3110 D3120 D3220 D3221 D3230 D3240 D3310 D3320 D3330 D3331 D3332 D3333 D3346 D3347 D3348 D3351 D3352 D3353 D3410 D3421

Topical fluoride varnish Nutri counsel-control caries Tobacco counseling Oral hygiene instruction Dental sealant per tooth Space maintainer fxd unilat Fixed bilat space maintainer Remove unilat space maintain Remove bilat space maintain Recement space maintainer Remove fix space maintainer Amalgam one surface permanen Amalgam two surfaces permane Amalgam three surfaces perma Amalgam 4 or > surfaces perm Resin one surface-anterior Resin two surfaces-anterior Resin three surfaces-anterio Resin 4/> surf or w incis an Ant resin-based cmpst crown Post 1 srfc resinbased cmpst Post 2 srfc resinbased cmpst Post 3 srfc resinbased cmpst Post >=4srfc resinbase cmpst Dental gold foil one surface Dental gold foil two surface Dental gold foil three surfa Dental inlay metalic 1 surf Dental inlay metallic 2 surf Dental inlay metl 3/more sur Dental onlay metallic 2 surf Dental onlay metallic 3 surf Dental onlay metl 4/more sur Inlay porcelain/ceramic 1 su Inlay porcelain/ceramic 2 su Dental onlay porc 3/more sur Dental onlay porcelin 2 surf Dental onlay porcelin 3 surf Dental onlay porc 4/more sur Inlay composite/resin one su Inlay composite/resin two su Dental inlay resin 3/mre sur Dental onlay resin 2 surface Dental onlay resin 3 surface Dental onlay resin 4/mre sur Crown resin-based indirect Crown 3/4 resin-based compos Crown resin w/ high noble me Crown resin w/ base metal Crown resin w/ noble metal Crown porcelain/ceramic subs Crown porcelain w/ h noble m Crown porcelain fused base m Crown porcelain w/ noble met Crown 3/4 cast hi noble met Crown 3/4 cast base metal Crown 3/4 cast noble metal Crown 3/4 porcelain/ceramic Crown full cast high noble m Crown full cast base metal Crown full cast noble metal Crown-titanium Provisional crown Recement inlay onlay or part Recement cast or prefab post Dental recement crown Prefab stnlss steel crwn pri Prefab stnlss steel crown pe Prefabricated resin crown Prefab stainless steel crown Prefab steel crown primary Dental sedative filling Core build-up incl any pins Tooth pin retention Post and core cast + crown Each addtnl cast post Prefab post/core + crown Post removal Each addtnl prefab post Laminate labial veneer Lab labial veneer resin Lab labial veneer porcelain Temp crown (fractured tooth) Add proc construct new crown Coping Crown repair Dental unspec restorative pr Pulp cap direct Pulp cap indirect Therapeutic pulpotomy Gross pulpal debridement Pulpal therapy anterior prim Pulpal therapy posterior pri Anterior Root canal therapy 2 canals Root canal therapy 3 canals Non-surg tx root canal obs Incomplete endodontic tx Internal root repair Retreat root canal anterior Retreat root canal bicuspid Retreat root canal molar Apexification/recalc initial Apexification/recalc interim Apexification/recalc final Apicoect/perirad surg anter Root surgery bicuspid

E E E E E S S S S S E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E S E E E E E E E E E E E E E E E E E E E E

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

0000 0000 0000 0000 0000 0330 0330 0330 0330 0330 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0330 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 9.1677 9.1677 9.1677 9.1677 9.1677 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 9.1677 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

12/11/07

Add taxonomy 261QR1300X and 261QF0400X effective 01/01/08

Added 1/1/07 to book per FQHC/RHC CSR to detail lines

Added 1/1/07 to book

SI = 1 effective 01/01/07

X

SI dropped off when non OPPS changes made

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

65 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only E E E E S E E E E S E E E E E E E E S E S S E E E S S S S E E E E E E E S S E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E S S E E E E E E E E E E E E E E E E E E E E E E E E E E E E E S S S E S E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Children's Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Critical PDD Access Update to Hospital ACS Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

D3425 D3426 D3430 D3450 D3460 D3470 D3910 D3920 D3950 D3999 D4210 D4211 D4230 D4231 D4240 D4241 D4245 D4249 D4260 D4261 D4263 D4264 D4265 D4266 D4267 D4268 D4270 D4271 D4273 D4274 D4275 D4276 D4320 D4321 D4341 D4342 D4355 D4381 D4910 D4920 D4999 D5110 D5120 D5130 D5140 D5211 D5212 D5213 D5214 D5225 D5226 D5281 D5410 D5411 D5421 D5422 D5510 D5520 D5610 D5620 D5630 D5640 D5650 D5660 D5670 D5671 D5710 D5711 D5720 D5721 D5730 D5731 D5740 D5741 D5750 D5751 D5760 D5761 D5810 D5811 D5820 D5821 D5850 D5851 D5860 D5861 D5862 D5867 D5875 D5899 D5911 D5912 D5913 D5914 D5915 D5916 D5919 D5922 D5923 D5924 D5925 D5926 D5927 D5928 D5929 D5931 D5932 D5933 D5934 D5935 D5936 D5937 D5951 D5952 D5953 D5954 D5955 D5958 D5959 D5960 D5982 D5983 D5984 D5985 D5986 D5987 D5988 D5999 D6010 D6012 D6040 D6050 D6053 D6054 D6055 D6056 D6057 D6058 D6059 D6060 D6061 D6062 D6063 D6064 D6065 D6066 D6067 D6068 D6069 D6070 D6071 D6072 D6073 D6074 D6075 D6076 D6077 D6078 D6079 D6080 D6090 D6091 D6092

Root surgery molar Root surgery ea add root Retrograde filling Root amputation Endodontic endosseous implan Intentional replantation Isolation- tooth w rubb dam Tooth splitting Canal prep/fitting of dowel Endodontic procedure Gingivectomy/plasty per quad Gingivectomy/plasty per toot Ana crown exp 4 or> per quad Ana crown exp 1-3 per quad Gingival flap proc w/ planin Gngvl flap w rootplan 1-3 th Apically positioned flap Crown lengthen hard tissue Osseous surgery per quadrant Osseous surgl-3teethperquad Bone replce graft first site Bone replce graft each add Bio mtrls to aid soft/os reg Guided tiss regen resorble Guided tiss regen nonresorb Surgical revision procedure Pedicle soft tissue graft pr Free soft tissue graft proc Subepithelial tissue graft Distal/proximal wedge proc Soft tissue allograft Con tissue w dble ped graft Provision splnt intracoronal Provisional splint extracoro Periodontal scaling & root Periodontal scaling 1-3teeth Full mouth debridement Localized delivery antimicro Periodontal maint procedures Unscheduled dressing change Unspecified periodontal proc Dentures complete maxillary Dentures complete mandible Dentures immediat maxillary Dentures immediat mandible Dentures maxill part resin Dentures mand part resin Dentures maxill part metal Dentures mandibl part metal Maxillary part denture flex Mandibular part denture flex Removable partial denture Dentures adjust cmplt maxil Dentures adjust cmplt mand Dentures adjust part maxill Dentures adjust part mandbl Dentur repr broken compl bas Replace denture teeth complt Dentures repair resin base Rep part denture cast frame Rep partial denture clasp Replace part denture teeth Add tooth to partial denture Add clasp to partial denture Replc tth&acrlc on mtl frmwk Replc tth&acrlc mandibular Dentures rebase cmplt maxil Dentures rebase cmplt mand Dentures rebase part maxill Dentures rebase part mandbl Denture reln cmplt maxil ch Denture reln cmplt mand chr Denture reln part maxil chr Denture reln part mand chr Denture reln cmplt max lab Denture reln cmplt mand lab Denture reln part maxil lab Denture reln part mand lab Denture interm cmplt maxill Denture interm cmplt mandbl Denture interm part maxill Denture interm part mandbl Denture tiss conditn maxill Denture tiss condtin mandbl Overdenture complete Overdenture partial Precision attachment Replacement of precision att Prosthesis modification Removable prosthodontic proc Facial moulage sectional Facial moulage complete Nasal prosthesis Auricular prosthesis Orbital prosthesis Ocular prosthesis Facial prosthesis Nasal septal prosthesis Ocular prosthesis interim Cranial prosthesis Facial augmentation implant Replacement nasal prosthesis Auricular replacement Orbital replacement Facial replacement Surgical obturator Postsurgical obturator Refitting of obturator Mandibular flange prosthesis Mandibular denture prosth Temp obturator prosthesis Trismus appliance Feeding aid Pediatric speech aid Adult speech aid Superimposed prosthesis Palatal lift prosthesis Intraoral con def inter plt Intraoral con def mod palat Modify speech aid prosthesis Surgical stent Radiation applicator Radiation shield Radiation cone locator Fluoride applicator Commissure splint Surgical splint Maxillofacial prosthesis Odontics endosteal implant Endosteal implant Odontics eposteal implant Odontics transosteal implnt Implnt/abtmnt spprt remv dnt Implnt/abtmnt spprt remvprtl Implant connecting bar Prefabricated abutment Custom abutment Abutment supported crown Abutment supported mtl crown Abutment supported mtl crown Abutment supported mtl crown Abutment supported mtl crown Abutment supported mtl crown Abutment supported mtl crown Implant supported crown Implant supported mtl crown Implant supported mtl crown Abutment supported retainer Abutment supported retainer Abutment supported retainer Abutment supported retainer Abutment supported retainer Abutment supported retainer Abutment supported retainer Implant supported retainer Implant supported retainer Implant supported retainer Implnt/abut suprtd fixd dent Implnt/abut suprtd fixd dent Implant maintenance Repair implant Repl semi/precision attach Recement supp crown

0000 0000 0000 0000 0330 0000 0000 0000 0000 0330 0000 0000 0000 0000 0000 0000 0000 0000 0330 0000 0330 0330 0000 0000 0000 0330 0330 0330 0330 0000 0000 0000 0000 0000 0000 0000 0330 0330 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0330 0330 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0330 0330 0330 0000 0330 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 9.1677 0.0000 0.0000 0.0000 0.0000 9.1677 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 9.1677 0.0000 9.1677 9.1677 0.0000 0.0000 0.0000 9.1677 9.1677 9.1677 9.1677 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 9.1677 9.1677 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 9.1677 9.1677 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 9.1677 9.1677 9.1677 0.0000 9.1677 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

Added 1/1/07 to book Added 1/1/07 to book

Added 1/1/07 to book

Added 1/1/07 to book Added 1/1/07 to book

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

66 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E S E E E E E E E E E E E E S S S S S S S S S S E E E E B E E E B E S E E E E E E B E E E E E E E E E E E E E E E E E E E E E B E B E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 B 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 B 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Children's Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Critical PDD Access Update to Hospital ACS Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

D6093 D6094 D6095 D6100 D6190 D6194 D6199 D6205 D6210 D6211 D6212 D6214 D6240 D6241 D6242 D6245 D6250 D6251 D6252 D6253 D6545 D6548 D6600 D6601 D6602 D6603 D6604 D6605 D6606 D6607 D6608 D6609 D6610 D6611 D6612 D6613 D6614 D6615 D6624 D6634 D6710 D6720 D6721 D6722 D6740 D6750 D6751 D6752 D6780 D6781 D6782 D6783 D6790 D6791 D6792 D6793 D6794 D6920 D6930 D6940 D6950 D6970 D6972 D6973 D6975 D6976 D6977 D6980 D6985 D6999 D7111 D7140 D7210 D7220 D7230 D7240 D7241 D7250 D7260 D7261 D7270 D7272 D7280 D7282 D7283 D7285 D7286 D7287 D7288 D7290 D7291 D7292 D7293 D7294 D7310 D7311 D7320 D7321 D7340 D7350 D7410 D7411 D7412 D7413 D7414 D7415 D7440 D7441 D7450 D7451 D7460 D7461 D7465 D7471 D7472 D7473 D7485 D7490 D7510 D7511 D7520 D7521 D7530 D7540 D7550 D7560 D7610 D7620 D7630 D7640 D7650 D7660 D7670 D7671 D7680 D7710 D7720 D7730 D7740 D7750 D7760 D7770 D7771 D7780 D7810 D7820 D7830 D7840 D7850 D7852 D7854 D7856 D7858 D7860 D7865 D7870 D7871 D7872 D7873 D7874 D7875 D7876

Recement supp part denture Abut support crown titanium Odontics repr abutment Removal of implant Radio/surgical implant index Abut support retainer titani Implant procedure Pontic-indirect resin based Prosthodont high noble metal Bridge base metal cast Bridge noble metal cast Pontic titanium Bridge porcelain high noble Bridge porcelain base metal Bridge porcelain nobel metal Bridge porcelain/ceramic Bridge resin w/high noble Bridge resin base metal Bridge resin w/noble metal Provisional pontic Dental retainr cast metl Porcelain/ceramic retainer Porcelain/ceramic inlay 2srf Porc/ceram inlay >= 3 surfac Cst hgh nble mtl inlay 2 srf Cst hgh nble mtl inlay >=3sr Cst bse mtl inlay 2 surfaces Cst bse mtl inlay >= 3 surfa Cast noble metal inlay 2 sur Cst noble mtl inlay >=3 surf Onlay porc/crmc 2 surfaces Onlay porc/crmc >=3 surfaces Onlay cst hgh nbl mtl 2 srfc Onlay cst hgh nbl mtl >=3srf Onlay cst base mtl 2 surface Onlay cst base mtl >=3 surfa Onlay cst nbl mtl 2 surfaces Onlay cst nbl mtl >=3 surfac Inlay titanium Onlay titanium Crown-indirect resin based Retain crown resin w hi nble Crown resin w/base metal Crown resin w/noble metal Crown porcelain/ceramic Crown porcelain high noble Crown porcelain base metal Crown porcelain noble metal Crown 3/4 high noble metal Crown 3/4 cast based metal Crown 3/4 cast noble metal Crown 3/4 porcelain/ceramic Crown full high noble metal Crown full base metal cast Crown full noble metal cast Provisional retainer crown Crown titanium Dental connector bar Dental recement bridge Stress breaker Precision attachment Post & core plus retainer Prefab post & core plus reta Core build up for retainer Coping metal Each addtnl cast post Each addtl prefab post Bridge repair Pediatric partial denture fx Fixed prosthodontic proc Extraction coronal remnants Extraction erupted tooth/exr Rem imp tooth w mucoper flp Impact tooth remov soft tiss Impact tooth remov part bony Impact tooth remov comp bony Impact tooth rem bony w/comp Tooth root removal Oral antral fistula closure Primary closure sinus perf Tooth reimplantation Tooth transplantation Exposure impact tooth orthod Mobilize erupted/malpos toot Place device impacted tooth Biopsy of oral tissue hard Biopsy of oral tissue soft Exfoliative cytolog collect Brush biopsy Repositioning of teeth Transseptal fiberotomy Screw retained plate Temp anchorage dev w flap Temp anchorage dev w/o flap Alveoplasty w/ extraction Alveoloplasty w/extract 1-3 Alveoplasty w/o extraction Alveoloplasty not w/extracts Vestibuloplasty ridge extens Vestibuloplasty exten graft Rad exc lesion up to 1.25 cm Excision benign lesion>1.25c Excision benign lesion compl Excision malig lesion<=1.25c Excision malig lesion>1.25cm Excision malig les complicat Malig tumor exc to 1.25 cm Malig tumor > 1.25 cm Rem odontogen cyst to 1.25cm Rem odontogen cyst > 1.25 cm Rem nonodonto cyst to 1.25cm Rem nonodonto cyst > 1.25 cm Lesion destruction Rem exostosis any site Removal of torus palatinus Remove torus mandibularis Surg reduct osseoustuberosit Maxilla or mandible resectio I&d absc intraoral soft tiss Incision/drain abscess intra I&d abscess extraoral Incision/drain abscess extra Removal fb skin/areolar tiss Removal of fb reaction Removal of sloughed off bone Maxillary sinusotomy Maxilla open reduct simple Clsd reduct simpl maxilla fx Open red simpl mandible fx Clsd red simpl mandible fx Open red simp malar/zygom fx Clsd red simp malar/zygom fx Closd rductn splint alveolus Alveolus open reduction Reduct simple facial bone fx Maxilla open reduct compound Clsd reduct compd maxilla fx Open reduct compd mandble fx Clsd reduct compd mandble fx Open red comp malar/zygma fx Clsd red comp malar/zygma fx Open reduc compd alveolus fx Alveolus clsd reduc stblz te Reduct compnd facial bone fx Tmj open reduct-dislocation Closed tmp manipulation Tmj manipulation under anest Removal of tmj condyle Tmj meniscectomy Tmj repair of joint disc Tmj excisn of joint membrane Tmj cutting of a muscle Tmj reconstruction Tmj cutting into joint Tmj reshaping components Tmj aspiration joint fluid Lysis + lavage w catheters Tmj diagnostic arthroscopy Tmj arthroscopy lysis adhesn Tmj arthroscopy disc reposit Tmj arthroscopy synovectomy Tmj arthroscopy discectomy

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0330 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0330 0330 0330 0330 0330 0330 0330 0330 0330 0330 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0330 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 9.1677 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 9.1677 9.1677 9.1677 9.1677 9.1677 9.1677 9.1677 9.1677 9.1677 9.1677 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 9.1677 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

Added 1/1/07 to book

Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

67 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only E E E E E E E S E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E N E E E E 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Children's Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Critical PDD Access Update to Hospital ACS Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

D7877 D7880 D7899 D7910 D7911 D7912 D7920 D7940 D7941 D7943 D7944 D7945 D7946 D7947 D7948 D7949 D7950 D7951 D7953 D7955 D7960 D7963 D7970 D7971 D7972 D7980 D7981 D7982 D7983 D7990 D7991 D7995 D7996 D7997 D7998 D7999 D8010 D8020 D8030 D8040 D8050 D8060 D8070 D8080 D8090 D8210 D8220 D8660 D8670 D8680 D8690 D8691 D8692 D8693 D8999 D9110 D9120 D9210 D9211 D9212

Tmj arthroscopy debridement Occlusal orthotic appliance Tmj unspecified therapy Dent sutur recent wnd to 5cm Dental suture wound to 5 cm Suture complicate wnd > 5 cm Dental skin graft Reshaping bone orthognathic Bone cutting ramus closed Cutting ramus open w/graft Bone cutting segmented Bone cutting body mandible Reconstruction maxilla total Reconstruct maxilla segment Reconstruct midface no graft Reconstruct midface w/graft Mandible graft Sinus aug w bone/bone sup Bone replacement graft Repair maxillofacial defects Frenulectomy/frenulotomy Frenuloplasty Excision hyperplastic tissue Excision pericoronal gingiva Surg redct fibrous tuberosit Sialolithotomy Excision of salivary gland Sialodochoplasty Closure of salivary fistula Emergency tracheotomy Dental coronoidectomy Synthetic graft facial bones Implant mandible for augment Appliance removal Intraoral place of fix dev Oral surgery procedure Limited dental tx primary Limited dental tx transition Limited dental tx adolescent Limited dental tx adult Intercep dental tx primary Intercep dental tx transitn Compre dental tx transition Compre dental tx adolescent Compre dental tx adult Orthodontic rem appliance tx Fixed appliance therapy habt Preorthodontic tx visit Periodic orthodontc tx visit Orthodontic retention Orthodontic treatment Repair ortho appliance Replacement retainer Rebond/cement/repair retain Orthodontic procedure Tx dental pain minor proc Fix partial denture section Dent anesthesia w/o surgery Regional block anesthesia Trigeminal block anesthesia

0000 0000 0000 0000 0000 0000 0000 0330 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 9.1677 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

Added 1/1/07 to book

Added 1/1/07 to book

Added 1/1/07 to book

Added 1/1/07 to book

D9215 D9220 D9221 D9230 D9241 D9242 D9248 D9310 D9410 D9420 D9430 D9440 D9450 D9610 D9612 D9630 D9910 D9911 D9920 D9930 D9940 D9941 D9942 D9950 D9951 D9952 D9970 D9971 D9972 D9973 D9974 D9999 E0100 E0105 E0110 E0111 E0112 E0113 E0114 E0116 E0117 E0118 E0130 E0135 E0140 E0141 E0143 E0144 E0147 E0148 E0149 E0153 E0154 E0155 E0156 E0157 E0158 E0159 E0160 E0161 E0162 E0163 E0165 E0167 E0168 E0170 E0171 E0172 E0175 E0181 E0182 E0184 E0185 E0186 E0187 E0188 E0189 E0190 E0191 E0193 E0194 E0196 E0197 E0198 E0199 E0200 E0202 E0203 E0205 E0210 E0215 E0217 E0218 E0220 E0221 E0225

Local anesthesia General anesthesia General anesthesia ea ad 15m Analgesia Intravenous sedation IV sedation ea ad 30 m Sedation (non-iv) Dental consultation Dental house call Hospital call Office visit during hours Office visit after hours Case presentation tx plan Dent therapeutic drug inject Thera par drugs 2 or > admin Other drugs/medicaments Dent appl desensitizing med Appl desensitizing resin Behavior management Treatment of complications Dental occlusal guard Fabrication athletic guard Repair/reline occlusal guard Occlusion analysis Limited occlusal adjustment Complete occlusal adjustment Enamel microabrasion Odontoplasty 1-2 teeth Extrnl bleaching per arch Extrnl bleaching per tooth Intrnl bleaching per tooth Adjunctive procedure Cane adjust/fixed with tip Cane adjust/fixed quad/3 pro Crutch forearm pair Crutch forearm each Crutch underarm pair wood Crutch underarm each wood Crutch underarm pair no wood Crutch underarm each no wood Underarm springassist crutch Crutch substitute Walker rigid adjust/fixed ht Walker folding adjust/fixed Walker w trunk support Rigid wheeled walker adj/fix Walker folding wheeled w/o s Enclosed walker w rear seat Walker variable wheel resist Heavyduty walker no wheels Heavy duty wheeled walker Forearm crutch platform atta Walker platform attachment Walker wheel attachment,pair Walker seat attachment Walker crutch attachment Walker leg extenders set of4 Brake for wheeled walker Sitz type bath or equipment Sitz bath/equipment w/faucet Sitz bath chair Commode chair stationry fxd Commode chair stationry det Commode chair pail or pan Heavyduty/wide commode chair Commode chair electric Commode chair non-electric Seat lift mechanism toilet Commode chair foot rest Press pad alternating w/ pum Pressure pad alternating pum Dry pressure mattress Gel pressure mattress pad Air pressure mattress Water pressure mattress Synthetic sheepskin pad Lambswool sheepskin pad Positioning cushion Protector heel or elbow Powered air flotation bed Air fluidized bed Gel pressure mattress Air pressure pad for mattres Water pressure pad for mattr Dry pressure pad for mattres Heat lamp without stand Phototherapy light w/ photom Therapeutic lightbox tabletp Heat lamp with stand Electric heat pad standard Electric heat pad moist Water circ heat pad w pump Water circ cold pad w pump Hot water bottle Infrared heating pad system Hydrocollator unit

E E E N E E N E E E E E E E E S E E E S E E S S S E E E E E E Y Y Y Y Y Y Y Y Y E Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y E Y Y Y Y Y Y Y Y Y E Y Y Y Y Y Y Y Y Y E Y Y Y Y Y Y Y Y

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Y Y Y Y Y Y Y Y Y 1 Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y 1 Y Y Y Y Y Y Y Y Y 3 Y Y Y Y Y Y Y Y Y 1 Y Y Y Y Y Y Y Y

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0330 0000 0000 0000 0330 0000 0000 0330 0330 0330 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 9.1677 0.0000 0.0000 0.0000 9.1677 0.0000 0.0000 9.1677 9.1677 9.1677 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Added 1/1/07 to book

SI = Y effective 01/01/08 SI = Y effective 01/01/08

x x

SI = Y effective 01/01/08 SI = Y effective 01/01/08 SI= Y effective 01/01/08

x x X x

SI change 1/1/07 (TR 1155)

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

68 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only Y E E Y Y Y Y E E E E E E E E E Y E E E E E E E E E E E E E Y Y Y Y E Y E Y E Y E Y Y Y Y E E E E E Y Y Y Y Y E E E Y Y Y Y E E Y Y E Y E Y Y Y Y A Y Y Y Y Y Y Y Y Y Y Y Y Y E Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y A A Y Y Y Y Y N Y A A Y Y E Y Y Y Y Y Y E E E E E E Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y E B E Y Y Y Y Y Y 3 3 Y Y Y Y 3 3 3 3 3 3 3 3 3 Y Y Y Y Y Y Y Y Y 1 Y 1 1 1 Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y 1 Y Y Y Y Y 1 1 3 Y Y Y Y 3 1 Y Y 3 1 3 Y Y Y Y 3 Y Y Y Y 1 1 1 Y Y Y Y Y Y 3 Y Y Y 1 1 Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y 3 3 Y Y Y Y Y 1 1 1 1 Y Y 3 Y Y Y Y Y Y Y 3 1 1 3 3 Y Y Y Y Y Y Y Y Y Y Y Y Y Y 1 1 1 1 1 1 B 3 Y Y Y Y Y

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 0.00 M01 M01 0.00 0.00 0.00 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 M01 0.00 M01 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00 0.00

Children's Hospital Outpatient Fee 0.00 M01 M01 0.00 0.00 0.00 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 M01 0.00 M01 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00 0.00

Critical PDD Access Update to Hospital ACS Outpatient Fee 0.00 M01 M01 0.00 0.00 0.00 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 M01 0.00 M01 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00 0.00

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

E0230 E0231 E0232 E0235 E0236 E0238 E0239 E0240 E0241 E0242 E0243 E0244 E0245 E0246 E0247 E0248 E0249 E0250 E0251 E0255 E0256 E0260 E0261 E0265 E0266 E0270 E0271 E0272 E0273 E0274 E0275 E0276 E0277 E0280 E0290 E0291 E0292 E0293 E0294 E0295 E0296 E0297 E0300 E0301 E0302 E0303 E0304 E0305 E0310 E0315 E0316 E0325 E0326 E0328 E0329 E0350 E0352 E0370 E0371 E0372 E0373 E0424 E0425 E0430 E0431 E0434 E0435 E0439 E0440 E0441 E0442 E0443 E0444 E0445 E0450 E0455 E0457 E0459 E0460 E0461 E0462 E0463 E0464 E0470 E0471 E0472 E0480 E0481 E0482 E0483 E0484 E0485 E0486 E0500 E0550 E0555 E0560 E0561 E0562 E0565 E0570 E0571 E0572 E0574 E0575 E0580 E0585 E0600 E0601 E0602 E0603 E0604 E0605 E0606 E0607 E0610 E0615 E0616 E0617 E0618 E0619 E0620 E0621 E0625 E0627 E0628 E0629 E0630 E0635 E0636 E0637 E0638 E0639 E0640 E0641 E0642 E0650 E0651 E0652 E0655 E0660 E0665 E0666 E0667 E0668 E0669 E0671 E0672 E0673 E0675 E0676 E0691 E0692 E0693 E0694 E0700 E0705 E0710 E0720 E0730 E0731 E0740 E0744

Ice cap or collar Wound warming device Warming card for NWT Paraffin bath unit portable Pump for water circulating p Heat pad non-electric moist Hydrocollator unit portable Bath/shower chair Bath tub wall rail Bath tub rail floor Toilet rail Toilet seat raised Tub stool or bench Transfer tub rail attachment Trans bench w/wo comm open HDtrans bench w/wo comm open Pad water circulating heat u Hosp bed fixed ht w/ mattres Hosp bed fixd ht w/o mattres Hospital bed var ht w/ mattr Hospital bed var ht w/o matt Hosp bed semi-electr w/ matt Hosp bed semi-electr w/o mat Hosp bed total electr w/ mat Hosp bed total elec w/o matt Hospital bed institutional t Mattress innerspring Mattress foam rubber Bed board Over-bed table Bed pan standard Bed pan fracture Powered pres-redu air mattrs Bed cradle Hosp bed fx ht w/o rails w/m Hosp bed fx ht w/o rail w/o Hosp bed var ht w/o rail w/o Hosp bed var ht w/o rail w/ Hosp bed semi-elect w/ mattr Hosp bed semi-elect w/o matt Hosp bed total elect w/ matt Hosp bed total elect w/o mat Enclosed ped crib hosp grade HD hosp bed, 350-600 lbs Ex hd hosp bed > 600 lbs Hosp bed hvy dty xtra wide Hosp bed xtra hvy dty x wide Rails bed side half length Rails bed side full length Bed accessory brd/tbl/supprt Bed safety enclosure Urinal male jug-type Urinal female jug-type Ped hospital bed, manual Ped hospital bed semi/elect Control unit bowel system Disposable pack w/bowel syst Air elevator for heel Nonpower mattress overlay Powered air mattress overlay Nonpowered pressure mattress Stationary compressed gas 02 Gas system stationary compre Oxygen system gas portable Portable gaseous 02 Portable liquid 02 Oxygen system liquid portabl Stationary liquid 02 Oxygen system liquid station Oxygen contents, gaseous Oxygen contents, liquid Portable 02 contents, gas Portable 02 contents, liquid Oximeter non-invasive Vol control vent invasiv int Oxygen tent excl croup/ped t Chest shell Chest wrap Neg press vent portabl/statn Vol control vent noninv int Rocking bed w/ or w/o side r Press supp vent invasive int Press supp vent noninv int RAD w/o backup non-inv intfc RAD w/backup non inv intrfc RAD w backup invasive intrfc Percussor elect/pneum home m Intrpulmnry percuss vent sys Cough stimulating device Chest compression gen system Non-elec oscillatory pep dvc Oral device/appliance prefab Oral device/appliance cusfab Ippb all types Humidif extens supple w ippb Humidifier for use w/ regula Humidifier supplemental w/ i Humidifier nonheated w PAP Humidifier heated used w PAP Compressor air power source Nebulizer with compression Aerosol compressor for svneb Aerosol compressor adjust pr Ultrasonic generator w svneb Nebulizer ultrasonic Nebulizer for use w/ regulat Nebulizer w/ compressor & he Suction pump portab hom modl Cont airway pressure device Manual breast pump Electric breast pump Hosp grade elec breast pump Vaporizer room type Drainage board postural Blood glucose monitor home Pacemaker monitr audible/vis Pacemaker monitr digital/vis Cardiac event recorder Automatic ext defibrillator Apnea monitor Apnea monitor w recorder Cap bld skin piercing laser Patient lift sling or seat Patient lift bathroom or toi Seat lift incorp lift-chair Seat lift for pt furn-electr Seat lift for pt furn-non-el Patient lift hydraulic Patient lift electric PT support & positioning sys Sit-stand w seatlift Standing frame sys Moveable patient lift system Fixed patient lift system Multi-position stnd fram sys Dynamic standing frame Pneuma compresor non-segment Pneum compressor segmental Pneum compres w/cal pressure Pneumatic appliance half arm Pneumatic appliance full leg Pneumatic appliance full arm Pneumatic appliance half leg Seg pneumatic appl full leg Seg pneumatic appl full arm Seg pneumatic appli half leg Pressure pneum appl full leg Pressure pneum appl full arm Pressure pneum appl half leg Pneumatic compression device Inter limb compress dev NOS Uvl pnl 2 sq ft or less Uvl sys panel 4 ft Uvl sys panel 6 ft Uvl md cabinet sys 6 ft Safety equipment Transfer Device Restraints any type Tens two lead Tens four lead Conductive garment for tens/ Incontinence treatment systm Neuromuscular stim for scoli

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

SI = Y effective 01/01/08

x

SI = Y effective 01/01/08

x

Change Valid Sex to M Change Valid Sex to F

x x X X

SI = Y effective 01/01/08

x

SI = Y effective 01/01/08

x

change valid sex to F change valid sex to F change valid sex to F SI = Y Effective 01/01/08

x x x x

SI = Y effective 01/01/08

x

SI = Y effective 01/01/08 SI = Y effective 01/01/08 SI = Y effective 01/01/08

x x x

SI = Y effective 01/01/08 Added 1/1/07 to book

x

Description Change

x

SI = Y effective 01/01/08 SI = Y effective 01/01/08 SI = Y effective 01/01/08

x x x

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

69 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only Y A Y Y N E Y E B Y Y B Y Y Y Y N N Y N N Y N Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y E Y Y Y Y Y Y Y Y A A A Y Y Y A B Y B B Y Y Y E B B B B Y Y Y Y Y Y Y B B Y B Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y A A A A A E E A A E E A A A A E E Y A A A A A A A A A A A A A A Y B Y Y Y Y Y Y Y Y Y Y Y Y Y A E E A A E E A Y Y Y E Y Y Y Y 1 Y Y 1 1 Y 1 B Y Y B Y Y Y Y N N Y 1 N Y 1 Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y 1 1 Y Y Y Y Y Y Y Y 3 3 3 Y Y Y 3 B Y B B Y Y Y 1 B B B B Y Y Y Y Y Y Y B B Y B Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y 1 Y Y Y 3 3 3 1 1 1 1 1 1 1 1 1 1 3 3 1 1 1 1 3 3 3 3 3 3 1 3 1 1 1 1 1 Y B Y Y Y Y Y Y Y Y Y Y Y Y Y 1 1 1 1 1 1 1 1 Y Y Y 1 Y Y Y

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 0.00 0.00 0.00 0.00 M01 M01 M01 M01 M01 M01 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Children's Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 0.00 0.00 0.00 0.00 M01 M01 M01 M01 M01 M01 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Critical PDD Access Update to Hospital ACS Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 0.00 0.00 0.00 0.00 M01 M01 M01 M01 M01 M01 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule x

E0745 E0746 E0747 E0748 E0749 E0755 E0760 E0761 E0762 E0764 E0765 E0769 E0776 E0779 E0780 E0781 E0782 E0783 E0784 E0785 E0786 E0791 E0830 E0840 E0849 E0850 E0855 E0856 E0860 E0870 E0880 E0890 E0900 E0910 E0911 E0912 E0920 E0930 E0935 E0936 E0940 E0941 E0942 E0944 E0945 E0946 E0947 E0948 E0950 E0951 E0952 E0955 E0956 E0957 E0958 E0959 E0960 E0961 E0966 E0967 E0968 E0969 E0970 E0971 E0973 E0974 E0978 E0980 E0981 E0982 E0983 E0984 E0985 E0986 E0990 E0992 E0994 E0995 E1002 E1003 E1004 E1005 E1006 E1007 E1008 E1009 E1010 E1011 E1014 E1015 E1016 E1017 E1018 E1020 E1028 E1029 E1030 E1031 E1035 E1037 E1038 E1039 E1050 E1060 E1070 E1083 E1084 E1085 E1086 E1087 E1088 E1089 E1090 E1092 E1093 E1100 E1110 E1130 E1140 E1150 E1160 E1161 E1170 E1171 E1172 E1180 E1190 E1195 E1200 E1220 E1221 E1222 E1223 E1224 E1225 E1226 E1227 E1228 E1229 E1230 E1231 E1232 E1233 E1234 E1235 E1236 E1237 E1238 E1239 E1240 E1250 E1260 E1270 E1280 E1285 E1290 E1295 E1296 E1297 E1298 E1300 E1310 E1340 E1353

Neuromuscular stim for shock Electromyograph biofeedback Elec osteogen stim not spine Elec osteogen stim spinal Elec osteogen stim implanted Electronic salivary reflex s Osteogen ultrasound stimltor Nontherm electromgntc device Trans elec jt stim dev sys Functional neuromuscularstim Nerve stimulator for tx n&v Electric wound treatment dev Iv pole Amb infusion pump mechanical Mech amb infusion pump <8hrs External ambulatory infus pu Non-programble infusion pump Programmable infusion pump Ext amb infusn pump insulin Replacement impl pump cathet Implantable pump replacement Parenteral infusion pump sta Ambulatory traction device Tract frame attach headboard Cervical pneum trac equip Traction stand free standing Cervical traction equipment Cervic collar w air bladder Tract equip cervical tract Tract frame attach footboard Trac stand free stand extrem Traction frame attach pelvic Trac stand free stand pelvic Trapeze bar attached to bed HD trapeze bar attach to bed HD trapeze bar free standing Fracture frame attached to b Fracture frame free standing Exercise device passive moti CPM device, other than knee Trapeze bar free standing Gravity assisted traction de Cervical head harness/halter Pelvic belt/harness/boot Belt/harness extremity Fracture frame dual w cross Fracture frame attachmnts pe Fracture frame attachmnts ce Tray Loop heel Toe loop/holder, each Cushioned headrest W/c lateral trunk/hip suppor W/c medial thigh support Whlchr att- conv 1 arm drive Amputee adapter W/c shoulder harness/straps Wheelchair brake extension Wheelchair head rest extensi Wheelchair hand rims Wheelchair commode seat Wheelchair narrowing device Wheelchair no. 2 footplates Wheelchair anti-tipping devi W/Ch access det adj armrest W/Ch access anti-rollback W/C acc,saf belt pelv strap Wheelchair safety vest Seat upholstery, replacement Back upholstery, replacement Add pwr joystick Add pwr tiller W/c seat lift mechanism Man w/c push-rim pow assist Whellchair elevating leg res Wheelchair solid seat insert Wheelchair arm rest Wheelchair calf rest Pwr seat tilt Pwr seat recline Pwr seat recline mech Pwr seat recline pwr Pwr seat combo w/o shear Pwr seat combo w/shear Pwr seat combo pwr shear Add mech leg elevation Add pwr leg elevation Ped wc modify width adjustm Reclining back add ped w/c Shock absorber for man w/c Shock absorber for power w/c HD shck absrbr for hd man wc HD shck absrber for hd powwc Residual limb support system W/c manual swingaway vent tray fixed W/c vent tray gimbaled Rollabout chair with casters Patient transfer system Transport chair, ped size Transport chair pt wt <250lb Transport chair pt wt>=250lb Whelchr fxd full length arms Wheelchair detachable arms Wheelchair detachable foot r Hemi-wheelchair fixed arms Hemi-wheelchair detachable a Hemi-wheelchair fixed arms Hemi-wheelchair detachable a Wheelchair lightwt fixed arm Wheelchair lightweight det a Wheelchair lightwt fixed arm Wheelchair lightweight det a Wheelchair wide w/ leg rests Wheelchair wide w/ foot rest Whchr s-recl fxd arm leg res Wheelchair semi-recl detach Whlchr stand fxd arm ft rest Wheelchair standard detach a Wheelchair standard w/ leg r Wheelchair fixed arms Manual adult wc w tiltinspac Whlchr ampu fxd arm leg rest Wheelchair amputee w/o leg r Wheelchair amputee detach ar Wheelchair amputee w/ foot r Wheelchair amputee w/ leg re Wheelchair amputee heavy dut Wheelchair amputee fixed arm Whlchr special size/constrc Wheelchair spec size w foot Wheelchair spec size w/ leg Wheelchair spec size w foot Wheelchair spec size w/ leg Manual semi-reclining back Manual fully reclining back Wheelchair spec sz spec ht a Wheelchair spec sz spec ht b Pediatric wheelchair NOS Power operated vehicle Rigid ped w/c tilt-in-space Folding ped wc tilt-in-space Rig ped wc tltnspc w/o seat Fld ped wc tltnspc w/o seat Rigid ped wc adjustable Folding ped wc adjustable Rgd ped wc adjstabl w/o seat Fld ped wc adjstabl w/o seat Ped power wheelchair NOS Whchr litwt det arm leg rest Wheelchair lightwt fixed arm Wheelchair lightwt foot rest Wheelchair lightweight leg r Whchr h-duty det arm leg res Wheelchair heavy duty fixed Wheelchair hvy duty detach a Wheelchair heavy duty fixed Wheelchair special seat heig Wheelchair special seat dept Wheelchair spec seat depth/w Whirlpool portable Whirlpool non-portable Repair for DME, per 15 min Oxygen supplies regulator

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

SI = Y effective 01/01/08

SI = B effective 01/01/08 SI = Y effective 01/01/08

x x

X

Added 1/1/07 to book

X

SI = Y effective 01/01/08 SI = Y effective 01/01/09 SI = Y effective 01/01/10 SI = Y effective 01/01/11

x x x x

SI = Y effective 01/01/08

x

X X

X X

X X

X X

X X SI = Y effective 01/01/08 SI = Y effective 01/01/08 SI = Y effective 01/01/08 SI = Y effective 01/01/08 x x x x

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

70 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only Y Y Y Y Y Y Y Y A A A A A A A A A A A A A A A A A A A A B A A A A A Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y A Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y 1 Y 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y 1 Y Y Y 1 Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y 1 1 Y Y Y Y Y Y Y Y Y Y Y Y Y Y 1 Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y 1 Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y 1 1 Y Y Y Y Y Y 1 1 1 Y Y Y

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Children's Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Critical PDD Access Update to Hospital ACS Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

E1355 E1372 E1390 E1391 E1392 E1399 E1405 E1406 E1500 E1510 E1520 E1530 E1540 E1550 E1560 E1570 E1575 E1580 E1590 E1592 E1594 E1600 E1610 E1615 E1620 E1625 E1630 E1632 E1634 E1635 E1636 E1637 E1639 E1699 E1700 E1701 E1702 E1800 E1801 E1802 E1805 E1806 E1810 E1811 E1812 E1815 E1816 E1818 E1820 E1821 E1825 E1830 E1840 E1841 E1902 E2000 E2100 E2101 E2120 E2201 E2202 E2203 E2204 E2205 E2206 E2207 E2208 E2209 E2210 E2211 E2212 E2213 E2214 E2215 E2216 E2217 E2218 E2219 E2220 E2221 E2222 E2223 E2224 E2225 E2226 E2227 E2228 E2291 E2292 E2293 E2294 E2300 E2301 E2310 E2311 E2312 E2313 E2321 E2322 E2323 E2324 E2325 E2326 E2327 E2328 E2329 E2330 E2331 E2340 E2341 E2342 E2343 E2351 E2360 E2361 E2362 E2363 E2364 E2365 E2366 E2367 E2368 E2369 E2370 E2371 E2372 E2373 E2374 E2375 E2376 E2377 E2381 E2382 E2383 E2384 E2385 E2386 E2387 E2388 E2389 E2390 E2391 E2392 E2393 E2394 E2395 E2396 E2397 E2399 E2402 E2500 E2502 E2504 E2506 E2508 E2510 E2511 E2512 E2599 E2601 E2602 E2603

Oxygen supplies stand/rack Oxy suppl heater for nebuliz Oxygen concentrator Oxygen concentrator, dual Portable oxygen concentrator Durable medical equipment mi O2/water vapor enrich w/heat O2/water vapor enrich w/o he Centrifuge Kidney dialysate delivry sys Heparin infusion pump Replacement air bubble detec Replacement pressure alarm Bath conductivity meter Replace blood leak detector Adjustable chair for esrd pt Transducer protect/fld bar Unipuncture control system Hemodialysis machine Auto interm peritoneal dialy Cycler dialysis machine Deli/install chrg hemo equip Reverse osmosis h2o puri sys Deionizer H2O puri system Replacement blood pump Water softening system Reciprocating peritoneal dia Wearable artificial kidney Peritoneal dialysis clamp Compact travel hemodialyzer Sorbent cartridges per 10 Hemostats for dialysis, each Dialysis scale Dialysis equipment noc Jaw motion rehab system Repl cushions for jaw motion Repl measr scales jaw motion Adjust elbow ext/flex device SPS elbow device Adjst forearm pro/sup device Adjust wrist ext/flex device SPS wrist device Adjust knee ext/flex device SPS knee device Knee ext/flex w act res ctrl Adjust ankle ext/flex device SPS ankle device SPS forearm device Soft interface material Replacement interface SPSD Adjust finger ext/flex devc Adjust toe ext/flex device Adj shoulder ext/flex device Static str shldr dev rom adj AAC non-electronic board Gastric suction pump hme mdl Bld glucose monitor w voice Bld glucose monitor w lance Pulse gen sys tx endolymp fl Man w/ch acc seat w>=20”<24” Seat width 24-27 in Frame depth less than 22 in Frame depth 22 to 25 in Manual wc accessory, handrim Complete wheel lock assembly Crutch and cane holder Cylinder tank carrier Arm trough each Wheelchair bearings Pneumatic propulsion tire Pneumatic prop tire tube Pneumatic prop tire insert Pneumatic caster tire each Pneumatic caster tire tube Foam filled propulsion tire Foam filled caster tire each Foam propulsion tire each Foam caster tire any size ea Solid propulsion tire each Solid caster tire each Solid caster integrated whl Valve replacement only each Propulsion whl excludes tire Caster wheel excludes tire Caster fork replacement only Gear reduction drive wheel Mwc acc, wheelchair brake Planar back for ped size wc Planar seat for ped size wc Contour back for ped size wc Contour seat for ped size wc Pwr seat elevation sys Pwr standing Electro connect btw control Electro connect btw 2 sys Mini-prop remote joystick PWC harness, expand control Hand interface joystick Mult mech switches Special joystick handle Chin cup interface Sip and puff interface Breath tube kit Head control interface mech Head/extremity control inter Head control nonproportional Head control proximity switc Attendant control W/c wdth 20-23 in seat frame W/c wdth 24-27 in seat frame W/c dpth 20-21 in seat frame W/c dpth 22-25 in seat frame Electronic SGD interface 22nf nonsealed leadacid 22nf sealed leadacid battery Gr24 nonsealed leadacid Gr24 sealed leadacid battery U1nonsealed leadacid battery U1 sealed leadacid battery Battery charger, single mode Battery charger, dual mode Power wc motor replacement Pwr wc gear box replacement Pwr wc motor/gear box combo Gr27 sealed leadacid battery Gr27 non-sealed leadacid Hand/chin ctrl spec joystick Hand/chin ctrl std joystick Non-expandable controller Expandable controller, repl Expandable controller, initl Pneum drive wheel tire Tube, pneum wheel drive tire Insert, pneum wheel drive Pneumatic caster tire Tube, pneumatic caster tire Foam filled drive wheel tire Foam filled caster tire Foam drive wheel tire Foam caster tire Solid drive wheel tire Solid caster tire Solid caster tire, integrate Valve, pneumatic tire tube Drive wheel excludes tire Caster wheel excludes tire Caster fork Pwc acc, lith-based battery Noc interface Neg press wound therapy pump SGD digitized pre-rec <=8min SGD prerec msg >8min <=20min SGD prerec msg>20min <=40min SGD prerec msg > 40 min SGD spelling phys contact SGD w multi methods msg/accs SGD sftwre prgrm for PC/PDA SGD accessory, mounting sys SGD accessory noc Gen w/c cushion wdth < 22 in Gen w/c cushion wdth >=22 in Skin protect wc cus wd <22in

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

SI change 1/1/07 (TR 1155)

SI = Y effective 01/01/08 SI = Y effective 01/01/08

x x

X X

X X

Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book X

SI = Y effective 01/01/08 SI = Y effective 01/01/09 SI = Y effective 01/01/10 SI = Y effective 01/01/11 SI = Y effective 01/01/12 SI = Y effective 01/01/13

x x x x x x

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

71 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only Y Y Y Y Y Y B Y Y Y Y Y Y Y Y Y Y E E E S S B A V N A S T S A A S S S T E A B T B P X B A A A A A B B B B B B T B S V P N M M M M T A A A E E S S S V V T V V M Y Y Y Y Y Y 1 Y Y Y Y Y Y Y Y Y Y 1 1 1 1 1 1 1 V N 1 S T S 3 3 S S S T 3 1 B T B 1 X B 1 1 1 1 1 B B B 1 1 1 T B S V 1 1 1 1 1 1 1 3 3 3 1 1 S 1 S V V T V V 1

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 40.07 0.00 0.00 224.57 375.01 98.65 M01 M01 41.54 28.20 98.65 375.01 M01 0.00 0.00 37.88 0.00 0.00 33.22 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 82.10 0.00 2,947.24 103.85 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 0.00 0.00 18.52 0.00 18.52 40.07 47.60 37.88 79.32 79.32 0.00

Children's Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 91.36 0.00 0.00 512.03 855.07 224.93 M01 M01 94.72 64.30 224.93 855.07 M01 0.00 0.00 86.37 0.00 0.00 75.74 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 187.20 0.00 6,719.98 236.79 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 0.00 0.00 42.23 0.00 42.23 91.36 108.53 86.37 180.85 180.85 0.00

Critical PDD Access Update to Hospital ACS Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 104.72 0.00 0.00 586.87 980.04 257.81 M01 M01 108.56 73.69 257.81 980.04 M01 0.00 0.00 99.00 0.00 0.00 86.81 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 214.56 0.00 7,702.19 271.40 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 0.00 0.00 48.40 0.00 48.40 104.72 124.39 99.00 207.28 207.28 0.00

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

E2604 E2605 E2606 E2607 E2608 E2609 E2610 E2611 E2612 E2613 E2614 E2615 E2616 E2617 E2619 E2620 E2621 E8000 E8001 E8002 G0008 G0009 G0010 G0027 G0101 G0102 G0103 G0104 G0105 G0106 G0108 G0109 G0117 G0118 G0120 G0121 G0122 G0123 G0124 G0127 G0128 G0129 G0130 G0141 G0143 G0144 G0145 G0147 G0148 G0151 G0152 G0153 G0154 G0155 G0156 G0166 G0168 G0173 G0175 G0176 G0177 G0179 G0180 G0181 G0182 G0186 G0202 G0204 G0206 G0219 G0235 G0237 G0238 G0239 G0245 G0246 G0247 G0248 G0249 G0250

Skin protect wc cus wd>=22in Position wc cush wdth <22 in Position wc cush wdth>=22 in Skin pro/pos wc cus wd <22in Skin pro/pos wc cus wd>=22in Custom fabricate w/c cushion Powered w/c cushion Gen use back cush wdth <22in Gen use back cush wdth>=22in Position back cush wd <22in Position back cush wd>=22in Pos back post/lat wdth <22in Pos back post/lat wdth>=22in Custom fab w/c back cushion Replace cover w/c seat cush WC planar back cush wd <22in WC planar back cush wd>=22in Posterior gait trainer Upright gait trainer Anterior gait trainer Admin influenza virus vac Admin pneumococcal vaccine Admin hepatitis b vaccine Semen analysis CA screen;pelvic/breast exam Prostate ca screening; dre PSA screening CA screen;flexi sigmoidscope Colorectal scrn; hi risk ind Colon CA screen;barium enema Diab manage trn per indiv Diab manage trn ind/group Glaucoma scrn hgh risk direc Glaucoma scrn hgh risk direc Colon ca scrn; barium enema Colon ca scrn not hi rsk ind Colon ca scrn; barium enema Screen cerv/vag thin layer Screen c/v thin layer by MD Trim nail(s) CORF skilled nursing service Partial hosp prog service Single energy x-ray study Scr c/v cyto,autosys and md Scr c/v cyto,thinlayer,rescr Scr c/v cyto,thinlayer,rescr Scr c/v cyto,thinlayer,rescr Scr c/v cyto, automated sys Scr c/v cyto, autosys, rescr HHCP-serv of pt,ea 15 min HHCP-serv of ot,ea 15 min HHCP-svs of s/l path,ea 15mn HHCP-svs of rn,ea 15 min HHCP-svs of csw,ea 15 min HHCP-svs of aide,ea 15 min Extrnl counterpulse, per tx Wound closure by adhesive Linear acc stereo radsur com OPPS Service,sched team conf OPPS/PHP;activity therapy OPPS/PHP; train & educ serv MD recertification HHA PT MD certification HHA patient Home health care supervision Hospice care supervision Dstry eye lesn,fdr vssl tech Screeningmammographydigital Diagnosticmammographydigital Diagnosticmammographydigital PET img wholbod melano nonco PET not otherwise specified Therapeutic procd strg endur Oth resp proc, indiv Oth resp proc, group Initial foot exam pt lops Followup eval of foot pt lop Routine footcare pt w lops Demonstrate use home inr mon Provide test material,equipm MD review interpret of test

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0350 0350 0000 0000 0604 0000 0000 0159 0158 0157 0000 0000 0698 0230 0157 0158 0000 0000 0000 0013 0000 0033 0260 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0678 0000 0067 0608 0033 0000 0000 0000 0000 0000 0235 0000 0000 0000 0000 0000 0077 0077 0077 0604 0605 0013 0607 0607 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.3945 0.3945 0.0000 0.0000 0.8388 0.0000 0.0000 4.7010 7.8504 2.0651 0.0000 0.0000 0.8696 0.5903 2.0651 7.8504 0.0000 0.0000 0.0000 0.7930 0.0000 0.0000 0.6954 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 1.7187 0.0000 61.6965 2.1740 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 4.1331 0.0000 0.0000 0.0000 0.0000 0.0000 0.3877 0.3877 0.3877 0.8388 0.9964 0.7930 1.6604 1.6604 0.0000

SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) Change Valid Sex to M change Valid Sex to F Per APC changes to OPPS effect date 01/01/07 x x

change valid sex to F

x

change valid sex to F

x

x

SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) WY not covered BUT codes redirected here so cover OPPS only

X X

G0251 G0252 G0255 G0257 G0259 G0260

Linear acc based stero radio PET imaging initial dx Current percep threshold tst Unsched dialysis ESRD pt hos Inject for sacroiliac joint Inj for sacroiliac jt anesth

S E E S N T

S 1 1 1 1 1

0065 0000 0000 0170 0000 0207

16.5911 0.0000 0.0000 6.5383 0.0000 7.0546

792.56 0.00 0.00 0.00 0.00 0.00

1,807.10 0.00 0.00 0.00 0.00 0.00

2,071.23 0.00 0.00 0.00 0.00 0.00

G0268 G0269 G0270 G0271 G0275 G0278 G0281 G0282 G0283 G0288 G0289 G0290 G0291 G0293 G0294 G0295

Removal of impacted wax md Occlusive device in vein art MNT subs tx for change dx Group MNT 2 or more 30 mins Renal angio, cardiac cath Iliac art angio,cardiac cath Elec stim unattend for press Elect stim wound care not pd Elec stim other than wound Recon, CTA for surg plan Arthro, loose body + chondro Drug-eluting stents, single Drug-eluting stents,each add Non-cov surg proc,clin trial Non-cov proc, clinical trial Electromagnetic therapy onc

N N A A N N A E A N N T T X X E

N 1 3 3 1 1 3 1 3 N 1 1 1 1 1 1

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0656 0656 0340 0340 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 118.4265 118.4265 0.6310 0.6310 0.0000

0.00 0.00 M01 M01 0.00 0.00 M01 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 M01 M01 0.00 0.00 M01 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 M01 M01 0.00 0.00 M01 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00

X

X

SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155)

G0302 G0303 G0304 G0305 G0306 G0307 G0308 G0309 G0310 G0311 G0312 G0313 G0314

Pre-op service LVRS complete Pre-op service LVRS 10-15dos Pre-op service LVRS 1-9 dos Post op service LVRS min 6 CBC/diffwbc w/o platelet CBC without platelet ESRD related svc 4+mo < 2yrs ESRD related svc 2-3mo <2yrs ESRD related svc 1 vst <2yrs ESRD related svs 4+mo 2-11yr ESRD relate svs 2-3 mo 2-11y ESRD related svs 1 mon 2-11y ESRD related svs 4+ mo 12-19

S S S S A A B B B B B B B

1 1 1 1 1 1 B B B B B B B

0209 0209 0213 0213 0000 0000 0000 0000 0000 0000 0000 0000 0000

11.2822 11.2822 2.2980 2.2980 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

G0315

ESRD related svs 2-3mo/12-19

B

B

0000

0.0000

0.00

0.00

0.00

12/11/07

G0316 G0317 G0318 G0319 G0320 G0321 G0322 G0323 G0324 G0325 G0326 G0327 G0328 G0329 G0332 G0333 G0337

ESRD related svs 1vis/12-19y ESRD related svs 4+mo 20+yrs ESRD related svs 2-3 mo 20+y ESRD related svs 1visit 20+y ESD related svs home undr 2 ESRDrelatedsvs home mo 2-11y ESRD related svs hom mo12-19 ESRD related svs home mo 20+ ESRD relate svs home/dy <2yr ESRD relate home/day/ 2-11yr ESRD relate home/dy 12-19yr ESRD relate home/dy 20+yrs Fecal blood scrn immunoassay Electromagntic tx for ulcers Preadmin IV immunoglobulin Dispense fee initial 30 day Hospice evaluation preelecti

B B B B B B B B B B B B A A S M B

B B B B B B B B B B B B 1 1 1 1 1

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0430 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.5921 0.0000 0.0000

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

12/11/07

SI=B effect 01/01/04 SI=B effect 01/01/04 SI=B effect 01/01/04 SI=B effect 01/01/04 SI=B effect 01/01/04 SI=B effect 01/01/04 SI=B effect 01/01/04 SI=B effect 01/01/04 add 261QR1300X and 261QF0400X effective 01/01/08 ERROR THIS WAS FOR S0315 SI=B effect 01/01/04 add 261QR1300X and 261QF0400X effective 01/01/08 ERROR THIS WAS FOR S0315 SI=B effect 01/01/04 SI=B effect 01/01/04 SI=B effect 01/01/04 SI=B effect 01/01/04 SI=B effect 01/01/04 SI=B effect 01/01/04 SI=B effect 01/01/04 SI=B effect 01/01/04 add 282N tax if necessary SI=B effect 01/01/04 SI=B effect 01/01/04 SI=B effect 01/01/04

G0339

Robot lin-radsurg com, first

S

S

0067

61.6965

2,947.24

6,719.98

7,702.19

G0340 G0341 G0342 G0343 G0344

Robt lin-radsurg fractx 2-5 Percutaneous islet celltrans Laparoscopy islet cell trans Laparotomy islet cell transp Initial preventive exam

S C C C V

S 1 1 1 1

0066 0000 0000 0000 0605

45.0693 0.0000 0.0000 0.0000 0.9964

2,152.96 0.00 0.00 0.00 0.00

4,908.95 0.00 0.00 0.00 0.00

5,626.45 0.00 0.00 0.00 0.00

WY not covered BUT codes redirected here so cover OPPS only WY not covered BUT codes redirected here so cover OPPS only

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

72 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only T S B S M M 1 1 1 1 1 1

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00

Children's Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00

Critical PDD Access Update to Hospital ACS Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

G0364 G0365 G0366 G0367 G0368 G0372

Bone marrow aspirate &biopsy Vessel mapping hemo access EKG for initial prevent exam EKG tracing for initial prev EKG interpret & report preve MD service required for PMD

0002 0267 0000 0099 0000 0000

1.1097 2.3792 0.0000 0.3892 0.0000 0.0000

SI change 1/1/07 (TR 1155)

G0377 G0378 G0379 G0380 G0381 G0382 G0383 G0384 G0389 G0390 G0392 G0393 G0394 G0396 G0397 G3001 G8006 G8007 G8008 G8009 G8010 G8011 G8012 G8013 G8014 G8015 G8016 G8017 G8018 G8019 G8020 G8021 G8022 G8023 G8024 G8025 G8026 G8027 G8028 G8029 G8030 G8031 G8032 G8033 G8034 G8035 G8036 G8037 G8038 G8039 G8040 G8041 G8051 G8052 G8053 G8054 G8055 G8056 G8057 G8058 G8059 G8060 G8061 G8062 G8075 G8076 G8077 G8078 G8079 G8080 G8081 G8082 G8085 G8093 G8094 G8099 G8100 G8103 G8104 G8106 G8107 G8108 G8109 G8110 G8111 G8112 G8113 G8114 G8115 G8116 G8117 G8126 G8127 G8128 G8129 G8130 G8131 G8152 G8153 G8154 G8155 G8156 G8157 G8159

Administra Part D vaccine Hospital observation per hr Direct admit hospital observ Lev 1 hosp type B ED visit Lev 2 hosp type B ED visit Lev 3 hosp type B ED visit Lev 4 hosp type B ED visit Lev 5 hosp type B ED visit Ultrasound exam AAA screen Trauma respon w/hosp cirtica AV fistula or graft arterial AV fistula or graft venous Blood occult test, colorecta Alcohol/subs interv 15-30mn Alcohol/subs interv >30 min Admin + supply, tositumomab AMI pt recd aspirin at arriv AMI pt did not receiv aspiri AMI pt ineligible for aspiri AMI pt recd Bblock at arr AMI pt did not rec bblock AMI pt inelig Bbloc at arriv Pneum pt recv antibiotic 4 h Pneum pt w/o antibiotic 4 hr Pneum pt not elig antibiotic Diabetic pt w/ HBA1c>9% Diabetic pt w/ HBA1c<or=9% DM pt inelig for HBA1c measu Care not provided for HbA1c Diabetic pt w/LDL>= 100mg/dl Diab pt w/LDL< 100mg/dl Diab pt inelig for LDL meas Care not provided for LDL DM pt w BP>=140/80 Diabetic pt wBP<140/80 Diabetic pt inelig for BP me Diabet pt w no care re BP me HF p w/LVSD on ACE-I/ARB HF pt w/LVSD not on ACE-I/AR HF pt not elig for ACE-I/ARB HF pt w/LVSD on Bblocker HF pt w/LVSD not on Bblocker HF pt not elig for Bblocker PMI-CAD pt on Bblocker PMI-CAD pt not on Bblocker PMI-CAD pt inelig Bblocker AMI-CAD pt doc on antiplatel AMI-CAD pt not docu on antip AMI-CAD inelig antiplate mea CAD pt w/LDL>100mg/dl CAD pt w/LDL<or=100mg/dl CAD pt not eligible for LDL Osteoporosis assess Osteopor pt not assess Pt inelig for osteopor meas Falls assess not docum 12 mo Falls assess w/ 12 mon Not elig for falls assessmen Hearing assess receive Pt w/o hearing assess Pt inelig for hearing assess Urinary incont pt assess Pt not assess for urinary in Pt not elig for urinary inco ESRD pt w/ dialy of URR>=65% ESRD pt w/ dialy of URR<65% ESRD pt not elig for URR/KtV ESRD pt w/Hct>or=33 ESRD pt w/Hct<33 ESRD pt inelig for HCT/Hgb ESRD pt w/ auto AV fistula ESRD pt w other fistula ESRD pt inelig autogenous Fis COPD pt rec smoking cessat COPD pt w/o smoke cessat int Osteopo pt given Ca+VitD sup Osteop pt inelig for Ca+VitD New dx osteo pt w/antiresorp Osteo pt inelig for antireso Bone dens meas test perf Bone dens meas test inelig Pt receiv influenza vacc Pt w/o influenza vacc Pt inelig for influenza vacc Pt receiv mammogram Pt not doc mammogram Pt ineligible mammography Care not provided for mamogr Pt receiv pneumo vacc Pt did not rec pneumo vacc Pt was inelig for pneumo vac Pt treat w/antidepress12wks Pt not treat w/antidepres12w Pt inelig for antidepres med Pt treat w/antidepres for 6m Pt not treat w/antidepres 6m Pt inelig for antidepres med Pt w/AB 1 hr prior to incisi Pt not doc for AB 1 hr prior Pt ineligi for AB therapy Pt recd thromboemb prophylax Pt did not rec thromboembo Pt ineligi for thrombolism Pt w/CABG w/o IMA

S N Q V V V V V S S T T A S S S M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M

1 N Q V V V V V 1 S 1 1 1 S S 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

0437 0000 0604 0604 0605 0606 0607 0608 0266 0618 0083 0083 0000 0432 0432 0442 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.3945 0.0000 0.8388 0.8388 0.9964 1.3226 1.6604 2.1740 1.5094 5.1854 45.3845 45.3845 0.0000 0.3128 0.3128 27.4298 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

0.00 0.00 40.07 40.07 47.60 63.18 79.32 103.85 0.00 247.71 0.00 0.00 0.00 14.94 14.94 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 91.36 91.36 108.53 144.06 180.85 236.79 0.00 564.79 0.00 0.00 0.00 34.07 34.07 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 104.72 104.72 124.39 165.11 207.28 271.40 0.00 647.35 0.00 0.00 0.00 39.05 39.05 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Added 1/1/07 to Medicare's Addendum B but not added to book X Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book X X

G8162 G8164 G8165 G8166 G8167 G8170 G8171 G8172 G8182 G8183 G8184 G8185 G8186

Iso CABG pt w/o preop Bblock Iso CABG pt w/prolng intub Iso CABG pt w/o prolng intub Iso CABG req surg rexpo Iso CABG w/o surg explo CEA/ext bypass pt on aspirin Pt w/carot endarct/ext bypas CEA/ext bypass pt not on asp CAD pt care not prov LDL HF/atrial fib pt on warfarin HF/atrial fib pt inelig warf Osteoarth pt w/ assess pain Osteoarth pt inelig assess

M M M M M M M M M M M M M

1 1 1 1 1 1 1 1 1 1 1 1 1

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

G8193

Antibio not doc prior surg

M

1

0000

0.0000

0.00

0.00

0.00

Added 1/1/07 to book

G8196

Antibio not docum prior surg

M

1

0000

0.0000

0.00

0.00

0.00

Added 1/1/07 to book

G8200

Cefazolin not docum prophy

M

1

0000

0.0000

0.00

0.00

0.00

Added 1/1/07 to book

G8204

MD not doc order to d/c anti

M

1

0000

0.0000

0.00

0.00

0.00

Added 1/1/07 to book

G8209

Clinician did not doc

M

1

0000

0.0000

0.00

0.00

0.00

Added 1/1/07 to book

G8214

Clini not doc order VTE

M

1

0000

0.0000

0.00

0.00

0.00

Added 1/1/07 to book

G8217 G8219 G8220 G8221

Pt not received DVT proph Received DVT proph day 2 Pt not rec DVT proph day 2 Pt inelig for DVT proph

M M M M

1 1 1 1

0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000

0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00

Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

73 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only M 1

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 0.00

Children's Hospital Outpatient Fee 0.00

Critical PDD Access Update to Hospital ACS Outpatient Fee 0.00

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

G8223

Pt not doc for presc antipla

0000

0.0000

Added 1/1/07 to book

G8226

Pt no prescr anticoa at D/C

M

1

0000

0.0000

0.00

0.00

0.00

Added 1/1/07 to book

G8231 G8234

Pt not doc for admin t-PA Pt not doc dysphagia screen

M M

1 1

0000 0000

0.0000 0.0000

0.00 0.00

0.00 0.00

0.00 0.00

Added 1/1/07 to book Added 1/1/07 to book

G8238 G8240

Pt not doc to rec rehab serv Inter carotid stenosis30-99%

M M

1 1

0000 0000

0.0000 0.0000

0.00 0.00

0.00 0.00

0.00 0.00

Added 1/1/07 to book Added 1/1/07 to book

G8243 G8246 G8248

Pt not doc MRI/CT w/o lesion Pt inelig hx w new/chg mole Pt w/one alarm symp not doc

M M M

1 1 1

0000 0000 0000

0.0000 0.0000 0.0000

0.00 0.00 0.00

0.00 0.00 0.00

0.00 0.00 0.00

Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book

G8251

Pt not doc w/Barretts, endo

M

1

0000

0.0000

0.00

0.00

0.00

Added 1/1/07 to book

G8254

Pt w/no doc order for barium

M

1

0000

0.0000

0.00

0.00

0.00

Added 1/1/07 to book

G8257

Pt not doc rev meds D/C

M

1

0000

0.0000

0.00

0.00

0.00

Added 1/1/07 to book

G8260

Pt not doc to have dec maker

M

1

0000

0.0000

0.00

0.00

0.00

Added 1/1/07 to book

G8263

Pt not doc assess urinary in

M

1

0000

0.0000

0.00

0.00

0.00

Added 1/1/07 to book

G8266 G8268

Pt not doc charc urin incon Pt not doc rec care urin inc

M M

1 1

0000 0000

0.0000 0.0000

0.00 0.00

0.00 0.00

0.00 0.00

Added 1/1/07 to book Added 1/1/07 to book

G8271

Pt no doc screen fall

M

1

0000

0.0000

0.00

0.00

0.00

Added 1/1/07 to book

G8274

Clini not doc pres/abs alarm

M

1

0000

0.0000

0.00

0.00

0.00

Added 1/1/07 to book

G8276

Pt not doc mole change

M

1

0000

0.0000

0.00

0.00

0.00

Added 1/1/07 to book

G8279

Pt not doc rec PE

M

1

0000

0.0000

0.00

0.00

0.00

Added 1/1/07 to book

G8282

Pt not doc to rec couns

M

1

0000

0.0000

0.00

0.00

0.00

Added 1/1/07 to book

G8285

Pt did not rec pres osteo

M

1

0000

0.0000

0.00

0.00

0.00

Added 1/1/07 to book

G8289

Pt not doc rec Ca/Vit D

M

1

0000

0.0000

0.00

0.00

0.00

Added 1/1/07 to book

G8293

COPD pt w/o spir results

M

1

0000

0.0000

0.00

0.00

0.00

Added 1/1/07 to book

G8296

COPD pt not doc bronch ther

M

1

0000

0.0000

0.00

0.00

0.00

Added 1/1/07 to book

G8298

Pt doc optic nerve eval

M

1

0000

0.0000

0.00

0.00

0.00

Added 1/1/07 to book

G8299

Pt not doc optic nerv eval

M

1

0000

0.0000

0.00

0.00

0.00

Added 1/1/07 to book

G8302

Pt doc w/ target IOP

M

1

0000

0.0000

0.00

0.00

0.00

Added 1/1/07 to book

G8303

Pt not doc w/ IOP

M

1

0000

0.0000

0.00

0.00

0.00

Added 1/1/07 to book

G8304

Clin doc pt inelig IOP

M

1

0000

0.0000

0.00

0.00

0.00

Added 1/1/07 to book

G8305

Clin not prov care POAG

M

1

0000

0.0000

0.00

0.00

0.00

Added 1/1/07 to book

G8306

POAG w/ IOP rec care plan

M

1

0000

0.0000

0.00

0.00

0.00

Added 1/1/07 to book

G8307

POAG w/ IOP no care plan

M

1

0000

0.0000

0.00

0.00

0.00

Added 1/1/07 to book

G8308

POAG w/ IOP not doc plan

M

1

0000

0.0000

0.00

0.00

0.00

Added 1/1/07 to book

G8310

Pt not doc rec antiox

M

1

0000

0.0000

0.00

0.00

0.00

Added 1/1/07 to book

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

74 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee

Children's Hospital Outpatient Fee

Critical PDD Access Update to Hospital ACS Outpatient Fee

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

G8314

Pt not doc to rec mac exam

M

1

0000

0.0000

0.00

0.00

0.00

Added 1/1/07 to book

G8318

Pt doc not have visual func

M

1

0000

0.0000

0.00

0.00

0.00

Added 1/1/07 to book

G8322

Pt not doc pre axial leng

M

1

0000

0.0000

0.00

0.00

0.00

SI= 1 effective 07/01/07

x

G8326

Pt not doc rec fundus exam

M

1

0000

0.0000

0.00

0.00

0.00

Added 1/1/07 to book

G8330

Pt not doc rec dilated mac

M

1

0000

0.0000

0.00

0.00

0.00

Added 1/1/07 to book

G8334

Doc of macular not giv MD

M

1

0000

0.0000

0.00

0.00

0.00

Added 1/1/07 to book

G8338

Clin not doc pt test osteo

M

1

0000

0.0000

0.00

0.00

0.00

Added 1/1/07 to book

G8341

Pt not doc for DEXA

M

1

0000

0.0000

0.00

0.00

0.00

Added 1/1/07 to book

G8345

Pt not doc have DEXA

M

1

0000

0.0000

0.00

0.00

0.00

Added 1/1/07 to book

G8351

Pt not doc ECG

M

1

0000

0.0000

0.00

0.00

0.00

add to fee schedule SI=1

G8354

Pt not rec aspirin prior ER

M

1

0000

0.0000

0.00

0.00

0.00

add to fee schedule SI=1

G8357

Pt not doc to have ECG

M

1

0000

0.0000

0.00

0.00

0.00

add to fee schedule SI=1

G8360 G8362

Pt not doc vital signs recor Pt not doc 02 SAT assess

M M

1 1

0000 0000

0.0000 0.0000

0.00 0.00

0.00 0.00

0.00 0.00

add to fee schedule SI=1 add to fee schedule SI=1

G8365 G8367 G8370 G8371 G8372 G8373 G8374 G8375 G8376 G8377 G8378 G8379 G8380 G8381 G8382 G8383 G8384 G8385 G8386 G8387 G8388 G8389 G8390 G8391 G8395 G8396 G8397 G8398 G8399 G8400 G8401 G8402 G8403 G8404 G8405 G8406 G8407 G8408

Pt not doc mental status Pt not doc have empiric AB Asthma pt w survey not docum Chemother not rec stg3 colon Chemother rec stg3 colon ca Chemo plan documen prior che Chemo plan not doc prior che CLL pt w/o doc flow cytometr Brst ca pt inelig tamoxifen MD doc colon ca pt inelig ch MD doc pt inelig radiation Doc radiat tx recom 12mo ov Pt w stgIC-3Brst ca not rec Pt w stgIC-3Brst ca rec tam MM pt w/o doc IV bisphophon No doc radiation rec 12mo ov base cytogen test MDS notper Diabet pt no do Hgb A 1 c 12m Diabet pt nodoc LDLiprotei ESRD pt w Hct/Hgb not docume ESRD pt w URR/Ktv notdoc eli MDS pt no doc Fe st prio EPO Diabetic w/o document BP 12m Pt w asthma no doc med or tx LVEF>=40% doc normal or mild LVEF not performed Dil macula/fundus exam/w doc Dil macular/fundus not perfo Pt w/DXA document or order Pt w/DXA no document or orde Pt inelig osteo screen measu Smoke preven interven counse Smoke preven nocounsel Low extemity neur exam docum Low extemity neur not perfor Pt inelig lower extrem neuro ABI documented ABI not documented

M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 11/30/07

add to fee schedule SI=1 add to fee schedule SI=1

Description change Description change

X X

Description Change Description Change

X X

Description Change Effective 07/01/07 Description Change Effective 07/01/07 Description Change Effective 07/01/07 Description Change Effective 07/01/07 Description Change Description Change

X X X X X X X X X X X X X X X X X X X X X X

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

75 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M B B B B B B B B B B B B E E E A A A A A A A A A A A A E E E E E E E E E E E E E M M M M M M M M M M M M M M M M M 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 B 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Children's Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Critical PDD Access Update to Hospital ACS Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X

G8409 G8410 G8415 G8416 G8417 G8418 G8419 G8420 G8421 G8422 G8423 G8424 G8425 G8426 G8427 G8428 G8429 G8430 G8431 G8432 G8433 G8434 G8435 G8436 G8437 G8438 G8439 G8440 G8441 G8442 G8443 G8445 G8446 G8447 G8448 G8449 G8450 G8451 G8452 G8453 G8454 G8455 G8456 G8457 G8458 G8459 G8460 G8461 G8462 G8463 G8464 G8465 G8466 G8467 G8468 G8469 G8470 G8471 G8472 G8473 G8474 G8475 G8476 G8477 G8478 G8479 G8480 G8481 G8482 G8483 G8484 G9001 G9002 G9003 G9004 G9005 G9006 G9007 G9008 G9009 G9010 G9011 G9012 G9013 G9014 G9016 G9017 G9018 G9019 G9020 G9033 G9034 G9035 G9036 G9041 G9042 G9043 G9044 G9050 G9051 G9052 G9053 G9054 G9055 G9056 G9057 G9058 G9059 G9060 G9061 G9062 G9063 G9064 G9065 G9066 G9067 G9068 G9069 G9070 G9071 G9072 G9073 G9074 G9075 G9077 G9078 G9079 G9080

Pt inelig for ABI measure Eval on foot documented Eval on foot not performed Pt inelig footwear evaluatio BMI >=30 calcuate w/followup BMI < 22 calcuate w/followup BMI>=30or<22 cal no followup BMI<30 and >=22 calc & docu BMI not calculated Pt inelig BMI calculation Pt screen flu vac & counsel Flu vaccine not screen Flu vaccine screen not curre Pt not approp screen & counc Doc meds verified w/pt or re Meds document w/o verifica Incomplete doc pt on meds Pt inelig med check Clin depression screen doc Clin depression screen not d Pt inelig for depression scr Cognitive impairment documen screen not screen Pt inelig for cognitive impa Tx plan develop & document Tx plan develop & not docum Pt inelig for co-develp tx p Pain assessment document No document of pain assess Pt inelig pain assessment Prescription by E-Prescrib s Prescrip not gen at encounte Some prescrib handwritten or Pt visit doc using CCHIT cer Pt visit docum w/non-CCHIT c Pt not doc w/EMR due to syst Beta-bloc rx pt w/abn lvef Pt w/abn lvef inelig b-bloc Pt w/abn lvef b-bloc no rx Tob use cess int counsel Tob use cess int no counsel Current tobacco smoker Smokeless tobacco user Tobacco non-user Pt inelig geno no antvir tx Doc pt rec antivir treat Pt inelig RNA no antvir tx Pt rec antivir treat hep c Pt inelig couns no antvir tx Pt rec antiviral treat doc Pt inelig; lo to no dter rsk High risk recurrence pro ca Pt inelig suic; MDD remis New dx init/rec episode MDD ACE/ARB rx pt w/abn lvef Pt w/abn lvef inelig ACE/ARB Pt w/ normal lvef LVEF not performed/doc ACE/ARB no rx pt w/abn lvef ACE/ARB thxpy rx'd ACE/ARB not rx'd; doc reas ACE/ARB thxpy not rx'd BP sys <130 and dias <80 BP sys>=130 and/or dias >=80 BP not performed/doc MD rx'd ACE/ARB thxpy Pt inelig ACE/ARB thxpy MD not rx'd ACE/ARB thxpy Flu immunize order/admin Flu imm no ord/admin doc rea Flu immunize no order/admin MCCD, initial rate MCCD,maintenance rate MCCD, risk adj hi, initial MCCD, risk adj lo, initial MCCD, risk adj, maintenance MCCD, Home monitoring MCCD, sch team conf Mccd,phys coor-care ovrsght MCCD, risk adj, level 3 MCCD, risk adj, level 4 MCCD, risk adj, level 5 Other Specified Case Mgmt ESRD demo bundle level I ESRD demo bundle-level II Demo-smoking cessation coun Amantadine HCL 100mg oral Zanamivir,inhalation pwd 10m Oseltamivir phosphate 75mg Rimantadine HCL 100mg oral Amantadine HCL oral brand Zanamivir, inh pwdr, brand Oseltamivir phospate 75mg o Rimantadine HCL 100mg Low vision serv occupational Low vision orient/mobility Low vision rehab therapist Low vision rehab teacher Oncology work-up evaluation Oncology tx decision-mgmt Onc surveillance for disease Onc expectant management pt Onc supervision palliative Onc visit unspecified NOS Onc prac mgmt adheres guide Onc pract mgmt differs trial Onc prac mgmt disagree w/gui Onc prac mgmt pt opt alterna Onc prac mgmt dif pt comorb Onc prac cond noadd by guide Onc prac guide differs nos Onc dx nsclc stgI no progres Onc dx nsclc stg2 no progres Onc dx nsclc stg3A no progres Onc dx nsclc stg3B-4 metasta Onc dx nsclc dx unknown nos Onc dx sclc/nsclc limited Onc dx sclc/nsclc ext at dx Onc dx sclc/nsclc ext unknwn Onc dx brst stg1-2B HR, no pro Onc dx brst stg1-2 no progres Onc dx brst stg3- HR, no pro Onc dx brst stg3- no progress Onc dx brst metastic/ recur Onc dx prostate T1no progres Onc dx prostate T2no progres Onc dx prostate T3b-T4noprog Onc dx prostate w/rise PSA

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155)

G9083 G9084 G9085 G9086 G9087 G9088 G9089 G9090 G9091 G9092 G9093 G9094 G9095 G9096 G9097 G9098 G9099 G9100 G9101 G9102 G9103 G9104 G9105 G9106 G9107 G9108 G9109 G9110 G9111 G9112 G9113 G9114 G9115

One dx prostate unknwn nos Onc dx colon t1-3,n1-2,no pr Onc dx colon T4, N0 w/o prog Onc dx colon T1-4 no dx prog Onc dx colon metas evid dx Onc dx colon metas no evid dx Onc dx colon extent unknown Onc dx rectal T1-2 no progr Onc dx rectal T3 N0 no prog Onc dx rectal T1-3,N1-2noprg Onc dx rectal T4,N,M0 no prg Onc dx rectal M1 w/mets prog Onc dx rectal extent unknwn Onc dx esophag T1-T3 noprog Onc dx esophageal T4 no prog Onc dx esophageal mets recur Onc dx esophageal unknown Onc dx gastric no recurrence Onc dx gastric p R1-R2noprog Onc dx gastric unresectable Onc dx gastric recurrent Onc dx gastric unknown NOS Onc dx pancreatc p R0 res no Onc dx pancreatc p R1/R2 no Onc dx pancreatic unresectab Onc dx pancreatic unknwn NOS Onc dx head/neck T1-T2no prg Onc dx head/neck T3-4 noprog Onc dx head/neck M1 mets rec Onc dx head/neck ext unknown Onc dx ovarian stg1A-B no pr Onc dx ovarian stg1A-B or 2 Onc dx ovarian stg3/4 noprog

M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Description Change

x

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

76 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only M M 1 1

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 0.00 0.00

Children's Hospital Outpatient Fee 0.00 0.00

Critical PDD Access Update to Hospital ACS Outpatient Fee 0.00 0.00

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

G9116 G9117

Onc dx ovarian recurrence Onc dx ovarian unknown NOS

0000 0000

0.0000 0.0000

G9123 G9124 G9125 G9126 G9128 G9129 G9130 G9131 G9132 G9133 G9134 G9135 G9136 G9137 G9138 G9139 G9140 J0120 J0128 J0129 J0130 J0132 J0133 J0135 J0150 J0152 J0170 J0180 J0190 J0200 J0205 J0207 J0210 J0215 J0220 J0256 J0270 J0275 J0278 J0280 J0282 J0285 J0287 J0288 J0289 J0290 J0295 J0300 J0330 J0348 J0350 J0360 J0364 J0365 J0380 J0390 J0395 J0400 J0456 J0460 J0470 J0475 J0476 J0480 J0500 J0515 J0520 J0530 J0540 J0550 J0560 J0570 J0580 J0583 J0585 J0587 J0592 J0594 J0595 J0600 J0610 J0620 J0630 J0636 J0637 J0640 J0670 J0690 J0692 J0694 J0696 J0697 J0698 J0702 J0704 J0706 J0710 J0713 J0715 J0720 J0725 J0735 J0740 J0743 J0744 J0745 J0760 J0770 J0780 J0795 J0800 J0835 J0850 J0878 J0881 J0882 J0885 J0886 J0894 J0895 J0900 J0945 J0970 J1000 J1020 J1030 J1040 J1051 J1055 J1056 J1060 J1070 J1080

Onc dx CML chronic phase Onc dx CML acceler phase Onc dx CML blast phase Onc dx CML remission Onc dx multi myeloma stage I Onc dx mult myeloma stg2 hig Onc dx multi myeloma unknown Onc dx brst unknown NOS Onc dx prostate mets no cast Onc dx prostate clinical met Onc NHLstg 1-2 no relap no Onc dx NHL stg 3-4 not relap Onc dx NHL trans to lg Bcell Onc dx NHL relapse/refractor Onc dx NHL stg unknown Onc dx CML dx status unknown Frontier extended stay demo Tetracyclin injection Abarelix injection Abatacept injection Abciximab injection Acetylcysteine injection Acyclovir injection Adalimumab injection Injection adenosine 6 MG Adenosine injection Adrenalin epinephrin inject Agalsidase beta injection Inj biperiden lactate/5 mg Alatrofloxacin mesylate Alglucerase injection Amifostine Methyldopate hcl injection Alefacept Aglucosidase alfa injection Alpha 1 proteinase inhibitor Alprostadil for injection Alprostadil urethral suppos Amikacin sulfate injection Aminophyllin 250 MG inj Amiodarone HCl Amphotericin B Amphotericin b lipid complex Ampho b cholesteryl sulfate Amphotericin b liposome inj Ampicillin 500 MG inj Ampicillin sodium per 1.5 gm Amobarbital 125 MG inj Succinycholine chloride inj Anadulafungin injection Injection anistreplase 30 u Hydralazine hcl injection Apomorphine hydrochloride Aprotonin, 10,000 kiu Inj metaraminol bitartrate Chloroquine injection Arbutamine HCl injection Aripiprazole injection Azithromycin Atropine sulfate injection Dimecaprol injection Baclofen 10 MG injection Baclofen intrathecal trial Basiliximab Dicyclomine injection Inj benztropine mesylate Bethanechol chloride inject Penicillin g benzathine inj Penicillin g benzathine inj Penicillin g benzathine inj Penicillin g benzathine inj Penicillin g benzathine inj Penicillin g benzathine inj Bivalirudin Botulinum toxin a per unit Botulinum toxin type B Buprenorphine hydrochloride Busulfan injection Butorphanol tartrate 1 mg Edetate calcium disodium inj Calcium gluconate injection Calcium glycer & lact/10 ML Calcitonin salmon injection Inj calcitriol per 0.1 mcg Caspofungin acetate Leucovorin calcium injection Inj mepivacaine HCL/10 ml Cefazolin sodium injection Cefepime HCl for injection Cefoxitin sodium injection Ceftriaxone sodium injection Sterile cefuroxime injection Cefotaxime sodium injection Betamethasone acet&sod phosp Betamethasone sod phosp/4 MG Caffeine citrate injection Cephapirin sodium injection Inj ceftazidime per 500 mg Ceftizoxime sodium / 500 MG Chloramphenicol sodium injec Chorionic gonadotropin/1000u Clonidine hydrochloride Cidofovir injection Cilastatin sodium injection Ciprofloxacin iv Inj codeine phosphate /30 MG Colchicine injection Colistimethate sodium inj Prochlorperazine injection Corticorelin ovine triflutal Corticotropin injection Inj cosyntropin per 0.25 MG Cytomegalovirus imm IV /vial Daptomycin injection Darbepoetin alfa, non-esrd Darbepoetin alfa, esrd use Epoetin alfa, non-esrd Epoetin alfa, esrd Decitabine injection Deferoxamine mesylate inj Testosterone enanthate inj Brompheniramine maleate inj Estradiol valerate injection Depo-estradiol cypionate inj Methylprednisolone 20 MG inj Methylprednisolone 40 MG inj Methylprednisolone 80 MG inj Medroxyprogesterone inj Medrxyprogester acetate inj MA/EC contraceptiveinjection Testosterone cypionate 1 ML Testosterone cypionat 100 MG Testosterone cypionat 200 MG

M M M M M M M M M M M M M M M M A N K G K N N K K K N K K N K K K K K K B B N N N N K K K N N N N G K N N K N N N K N N N K K K N N N N N N N N N K K K N K N K N N N N K N N N N N N N N N N N N N N N N K K N N N N N N K K K K K K A K A G N N N N N N N N N E E N N N

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 N K G K N 1 K K K N K K 1 K 1 K 1 K K B 1 N N 1 N 1 1 1 N N N N G K N N K N N N K N N N K K 1 N N N N N N N N N 1 K K 1 K N K N N N 1 1 N N N N N N N N N N 1 N N N N N K K N N N N N N K K K K 1 K 3 K 3 G N N N N N N N N 1 3 3 N N N

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 9216 9230 1605 0000 0000 1083 0379 0917 0000 9208 0998 0000 0900 7000 2210 1633 9234 0901 0000 0000 0000 0000 0000 0000 9024 0735 0736 0000 0000 0000 0000 0760 1606 0000 0000 1682 0000 0000 0000 1165 0000 0000 0000 9032 1631 1683 0000 0000 0000 0000 0000 0000 0000 0000 0000 3041 0902 9018 0000 1178 0000 0999 0000 0000 0000 0000 9019 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0935 9033 0000 0000 0000 0000 0000 0000 1684 1280 0835 0903 9124 1685 0000 1686 0000 9231 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 1.0671 0.2934 6.5438 0.0000 0.0000 5.1427 0.3536 1.0659 0.0000 1.9782 0.1922 0.0000 0.6099 7.7182 0.2608 0.4131 1.9782 0.0526 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.1614 0.1867 0.2567 0.0000 0.0000 0.0000 0.0000 0.0292 26.7849 0.0000 0.0000 0.0418 0.0000 0.0000 0.0000 0.0044 0.0000 0.0000 0.0000 3.0626 1.1036 23.3730 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0308 0.0818 0.1355 0.0000 0.1504 0.0000 0.7805 0.0000 0.0000 0.0000 0.0000 0.3294 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 1.0105 11.8338 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0661 13.5496 1.0090 13.6674 0.0055 0.0449 0.0000 0.1394 0.0000 0.4157 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 50.98 14.02 312.60 0.00 0.00 245.67 16.89 50.92 0.00 94.50 9.18 0.00 29.14 0.00 12.46 0.00 94.50 2.51 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1.39 1,279.52 0.00 0.00 1.99 0.00 0.00 0.00 0.21 0.00 0.00 0.00 146.30 52.72 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3.91 6.47 0.00 7.18 0.00 37.28 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 48.27 565.30 0.00 0.00 0.00 0.00 0.00 0.00 3.16 647.27 48.20 652.89 0.00 2.14 M01 6.66 M01 19.86 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 116.23 31.96 712.75 0.00 0.00 560.14 38.51 116.10 0.00 215.47 20.93 0.00 66.44 0.00 28.40 0.00 215.47 5.73 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3.18 2,917.42 0.00 0.00 4.55 0.00 0.00 0.00 0.48 0.00 0.00 0.00 333.58 120.20 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8.91 14.76 0.00 16.38 0.00 85.01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 110.06 1,288.93 0.00 0.00 0.00 0.00 0.00 0.00 7.20 1,475.83 109.90 1,488.65 0.00 4.89 M01 15.19 M01 45.28 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 133.22 36.63 816.93 0.00 0.00 642.02 44.14 133.06 0.00 246.96 23.99 0.00 76.15 0.00 32.56 0.00 246.96 6.57 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3.65 3,343.83 0.00 0.00 5.21 0.00 0.00 0.00 0.55 0.00 0.00 0.00 382.34 137.77 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 10.21 16.91 0.00 18.78 0.00 97.43 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 126.15 1,477.33 0.00 0.00 0.00 0.00 0.00 0.00 8.25 1,691.54 125.97 1,706.24 0.00 5.61 M01 17.40 M01 51.90 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 0.00 0.00 0.00

Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book effective 10/01/07 SI change 1/1/07 (TR 1155) Added 1/1/07 to book

X

* * *

X

* * * * * * * * * * *

SI change 1/1/07 (TR 1155)

X

SI change 1/1/07 (TR 1155)

SI change 1/1/07 (TR 1155)

* * *

* *

Added 1/1/07 to book

Added 1/1/07 to book SI change 1/1/07 (TR 1155)

X X X X

*

*

SI change 1/1/07 (TR 1155)

* * *

SI dropped off when non OPPS changes made

* * * * *

SI change 1/1/07 (TR 1155)

Added 1/1/07 to book

SI change 1/1/07 (TR 1155)

*

X

* *

* * * * * * * *

SI change 1/1/07 (TR 1155)

Added 1/1/07 to book X

J1094 J1100 J1110 J1120 J1160 J1162 J1165 J1170 J1180 J1190 J1200 J1205 J1212 J1230 J1240 J1245 J1250

Inj dexamethasone acetate Dexamethasone sodium phos Inj dihydroergotamine mesylt Acetazolamid sodium injectio Digoxin injection Digoxin immune fab (ovine) Phenytoin sodium injection Hydromorphone injection Dyphylline injection Dexrazoxane HCl injection Diphenhydramine hcl injectio Chlorothiazide sodium inj Dimethyl sulfoxide 50% 50 ML Methadone injection Dimenhydrinate injection Dipyridamole injection Inj dobutamine HCL/250 mg

N N N N N K N N N K N K N N N N N

N N N N N K N N N K N K N N N N N

0000 0000 0000 0000 0000 1687 0000 0000 0000 0726 0000 0747 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 7.6450 0.0000 0.0000 0.0000 2.5481 0.0000 2.3150 0.0000 0.0000 0.0000 0.0000 0.0000

*

* *

0.00 0.00 0.00 0.00 0.00 365.20 0.00 0.00 0.00 121.72 0.00 110.59 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 832.69 0.00 0.00 0.00 277.54 0.00 252.15 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 954.40 0.00 0.00 0.00 318.11 0.00 289.00 0.00 0.00 0.00 0.00 0.00

SI change 1/1/07 (TR 1155)

SI change 1/1/07 (TR 1155)

SI change 1/1/07 (TR 1155)

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

77 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only K N N G N K N K N N N N N K K N K K K K N K N N K K K K K K K K K K K K K K K K K K N K K K N N K N K K K N N K N N N N K N K B N N N K G K G K K K K K N N E N N E K K N N N N K N K K B N N N N N N K N N K N N N N G N N N N N K N N N K N N N G K K N K K N N N K N K K N N K N K K K N K N N N B N N N N N N N N N N N N K N N G N K 1 1 1 1 N N N K 1 N K 1 K K N K 1 N 1 K K K K K K K K K K K K K K K K K N K K K N N 1 N K K K N N 1 N N N N 1 N K 1 N N N K G K G K K 1 1 K N N 3 N 1 1 K K N N N N 1 N K K B N N 1 N N N K N N K N N 1 N G N N N 1 N K 1 N N K N N N G K 1 1 K 1 N N N K N K K N N K 1 K K K N 1 N N 1 B N N N N N N N N N N N N

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight *

General Hospital Outpatient Fee 3.56 0.00 0.00 132.28 0.00 0.30 0.00 0.00 0.00 0.00 0.00 0.00 0.00 52.98 0.00 0.00 53.05 0.00 147.87 226.87 0.00 10.20 0.00 0.00 0.00 233.07 8.74 17.47 26.20 34.94 43.68 52.44 61.12 69.89 78.67 87.36 87.36 24.43 5.26 12.01 20.55 25.12 23.51 0.00 44.02 24.23 44.02 0.00 0.00 0.00 0.00 54.20 133.94 3.51 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 75.17 0.00 0.00 0.00 0.00 84.93 104.28 237.37 341.27 41.02 8.63 0.00 0.00 2.92 0.00 0.00 M01 0.00 0.00 0.00 86.35 29.92 0.00 0.00 0.00 0.00 0.00 0.00 119.01 336.78 0.00 0.00 0.00 0.00 0.00 0.00 0.00 19.85 0.00 0.00 11.71 0.00 0.00 0.00 0.00 1.02 0.00 0.00 0.00 0.00 0.00 4.84 0.00 0.00 0.00 1.39 0.00 0.00 0.00 5.63 24.91 0.00 0.00 185.00 0.00 0.00 0.00 0.00 0.21 0.00 8.44 22.01 0.00 0.00 12.36 0.00 776.71 148.13 1,628.04 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Children's Hospital Outpatient Fee 8.12 0.00 0.00 301.62 0.00 0.68 0.00 0.00 0.00 0.00 0.00 0.00 0.00 120.80 0.00 0.00 120.95 0.00 337.15 517.29 0.00 23.26 0.00 0.00 0.00 531.42 19.92 39.84 59.75 79.67 99.59 119.57 139.35 159.36 179.37 199.19 199.19 55.70 11.99 27.40 46.86 57.27 53.61 0.00 100.36 55.25 100.36 0.00 0.00 0.00 0.00 123.59 305.40 8.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 171.40 0.00 0.00 0.00 0.00 193.65 237.77 541.21 778.12 93.52 19.68 0.00 0.00 6.65 0.00 0.00 M01 0.00 0.00 0.00 196.88 68.23 0.00 0.00 0.00 0.00 0.00 0.00 271.35 767.88 0.00 0.00 0.00 0.00 0.00 0.00 0.00 45.27 0.00 0.00 26.71 0.00 0.00 0.00 0.00 2.33 0.00 0.00 0.00 0.00 0.00 11.03 0.00 0.00 0.00 3.18 0.00 0.00 0.00 12.84 56.79 0.00 0.00 421.82 0.00 0.00 0.00 0.00 0.48 0.00 19.26 50.19 0.00 0.00 28.18 0.00 1,770.96 337.75 3,712.08 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Critical PDD Access Update to Hospital ACS Outpatient Fee 9.31 0.00 0.00 345.70 0.00 0.78 0.00 0.00 0.00 0.00 0.00 0.00 0.00 138.45 0.00 0.00 138.63 0.00 386.43 592.90 0.00 26.66 0.00 0.00 0.00 609.09 22.83 45.67 68.48 91.32 114.15 137.04 159.72 182.65 205.58 228.30 228.30 63.84 13.74 31.40 53.70 65.64 61.45 0.00 115.03 63.33 115.03 0.00 0.00 0.00 0.00 141.65 350.04 9.17 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 196.45 0.00 0.00 0.00 0.00 221.95 272.52 620.32 891.86 107.19 22.56 0.00 0.00 7.62 0.00 0.00 M01 0.00 0.00 0.00 225.65 78.20 0.00 0.00 0.00 0.00 0.00 0.00 311.01 880.12 0.00 0.00 0.00 0.00 0.00 0.00 0.00 51.88 0.00 0.00 30.62 0.00 0.00 0.00 0.00 2.67 0.00 0.00 0.00 0.00 0.00 12.64 0.00 0.00 0.00 3.65 0.00 0.00 0.00 14.72 65.09 0.00 0.00 483.47 0.00 0.00 0.00 0.00 0.55 0.00 22.07 57.53 0.00 0.00 32.30 0.00 2,029.81 387.12 4,254.64 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 11/30/07

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

J1260 J1265 J1270 J1300 J1320 J1324 J1325 J1327 J1330 J1335 J1364 J1380 J1390 J1410 J1430 J1435 J1436 J1438 J1440 J1441 J1450 J1451 J1452 J1455 J1457 J1458 J1460 J1470 J1480 J1490 J1500 J1510 J1520 J1530 J1540 J1550 J1560 J1561 J1562 J1565 J1566 J1568 J1569 J1570 J1571 J1572 J1573 J1580 J1590 J1595 J1600 J1610 J1620 J1626 J1630 J1631 J1640 J1642 J1644 J1645 J1650 J1652 J1655 J1670 J1675 J1700 J1710 J1720 J1730 J1740 J1742 J1743 J1745 J1751 J1752 J1756 J1785 J1790 J1800 J1810 J1815 J1817 J1825 J1830 J1835 J1840 J1850 J1885 J1890 J1931 J1940 J1945 J1950 J1955 J1956 J1960 J1980 J1990 J2001 J2010 J2020 J2060 J2150 J2170 J2175 J2180 J2185 J2210 J2248 J2250 J2260 J2270 J2271 J2275 J2278 J2280 J2300 J2310 J2315 J2320 J2321 J2322 J2323 J2325 J2353 J2354 J2355 J2357 J2360 J2370 J2400 J2405 J2410 J2425 J2430 J2440 J2460 J2469 J2501 J2503 J2504 J2505 J2510 J2513 J2515 J2540 J2543 J2545 J2550 J2560 J2590 J2597 J2650 J2670 J2675 J2680 J2690 J2700 J2710 J2720

Dolasetron mesylate Dopamine injection Injection, doxercalciferol Eculizumab injection Amitriptyline injection Enfuvirtide injection Epoprostenol injection Eptifibatide injection Ergonovine maleate injection Ertapenem injection Erythro lactobionate /500 MG Estradiol valerate 10 MG inj Estradiol valerate 20 MG inj Inj estrogen conjugate 25 MG Ethanolamine oleate 100 mg Injection estrone per 1 MG Etidronate disodium inj Etanercept injection Filgrastim 300 mcg injection Filgrastim 480 mcg injection Fluconazole Fomepizole, 15 mg Intraocular Fomivirsen na Foscarnet sodium injection Gallium nitrate injection Galsulfase injection Gamma globulin 1 CC inj Gamma globulin 2 CC inj Gamma globulin 3 CC inj Gamma globulin 4 CC inj Gamma globulin 5 CC inj Gamma globulin 6 CC inj Gamma globulin 7 CC inj Gamma globulin 8 CC inj Gamma globulin 9 CC inj 10 CC inj Gamma globulin > 10 CC inj Gamunex injection Vivaglobin, inj RSV-ivig Immune globulin, powder Octagam injection Gammagard liquid injection Ganciclovir sodium injection HepaGam B IM injection Flebogamma injection Hepagam B intravenous, inj Garamycin gentamicin inj Gatifloxacin injection Injection glatiramer acetate Gold sodium thiomaleate inj Glucagon hydrochloride/1 MG Gonadorelin hydroch/ 100 mcg Granisetron HCl injection Haloperidol injection Haloperidol decanoate inj Hemin, 1 mg Inj heparin sodium per 10 u Inj heparin sodium per 1000u Dalteparin sodium Inj enoxaparin sodium Fondaparinux sodium Tinzaparin sodium injection Tetanus immune globulin inj Histrelin acetate Hydrocortisone acetate inj Hydrocortisone sodium ph inj Hydrocortisone sodium succ i Diazoxide injection Ibandronate sodium injection Ibutilide fumarate injection Idursulfase injection Infliximab injection Iron dextran 165 injection Iron dextran 267 injection Iron sucrose injection Injection imiglucerase /unit Droperidol injection Propranolol injection Droperidol/fentanyl inj Insulin injection Insulin for insulin pump use Interferon beta-1a Interferon beta-1b / .25 MG Itraconazole injection Kanamycin sulfate 500 MG inj Kanamycin sulfate 75 MG inj Ketorolac tromethamine inj Cephalothin sodium injection Laronidase injection Furosemide injection Lepiridin Leuprolide acetate /3.75 MG Inj levocarnitine per 1 gm Levofloxacin injection Levorphanol tartrate inj Hyoscyamine sulfate inj Chlordiazepoxide injection Lidocaine injection Lincomycin injection Linezolid injection Lorazepam injection Mannitol injection Mecasermin injection Meperidine hydrochl /100 MG Meperidine/promethazine inj Meropenem Methylergonovin maleate inj Micafungin sodium injection Inj midazolam hydrochloride Inj milrinone lactate / 5 MG Morphine sulfate injection Morphine so4 injection 100mg Morphine sulfate injection Ziconotide injection Inj, moxifloxacin 100 mg Inj nalbuphine hydrochloride Inj naloxone hydrochloride Naltrexone, depot form Nandrolone decanoate 50 MG Nandrolone decanoate 100 MG Nandrolone decanoate 200 MG Natalizumab injection Nesiritide injection Octreotide injection, depot Octreotide inj, non-depot Oprelvekin injection Omalizumab injection Orphenadrine injection Phenylephrine hcl injection Chloroprocaine hcl injection Ondansetron hcl injection Oxymorphone hcl injection Palifermin injection Pamidronate disodium /30 MG Papaverin hcl injection Oxytetracycline injection Palonosetron HCl Paricalcitol Pegaptanib sodium injection Pegademase bovine, 25 iu Injection, pegfilgrastim 6mg Penicillin g procaine inj Pentastarch 10% solution Pentobarbital sodium inj Penicillin g potassium inj Piperacillin/tazobactam Pentamidine non-comp unit Promethazine hcl injection Phenobarbital sodium inj Oxytocin injection Inj desmopressin acetate Prednisolone acetate inj Totazoline hcl injection Inj progesterone per 50 MG Fluphenazine decanoate 25 MG Procainamide hcl injection Oxacillin sodium injeciton Neostigmine methylslfte inj Inj protamine sulfate/10 MG

0750 0000 0000 9236 0000 0767 0000 1607 0000 0000 0000 0000 0000 9038 1688 0000 1436 1608 0728 7049 0000 1689 0000 0000 0878 9224 3043 0898 0899 0904 0919 0920 0921 0922 0923 0924 0933 0948 0804 0906 2731 0943 0944 0000 0946 0947 1138 0000 0000 1015 0000 9042 7005 0764 0000 0000 1690 0000 0000 0000 0000 0883 0000 1670 0000 0000 0000 0000 1740 9229 9044 9232 7043 1691 1692 9046 0916 0000 0000 0000 0000 0000 0000 0910 9047 0000 0000 0000 0000 9209 0000 1693 0800 0000 0000 0000 0000 0000 0000 0000 9001 0000 0000 0805 0000 0000 0000 0000 9227 0000 0000 0000 0000 0000 1694 0000 0000 0000 0759 0000 0000 0000 9126 1695 1207 0000 7011 9300 0000 0000 0000 0768 0000 1696 0730 0000 0000 9210 0000 1697 1739 9119 0000 0880 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0746 0.0000 0.0000 2.7692 0.0000 0.0063 0.0000 0.2743 0.0000 0.0000 0.0000 0.0000 0.0000 1.1091 1.1894 0.0000 1.1105 2.6244 3.0954 4.7493 0.0000 0.2135 0.0000 0.0000 0.0253 4.8790 0.1829 0.3658 0.5486 0.7315 0.9144 1.0977 1.2794 1.4631 1.6468 1.8287 1.8287 0.5114 0.1101 0.2515 0.4302 0.5258 0.4922 0.0000 0.9214 0.5073 0.9214 0.0000 0.0000 0.8178 0.0000 1.1346 2.8039 0.0735 0.0000 0.0000 0.1138 0.0000 0.0000 0.0000 0.0000 0.0944 0.0000 1.5736 0.0000 0.0000 0.0000 0.0000 1.7779 2.1829 4.9689 7.1440 0.8586 0.1807 0.1807 0.0057 0.0611 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 1.8075 0.6264 0.0000 0.0000 0.0000 0.0000 0.3711 0.0000 2.4913 7.0500 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.4156 0.0000 0.0000 0.2452 0.0000 0.0000 0.0000 0.0000 0.0214 0.0000 0.0000 0.0000 0.0000 0.0000 0.1013 0.0000 0.0000 0.0000 0.0292 0.0000 0.0000 0.0000 0.1179 0.5214 1.5818 0.0000 3.8727 0.2710 0.0000 0.0000 0.0000 0.0044 0.0000 0.1768 0.4608 0.0000 0.0000 0.2587 0.0000 16.2593 3.1009 34.0808 0.0000 0.3451 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

* * *

X Added 1/1/07 to book

X SI dropped off when non OPPS changes made

* * * * * * *

* * * * * * * * * * * * * * * * * * * * *

SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) Added 1/1/07 to book SI change 1/1/07 (TR 1155)

X X X

X X X X X X X X X X Added 1/1/07 to book Description Change x

X X X X X

* * * *

X

*

* *

X X

* * * * * * * * *

Added 1/1/07 to book X

* *

* * *

*

*

Added 1/1/07 to book

SI change 1/1/07 (TR 1155) Added 1/1/07 to book

X

*

*

X

*

Added 1/1/07 to book

* * * * *

X

SI change 1/1/07 (TR 1155)

* * *

*

Factor Code = N so SI needs to be 1 X

* * * *

SI change 1/1/07 (TR 1155)

X

SI change 1/1/07 (TR 1155)

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

78 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only K N K N N K G N K K K K K K N N N N K K N N N N K K N K K K N N K N K N B N N N N N K G K N N N N K N N N K N K N K K N N K N K N N N N N N K N N K G N N N N K G N E N E E N N N N N N N N N N N K K K N K K K K K K B E E E E E E K K K K K K K B K N K K K K K G G N K K K K N K N N K K N N K K K K N M M M M M M M M K N K N N K G N 1 1 K K K K 1 N N N K 1 1 1 N N K K N K K K N N K N K N 1 N N N N N K G 1 N N N N K N N N K N 1 N K 1 N N K N K N N 1 N N N 1 N N K G N N N 1 K G 1 3 1 1 1 1 N N N N N N N N N N K K K N K K K K K 1 1 3 3 3 3 1 1 1 1 K K K K K 1 K 1 1 1 1 K K G G 1 1 1 1 1 1 1 1 1 K 1 1 1 1 1 1 K 1 3 3 1 3 B 1 B B

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight * *

General Hospital Outpatient Fee 9.06 0.00 66.07 0.00 0.00 94.95 304.63 0.00 0.00 0.00 60.20 3.96 11.63 3.64 0.00 0.00 0.00 0.00 18.25 0.00 0.00 0.00 0.00 0.00 32.02 36.58 0.00 634.86 15.67 25.54 0.00 0.00 48.91 0.00 1,469.47 0.00 0.00 0.00 0.00 0.00 0.00 0.00 623.74 0.76 0.00 0.00 0.00 0.00 0.00 41.52 0.00 0.00 0.00 111.22 0.00 0.00 0.00 17.42 0.00 0.00 0.00 340.05 0.00 6.77 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 100.33 0.31 0.00 0.00 0.00 0.00 155.09 162.46 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.65 0.87 0.58 0.00 0.79 0.67 0.61 0.79 1.42 0.00 0.00 M01 M01 M01 M01 0.00 0.00 0.00 0.00 14,371.72 75.82 132.36 82.36 127.31 0.00 22.38 0.00 0.00 0.00 0.00 572.06 24.34 69.23 30.64 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 254.29 0.00 0.00 0.00 0.00 0.00 0.00 103.78 0.00 M01 M01 0.00 M01 0.00 0.00 0.00 0.00

Children's Hospital Outpatient Fee 20.66 0.00 150.66 0.00 0.00 216.49 694.59 0.00 0.00 0.00 137.27 9.03 26.52 8.31 0.00 0.00 0.00 0.00 41.62 0.00 0.00 0.00 0.00 0.00 73.00 83.40 0.00 1,447.54 35.72 58.23 0.00 0.00 111.53 0.00 3,350.54 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1,422.18 1.74 0.00 0.00 0.00 0.00 0.00 94.67 0.00 0.00 0.00 253.60 0.00 0.00 0.00 39.72 0.00 0.00 0.00 775.35 0.00 15.44 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 228.75 0.70 0.00 0.00 0.00 0.00 353.62 370.41 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1.49 1.98 1.32 0.00 1.80 1.52 1.39 1.80 3.23 0.00 0.00 M01 M01 M01 M01 0.00 0.00 0.00 0.00 32,768.86 172.87 301.79 187.80 290.28 0.00 51.03 0.00 0.00 0.00 0.00 1,304.36 55.51 157.85 69.87 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 579.81 0.00 0.00 0.00 0.00 0.00 0.00 236.64 0.00 M01 M01 0.00 M01 0.00 0.00 0.00 0.00

Critical PDD Access Update to Hospital ACS Outpatient Fee 23.68 0.00 172.68 0.00 0.00 248.14 796.11 0.00 0.00 0.00 157.33 10.35 30.40 9.53 0.00 0.00 0.00 0.00 47.71 0.00 0.00 0.00 0.00 0.00 83.67 95.59 0.00 1,659.12 40.94 66.74 0.00 0.00 127.83 0.00 3,840.26 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1,630.05 2.00 0.00 0.00 0.00 0.00 0.00 108.51 0.00 0.00 0.00 290.67 0.00 0.00 0.00 45.53 0.00 0.00 0.00 888.68 0.00 17.70 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 262.19 0.80 0.00 0.00 0.00 0.00 405.31 424.55 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1.71 2.27 1.51 0.00 2.06 1.74 1.59 2.06 3.70 0.00 0.00 M01 M01 M01 M01 0.00 0.00 0.00 0.00 37,558.43 198.14 345.90 215.25 332.71 0.00 58.49 0.00 0.00 0.00 0.00 1,495.01 63.62 180.93 80.09 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 664.56 0.00 0.00 0.00 0.00 0.00 0.00 271.22 0.00 M01 M01 0.00 M01 0.00 0.00 0.00 0.00

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule X

J2724 J2725 J2730 J2760 J2765 J2770 J2778 J2780 J2783 J2788 J2790 J2791 J2792 J2794 J2795 J2800 J2805 J2810 J2820 J2850 J2910 J2916 J2920 J2930 J2940 J2941 J2950 J2993 J2995 J2997 J3000 J3010 J3030 J3070 J3100 J3105 J3110 J3120 J3130 J3140 J3150 J3230 J3240 J3243 J3246 J3250 J3260 J3265 J3280 J3285 J3301 J3302 J3303 J3305 J3310 J3315 J3320 J3350 J3355 J3360 J3364 J3365 J3370 J3396 J3400 J3410 J3411 J3415 J3420 J3430 J3465 J3470 J3471 J3472 J3473 J3475 J3480 J3485 J3486 J3487 J3488 J3490 J3520 J3530 J3535 J3570 J3590 J7030 J7040 J7042 J7050 J7060 J7070 J7100 J7110 J7120 J7130 J7187 J7189 J7190 J7191 J7192 J7193 J7194 J7195 J7197 J7198 J7199 J7300 J7302 J7303 J7304 J7306 J7307 J7308 J7310 J7311 J7321 J7322 J7323 J7324 J7330 J7340 J7341 J7342 J7343 J7344 J7346 J7347 J7348 J7349 J7500 J7501 J7502 J7504 J7505 J7506 J7507 J7509 J7510 J7511 J7513 J7515 J7516 J7517 J7518 J7520 J7525 J7599 J7602 J7603 J7604 J7605 J7607 J7608 J7609 J7610

Protein C concentrate Inj protirelin per 250 mcg Pralidoxime chloride inj Phentolaine mesylate inj Metoclopramide hcl injection Quinupristin/dalfopristin Ranibizumab injection Ranitidine hydrochloride inj Rasburicase Rho d immune globulin 50 mcg Rho d immune globulin inj Rhophylac injection Rho(D) immune globulin h, sd Risperidone, long acting Ropivacaine HCl injection Methocarbamol injection Sincalide injection Inj theophylline per 40 MG Sargramostim injection Inj secretin synthetic human Aurothioglucose injeciton Na ferric gluconate complex Methylprednisolone injection Methylprednisolone injection Somatrem injection Somatropin injection Promazine hcl injection Reteplase injection Inj streptokinase /250000 IU Alteplase recombinant Streptomycin injection Fentanyl citrate injeciton Sumatriptan succinate / 6 MG Pentazocine injection Tenecteplase injection Terbutaline sulfate inj Teriparatide injection Testosterone enanthate inj Testosterone enanthate inj Testosterone suspension inj Testosteron propionate inj Chlorpromazine hcl injection Thyrotropin injection Tigecycline injection Tirofiban HCl Trimethobenzamide hcl inj Tobramycin sulfate injection Injection torsemide 10 mg/ml Thiethylperazine maleate inj Treprostinil injection Triamcinolone acetonide inj Triamcinolone diacetate inj Triamcinolone hexacetonl inj Inj trimetrexate glucoronate Perphenazine injeciton Triptorelin pamoate Spectinomycn di-hcl inj Urea injection Urofollitropin, 75 iu Diazepam injection Urokinase 5000 IU injection Urokinase 250,000 IU inj Vancomycin hcl injection Verteporfin injection Triflupromazine hcl inj Hydroxyzine hcl injection Thiamine hcl 100 mg Pyridoxine hcl 100 mg Vitamin b12 injection Vitamin k phytonadione inj Injection, voriconazole Hyaluronidase injection Ovine, up to 999 USP units Ovine, 1000 USP units Hyaluronidase recombinant Inj magnesium sulfate Inj potassium chloride Zidovudine Ziprasidone mesylate Zoledronic acid Reclast injection Drugs unclassified injection Edetate disodium per 150 mg Nasal vaccine inhalation Metered dose inhaler drug Laetrile amygdalin vit B17 Unclassified biologics Normal saline solution infus Normal saline solution infus 5% dextrose/normal saline Normal saline solution infus 5% dextrose/water D5w infusion Dextran 40 infusion Dextran 75 infusion Ringers lactate infusion Hypertonic saline solution Humate-P, inj Factor viia Factor viii Factor VIII (porcine) Factor viii recombinant Factor IX non-recombinant Factor ix complex Factor IX recombinant Antithrombin iii injection Anti-inhibitor Hemophilia clot factor noc Intraut copper contraceptive Levonorgestrel iu contracept Contraceptive vaginal ring Contraceptive hormone patch Levonorgestrel implant sys Etonogestrel implant system Aminolevulinic acid hcl top Ganciclovir long act implant Fluocinolone acetonide implt Hyalgan/supartz inj per dose Synvisc inj per dose Euflexxa inj per dose Orthovisc inj per dose Cultured chondrocytes implnt Metabolic active D/E tissue Non-human, metabolic tissue Metabolically active tissue Nonmetabolic act d/e tissue Nonmetabolic active tissue Injectable human tissue Integra matrix tissue Tissuemend tissue Primatrix tissue Azathioprine oral 50mg Azathioprine parenteral Cyclosporine oral 100 mg Lymphocyte immune globulin Monoclonal antibodies Prednisone oral Tacrolimus oral per 1 MG Methylprednisolone oral Prednisolone oral per 5 mg Antithymocyte globuln rabbit Daclizumab, parenteral Cyclosporine oral 25 mg Cyclosporin parenteral 250mg Mycophenolate mofetil oral Mycophenolic acid Sirolimus, oral Tacrolimus injection Immunosuppressive drug noc Albuterol inh non-comp con Albuterol inh non-comp u d Acetylcysteine comp unit Arformoterol non-comp unit Levalbuterol comp con Acetylcysteine non-comp unit Albuterol comp unit Albuterol comp con

1139 0000 1023 0000 0000 2770 9233 0000 0738 9023 0884 0945 1609 9125 0000 0000 0000 0000 0731 1700 0000 0000 0000 0000 2940 7034 0000 9005 0911 7048 0000 0000 3030 0000 9002 0000 0000 0000 0000 0000 0000 0000 9108 9228 7041 0000 0000 0000 0000 1701 0000 0000 0000 7045 0000 9122 0000 9051 1741 0000 0000 7036 0000 1203 0000 0000 0000 0000 0000 0000 1052 0000 0000 1703 0806 0000 0000 0000 0000 9115 0951 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 1704 1705 0925 0000 0927 0931 0928 0932 0930 0929 0000 0000 0000 0000 0000 0000 0000 7308 0913 9225 0873 0874 0875 0877 0000 1632 0000 9054 1629 9156 9222 1140 9351 1141 0000 0887 0888 0890 7038 0000 0891 0000 0000 9104 1612 0000 0000 9015 9219 9020 9006 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.1897 0.0000 1.3832 0.0000 0.0000 1.9876 6.3771 0.0000 2.3255 0.4256 1.2602 0.0829 0.2435 0.0763 0.0000 0.0000 0.0000 0.0000 0.3821 0.3159 0.0000 0.0000 0.0000 0.0000 0.6702 0.7657 0.0000 13.2899 0.3280 0.5346 0.0000 0.0000 1.0240 0.0000 30.7615 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 13.0571 0.0160 0.1178 0.0000 0.0000 0.0000 0.0000 0.8692 0.0000 0.0000 0.0000 2.3283 0.0000 2.2818 0.0000 0.3647 0.8400 0.0000 0.0000 7.1186 0.0000 0.1418 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0798 0.0000 0.0000 2.1002 0.0064 0.0000 0.0000 0.0000 0.0000 3.2466 3.4008 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0137 0.0182 0.0121 0.0000 0.0165 0.0140 0.0127 0.0165 0.0297 0.0223 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 1.7177 74.1828 300.8525 1.5871 2.7707 1.7242 2.6651 0.0000 0.4685 0.0000 0.5712 0.3105 1.4833 11.9754 0.5096 1.4493 0.6415 0.0000 0.7549 0.0546 5.8640 15.3507 0.0000 0.0601 0.0000 0.0000 5.3233 5.0096 0.0000 0.0000 0.0438 0.0383 0.1179 2.1726 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

SI change 1/1/07 (TR 1155)

X

* * * * * * * *

X SI change 1/1/07 (TR 1155)

X SI change 1/1/07 (TR 1155)

SI change 1/1/07 (TR 1155)

* *

SI change 1/1/07 (TR 1155)

* * * * *

* *

* * *

Added 1/1/07 to book

*

* * * *

SI change 1/1/07 (TR 1155)

X

* *

*

SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) Added 1/1/07 to book

* *

* *

X

* * * * * * * * *

Added 1/1/07 to book Description Change

x

X

X

* * * * * * * * * * * * * * * * * * * *

Added 1/1/07 to book

X X X X X

X

Added 1/1/07 to book X X X

* *

SI change 1/1/07 (TR 1155)

* * * *

SI change 1/1/07 (TR 1155)

Added 1/1/07 to book Description Change Added 1/1/07 to book Added 1/1/07 to book

X X X X X X X X

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

79 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee

Children's Hospital Outpatient Fee

Critical PDD Access Update to Hospital ACS Outpatient Fee

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

J7615 J7620 J7622 J7624 J7626 J7627 J7628 J7629 J7631 J7632 J7633 J7634 J7635 J7636 J7637 J7638 J7639 J7640 J7641 J7642 J7643 J7644 J7645 J7647 J7648 J7649 J7650 J7657 J7658 J7659 J7660 J7667 J7668 J7669 J7670 J7674 J7676 J7680 J7681 J7682 J7683 J7684 J7685 J7699 J7799 J8498 J8499 J8501 J8510 J8515 J8520 J8521 J8530 J8540 J8560 J8565 J8597 J8600 J8610 J8650 J8700 J8999 J9000 J9001 J9010 J9015 J9017 J9020 J9025 J9027 J9031 J9035 J9040 J9041 J9045 J9050 J9055 J9060 J9062 J9065 J9070 J9080 J9090 J9091 J9092 J9093 J9094 J9095 J9096 J9097 J9098 J9100 J9110 J9120 J9130 J9140 J9150 J9151 J9160 J9165 J9170 J9175 J9178 J9181 J9182 J9185 J9190 J9200 J9201 J9202 J9206 J9208 J9209 J9211 J9212 J9213 J9214 J9215 J9216 J9217 J9218 J9219 J9225 J9226 J9230 J9245 J9250 J9260 J9261 J9263 J9264 J9265 J9266 J9268 J9270 J9280 J9290 J9291 J9293 J9300 J9303 J9305 J9310 J9320 J9340 J9350 J9355 J9357 J9360 J9370 J9375 J9380 J9390 J9395 J9600 J9999 K0001 K0002 K0003 K0004 K0005

Levalbuterol comp unit Albuterol non-compounded Beclomethasone inhalatn sol Betamethasone inhalation sol Budesonide inhalation sol Budesonide, compounded Bitolterol mes inhal sol con Bitolterol mes inh sol u d Cromolyn sodium noncomp unit Cromolyn sodium comp unit Budesonide concentrated sol Budesonide comp con Atropine inhal sol con Atropine inhal sol unit dose Dexamethasone inhal sol con Dexamethasone inhal sol u d Dornase alpha non-comp unit Formoterol injection Flunisolide, inhalation sol Glycopyrrolate inhal sol con Glycopyrrolate inhal sol u d Ipratropium brom inh sol u d Ipratropium bromide comp Isoetharine comp con Isoetharine hcl inh sol con Isoetharine hcl inh sol u d Isoetharine comp unit Isoproterenol comp con Isoproterenolhcl inh sol con Isoproterenol hcl inh sol ud Isoproterenol comp unit Metaproterenol comp con Metaproterenol inh sol con Metaproterenol inh sol u d Metaproterenol comp unit Methacholine chloride, neb Pentamidine comp unit dose Terbutaline so4 inh sol con Terbutaline so4 inh sol u d Tobramycin inhalation sol Triamcinolone inh sol con Triamcinolone inh sol u d Tobramycin comp unit Inhalation solution for DME Non-inhalation drug for DME Antiemetic rectal/supp NOS Oral prescrip drug non chemo Oral aprepitant Oral busulfan Cabergoline, oral 0.25mg Capecitabine, oral, 150 mg Capecitabine, oral, 500 mg Cyclophosphamide oral 25 MG Oral dexamethasone Etoposide oral 50 MG Gefitinib oral Antiemetic drug oral NOS Melphalan oral 2 MG Methotrexate oral 2.5 MG Nabilone oral Temozolomide Oral prescription drug chemo Doxorubic hcl 10 MG vl chemo Doxorubicin hcl liposome inj Alemtuzumab injection Aldesleukin/single use vial Arsenic trioxide Asparaginase injection Azacitidine injection Clofarabine injection Bcg live intravesical vac Bevacizumab injection Bleomycin sulfate injection Bortezomib injection Carboplatin injection Carmus bischl nitro inj Cetuximab injection Cisplatin 10 MG injection Cisplatin 50 MG injection Inj cladribine per 1 MG Cyclophosphamide 100 MG inj Cyclophosphamide 200 MG inj Cyclophosphamide 500 MG inj Cyclophosphamide 1.0 grm inj Cyclophosphamide 2.0 grm inj Cyclophosphamide lyophilized Cyclophosphamide lyophilized Cyclophosphamide lyophilized Cyclophosphamide lyophilized Cyclophosphamide lyophilized Cytarabine liposome Cytarabine hcl 100 MG inj Cytarabine hcl 500 MG inj Dactinomycin actinomycin d Dacarbazine 100 mg inj Dacarbazine 200 MG inj Daunorubicin Daunorubicin citrate liposom Denileukin diftitox, 300 mcg Diethylstilbestrol injection Docetaxel Elliotts b solution per ml Inj, epirubicin hcl, 2 mg Etoposide 10 MG inj Etoposide 100 MG inj Fludarabine phosphate inj Fluorouracil injection Floxuridine injection Gemcitabine HCl Goserelin acetate implant Irinotecan injection Ifosfomide injection Mesna injection Idarubicin hcl injection Interferon alfacon-1 Interferon alfa-2a inj Interferon alfa-2b inj Interferon alfa-n3 inj Interferon gamma 1-b inj Leuprolide acetate suspnsion Leuprolide acetate injeciton Leuprolide acetate implant Vantas implant Supprelin LA implant Mechlorethamine hcl inj Inj melphalan hydrochl 50 MG Methotrexate sodium inj Methotrexate sodium inj Nelarabine injection Oxaliplatin Paclitaxel injection Paclitaxel injection Pegaspargase/singl dose vial Pentostatin injection Plicamycin (mithramycin) inj Mitomycin 5 MG inj Mitomycin 20 MG inj Mitomycin 40 MG inj Mitoxantrone hydrochl / 5 MG Gemtuzumab ozogamicin Panitumumab injection Pemetrexed injection Rituximab cancer treatment Streptozocin injection Thiotepa injection Topotecan Trastuzumab Valrubicin, 200 mg Vinblastine sulfate inj Vincristine sulfate 1 MG inj Vincristine sulfate 2 MG inj Vincristine sulfate 5 MG inj Vinorelbine tartrate/10 mg Injection, Fulvestrant Porfimer sodium Chemotherapy drug Standard wheelchair Stnd hemi (low seat) whlchr Lightweight wheelchair High strength ltwt whlchr Ultralightweight wheelchair

M M M M M M M M M M M M M M M M M E M M M M M M M M M M M M M M M M M N M M M M M M M M N B E K K E K K N N K E N K N K K B N K K K K K K K K K K K K K K N N K N N N N N N N N N N K N N K N N K K K N K N K N N K N K K K K K K K K K K K K K K K K K K K N N G K K K K K K K K K K K G K K K K K K K N N N N K K K N Y Y Y Y Y

B 1 1 1 1 1 1 1 1 3 1 B 1 1 1 1 1 1 1 1 1 1 B B 1 1 B B 1 1 B B 1 1 B 1 3 1 1 1 1 1 B 1 1 1 1 K 1 3 1 K 1 N 1 1 1 1 1 K 1 1 N K 1 K K K K K K K K K K K K N N K N N N N N N N N N N 1 N N K N N K K K N K 1 K N N K N K K K K K K K K K K K K K K 1 1 K K K N N G K K K K K K K K K K 1 G K K K K K K 1 N N N N K K K 1 Y Y Y Y Y

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0868 7015 0000 7042 0934 0000 0000 0802 0000 0000 0882 0000 0808 1086 0000 0000 7046 9110 0807 9012 0814 1709 1710 0809 9214 0748 9207 0811 0812 9215 0000 0000 0858 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 1166 0000 0000 0752 0000 0000 0820 0821 1084 0000 0823 0000 1167 0000 0000 0842 0000 0827 0828 0810 0830 0831 0732 0832 0912 0834 0836 0865 0838 9217 0861 7051 1711 1142 0751 0840 0000 0000 0825 1738 1712 0863 0843 0844 1041 0862 0941 0942 0864 9004 9235 9213 0849 0850 0851 0852 1613 9167 0000 0000 0000 0000 0855 9120 0856 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0813 0.0374 0.0000 0.0714 0.2364 0.0000 0.0000 0.4453 0.0000 0.0000 0.0650 0.0000 0.2638 0.1195 0.0000 0.0000 6.4113 8.5650 12.3848 0.5285 0.8519 0.0683 1.8085 1.8250 0.8936 0.5580 0.5357 0.1097 2.3916 0.7743 0.0000 0.0000 0.5236 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 6.4709 0.0000 0.0000 7.6739 0.0000 0.0000 0.3104 0.8714 21.9408 0.0000 4.9675 0.0000 0.1780 0.0000 0.0000 3.6938 0.0000 0.8786 2.0474 2.9838 1.9644 0.5530 0.1229 4.5166 0.0725 0.6500 0.2220 0.1418 4.8146 3.7759 0.1206 26.6695 22.9901 0.0000 2.2464 24.3175 0.0000 0.0000 1.3843 0.1473 0.1380 0.2112 32.6415 28.9062 0.3110 0.2342 0.9371 1.8743 1.6352 37.8682 1.3011 0.7166 7.9106 2.4563 0.6409 13.6151 0.9178 3.4444 0.0000 0.0000 0.0000 0.0000 0.2933 1.2654 39.7590 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

* * * *

*

* * *

* * * * * * * * * * * * * *

*

*

*

* * * *

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3.88 0.00 M01 0.00 11.29 0.00 0.00 0.00 0.00 0.00 0.00 0.00 12.60 0.00 0.00 0.00 306.27 0.00 591.62 25.24 40.69 3.26 86.39 87.18 42.69 26.65 25.59 5.24 114.25 36.99 0.00 0.00 25.01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 366.58 0.00 0.00 14.83 41.62 1,048.11 0.00 237.30 0.00 8.50 0.00 0.00 176.45 0.00 41.97 97.81 142.54 93.84 26.41 5.87 215.76 3.46 31.05 10.60 6.77 229.99 180.37 5.76 0.00 0.00 0.00 107.31 1,161.65 0.00 0.00 66.13 7.03 6.59 10.09 1,559.29 1,380.85 14.86 11.19 44.77 89.53 78.11 0.00 62.15 34.23 377.89 117.34 30.61 650.39 43.84 0.00 0.00 0.00 0.00 0.00 14.01 60.45 1,899.29 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8.86 0.00 M01 0.00 25.75 0.00 0.00 0.00 0.00 0.00 0.00 0.00 28.73 0.00 0.00 0.00 698.32 0.00 1,348.96 57.56 92.79 7.44 196.98 198.78 97.34 60.78 58.35 11.95 260.49 84.34 0.00 0.00 57.03 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 835.84 0.00 0.00 33.81 94.91 2,389.80 0.00 541.06 0.00 19.39 0.00 0.00 402.32 0.00 95.69 223.01 325.00 213.96 60.23 13.39 491.95 7.90 70.80 24.18 15.44 524.40 411.27 13.13 0.00 0.00 0.00 244.67 2,648.66 0.00 0.00 150.78 16.04 15.03 23.00 3,555.32 3,148.46 33.88 25.51 102.07 204.15 178.10 0.00 141.71 78.05 861.63 267.54 69.80 1,482.96 99.97 0.00 0.00 0.00 0.00 0.00 31.94 137.83 4,330.55 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 10.15 0.00 M01 0.00 29.52 0.00 0.00 0.00 0.00 0.00 0.00 0.00 32.93 0.00 0.00 0.00 800.38 0.00 1,546.12 65.97 106.35 8.53 225.77 227.83 111.56 69.66 66.88 13.70 298.57 96.67 0.00 0.00 65.37 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 958.01 0.00 0.00 38.75 108.78 2,739.09 0.00 620.14 0.00 22.23 0.00 0.00 461.13 0.00 109.68 255.60 372.50 245.23 69.03 15.35 563.85 9.06 81.14 27.71 17.70 601.05 471.38 15.05 0.00 0.00 0.00 280.44 3,035.80 0.00 0.00 172.81 18.38 17.23 26.36 4,074.97 3,608.65 38.83 29.24 116.99 233.98 204.13 0.00 162.42 89.45 987.56 306.64 80.01 1,699.71 114.58 0.00 0.00 0.00 0.00 0.00 36.61 157.98 4,963.51 0.00 0.00 0.00 0.00 0.00 0.00

Added 1/1/07 to book

Description Change

Added 1/1/07 to book

Description Change

X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X

Added 1/1/07 to book Added 1/1/07 to book

Added 1/1/07 to book Added 1/1/07 to book

Added 1/1/07 to book Added 1/1/07 to book

Added 1/1/07 to book

Added 1/1/07 to book

X

X SI change 1/1/07 (TR 1155)

X Added 1/1/07 to book

SI change 1/1/07 (TR 1155)

X

X SI change 1/1/07 (TR 1155)

SI change 1/1/07 (TR 1155) X

SI change 1/1/07 (TR 1155)

X X X X X X X X X

X SI change 1/1/07 (TR 1155) X X

*

SI=K effect.01/01/07 add 282N taxonomy if needed. X

* * * * * * * * * * * * * * * * * * * *

Description Change SI change 1/1/07 (TR 1155)

x X

X SI= G effective 07/01/07 X

* * * * * * * * * * * * * * * * * * * *

X X

X SI change 1/1/07 (TR 1155)

X X

* * *

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

80 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y 1 Y

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Children's Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Critical PDD Access Update to Hospital ACS Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

K0006 K0007 K0009 K0010 K0011 K0012 K0014 K0015 K0017 K0018 K0019 K0020 K0037 K0038 K0039 K0040 K0041 K0042 K0043 K0044 K0045 K0046 K0047 K0050 K0051 K0052 K0053 K0056 K0065 K0069 K0070 K0071 K0072 K0073 K0077 K0098 K0105 K0108 K0195 K0455 K0462 K0552

Heavy duty wheelchair Extra heavy duty wheelchair Other manual wheelchair/base Stnd wt frame power whlchr Stnd wt pwr whlchr w control Ltwt portbl power whlchr Other power whlchr base Detach non-adjus hght armrst Detach adjust armrest base Detach adjust armrst upper Arm pad each Fixed adjust armrest pair High mount flip-up footrest Leg strap each Leg strap h style each Adjustable angle footplate Large size footplate each Standard size footplate each Ftrst lower extension tube Ftrst upper hanger bracket Footrest complete assembly Elevat legrst low extension Elevat legrst up hangr brack Ratchet assembly Cam relese assem ftrst/lgrst Swingaway detach footrest Elevate footrest articulate Seat ht <17 or >=21 ltwt wc Spoke protectors Rear whl complete solid tire Rear whl compl pneum tire Front castr compl pneum tire Frnt cstr cmpl sem-pneum tir Caster pin lock each Front caster assem complete Drive belt power wheelchair Iv hanger W/c component-accessory NOS Elevating whlchair leg rests Pump uninterrupted infusion Temporary replacement eqpmnt Supply/ext inf pump syr type

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

K0601 K0602 K0603 K0604 K0605 K0606 K0607 K0608 K0609 K0669 K0730 K0733 K0734 K0735 K0736 K0737

Repl batt silver oxide 1.5 v Repl batt silver oxide 3 v Repl batt alkaline 1.5 v Repl batt lithium 3.6 v Repl batt lithium 4.5 v AED garment w elec analysis Repl batt for AED Repl garment for AED Repl electrode for AED Seat/back cus no sadmerc ver Ctrl dose inh drug deliv sys 12-24hr sealed lead acid Adj skin pro w/c cus wd<22in Adj skin pro wc cus wd>=22in Adj skin pro/pos wc cus<22in Adj skin pro/pos wc cus>=22"

Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y

Y Y Y Y Y 1 Y Y Y 1 1 Y Y Y Y Y

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Added 1/1/07 to book - On Medicare's Addendum B but not in TR 1155

K0738 K0800 K0801 K0802 K0806 K0807 K0808 K0812 K0813 K0814 K0815 K0816 K0820 K0821 K0822 K0823 K0824 K0825 K0826 K0827 K0828 K0829 K0830 K0831 K0835 K0836 K0837 K0838 K0839 K0840 K0841 K0842 K0843 K0848 K0849 K0850 K0851 K0852 K0853 K0854 K0855 K0856 K0857 K0858 K0859 K0860 K0861 K0862 K0863 K0864 K0868 K0869 K0870 K0871 K0877 K0878 K0879 K0880 K0884 K0885 K0886 K0890 K0891 K0898 K0899 L0112 L0120 L0130 L0140 L0150 L0160 L0170 L0172 L0174 L0180 L0190 L0200 L0210 L0220 L0430 L0450 L0452 L0454 L0456 L0458 L0460 L0462 L0464 L0466 L0468 L0470 L0472 L0480 L0482 L0484 L0486 L0488 L0490

Portable gas oxygen system POV group 1 std up to 300 lbs POV group 1 hd 301-450 lbs POV group 1 vhd 451-600 lbs POV group 2 std up to 300lbs POV group 2 hd 301-450 lbs POV group 2 vhd 451-600 lbs Power operated vehicle NOC PWC gp 1 std port seat/back PWC gp 1 std port cap chair PWC gp 1 std seat/back PWC gp 1 std cap chair PWC gp 2 std port seat/back PWC gp 2 std port cap chair PWC gp 2 std seat/back PWC gp 2 std cap chair PWC gp 2 hd seat/back PWC gp 2 hd cap chair PWC gp2 vhd seat/back PWC gp 2 vhd cap chair PWC gp 2 xtra hd seat/back PWC gp 2 xtra hd cap chair PWC gp2 std seat elevate s/b PWC gp2 std seat elevate cap PWC gp2 std sing pow opt s/b PWC gp2 std sing pow opt cap PWC gp 2 hd sing pow opt s/b PWC gp 2 hd sing pow opt cap PWC gp2 vhd sing pow opt s/b PWC gp2 xhd sing pow opt s/b PWC gp2 std mult pow opt s/b PWC gp2 std mult pow opt cap PWC gp2 hd mult pow opt s/b PWC gp 3 std seat/back PWC gp 3 std cap chair PWC gp 3 hd seat/back PWC gp 3 hd cap chair PWC gp 3 vhd seat/back PWC gp 3 vhd cap chair PWC gp 3 xhd seat/back PWC gp 3 xhd cap chair PWC gp3 std sing pow opt s/b PWC gp3 std sing pow opt cap PWC gp3 hd sing pow opt s/b PWC gp3 hd sing pow opt cap PWC gp3 vhd sing pow opt s/b PWC gp3 std mult pow opt s/b PWC gp3 hd mult pow opt s/b PWC gp3 vhd mult pow opt s/b PWC gp3 xhd mult pow opt s/b PWC gp 4 std seat/back PWC gp 4 std cap chair PWC gp 4 hd seat/back PWC gp 4 vhd seat/back PWC gp4 std sing pow opt s/b PWC gp4 std sing pow opt cap PWC gp4 hd sing pow opt s/b PWC gp4 vhd sing pow opt s/b PWC gp4 std mult pow opt s/b PWC gp4 std mult pow opt cap PWC gp4 hd mult pow s/b PWC gp5 ped sing pow opt s/b PWC gp5 ped mult pow opt s/b Power wheelchair NOC Pow mobility dev no sadmerc Cranial cervical orthosis Cerv flexible non-adjustable Flex thermoplastic collar mo Cervical semi-rigid adjustab Cerv semi-rig adj molded chn Cerv semi-rig wire occ/mand Cervical collar molded to pt Cerv col thermplas foam 2 pi Cerv col foam 2 piece w thor Cer post col occ/man sup adj Cerv collar supp adj cerv ba Cerv col supp adj bar & thor Thoracic rib belt Thor rib belt custom fabrica Dewall posture protector TLSO flex prefab thoracic tlso flex custom fab thoraci TLSO flex prefab sacrococ-T9 TLSO flex prefab TLSO 2Mod symphis-xipho pre TLSO2Mod symphysis-stern pre TLSO 3Mod sacro-scap pre TLSO 4Mod sacro-scap pre TLSO rigid frame pre soft ap TLSO rigid frame prefab pelv TLSO rigid frame pre subclav TLSO rigid frame hyperex pre TLSO rigid plastic custom fa TLSO rigid lined custom fab TLSO rigid plastic cust fab TLSO rigidlined cust fab two TLSO rigid lined pre one pie TLSO rigid plastic pre one

Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A

1 Y Y Y Y Y Y 1 Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y 1 1 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 1 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 11/30/07

Description Change

x

Factor Code = N so SI needs to be 1

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

81 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A 3 3 3 3 1 1 3 3 3 3 1 3 3 1 3 1 3 3 3 1 3 1 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 1 3 1 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 1 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee M01 M01 M01 M01 0.00 0.00 M01 M01 M01 M01 0.00 M01 M01 0.00 M01 0.00 M01 M01 M01 0.00 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

Children's Hospital Outpatient Fee M01 M01 M01 M01 0.00 0.00 M01 M01 M01 M01 0.00 M01 M01 0.00 M01 0.00 M01 M01 M01 0.00 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

Critical PDD Access Update to Hospital ACS Outpatient Fee M01 M01 M01 M01 0.00 0.00 M01 M01 M01 M01 0.00 M01 M01 0.00 M01 0.00 M01 M01 M01 0.00 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

L0491 L0492 L0621 L0622 L0623 L0624 L0625 L0626 L0627 L0628 L0629 L0630 L0631 L0632 L0633 L0634 L0635 L0636 L0637 L0638 L0639 L0640 L0700 L0710 L0810 L0820 L0830 L0859 L0861 L0970 L0972 L0974 L0976 L0978 L0980 L0982 L0984 L0999 L1000 L1001 L1005 L1010 L1020 L1025 L1030 L1040 L1050 L1060 L1070 L1080 L1085 L1090 L1100 L1110 L1120 L1200 L1210 L1220 L1230 L1240 L1250 L1260 L1270 L1280 L1290 L1300 L1310 L1499 L1500 L1510 L1520 L1600 L1610 L1620 L1630 L1640 L1650 L1652 L1660 L1680 L1685 L1686 L1690 L1700 L1710 L1720 L1730 L1755 L1800 L1810 L1815 L1820 L1825 L1830 L1831 L1832 L1834 L1836 L1840 L1843 L1844 L1845 L1846 L1847 L1850

TLSO 2 piece rigid shell TLSO 3 piece rigid shell SIO flex pelvisacral prefab SIO flex pelvisacral custom SIO panel prefab SIO panel custom LO flexibl L1-below L5 pre LO sag stays/panels pre-fab LO sagitt rigid panel prefab LO flex w/o rigid stays pre LSO flex w/rigid stays cust LSO post rigid panel pre LSO sag-coro rigid frame pre LSO sag rigid frame cust LSO flexion control prefab LSO flexion control custom LSO sagit rigid panel prefab LSO sagittal rigid panel cus LSO sag-coronal panel prefab LSO sag-coronal panel custom LSO s/c shell/panel prefab LSO s/c shell/panel custom Ctlso a-p-l control molded Ctlso a-p-l control w/ inter Halo cervical into jckt vest Halo cervical into body jack Halo cerv into milwaukee typ MRI compatible system Halo repl liner/interface Tlso corset front Lso corset front Tlso full corset Lso full corset Axillary crutch extension Peroneal straps pair Stocking supp grips set of f Protective body sock each Add to spinal orthosis NOS Ctlso milwauke initial model CTLSO infant immobilizer Tension based scoliosis orth Ctlso axilla sling Kyphosis pad Kyphosis pad floating Lumbar bolster pad Lumbar or lumbar rib pad Sternal pad Thoracic pad Trapezius sling Outrigger Outrigger bil w/ vert extens Lumbar sling Ring flange plastic/leather Ring flange plas/leather mol Covers for upright each Furnsh initial orthosis only Lateral thoracic extension Anterior thoracic extension Milwaukee type superstructur Lumbar derotation pad Anterior asis pad Anterior thoracic derotation Abdominal pad Rib gusset (elastic) each Lateral trochanteric pad Body jacket mold to patient Post-operative body jacket Spinal orthosis NOS Thkao mobility frame Thkao standing frame Thkao swivel walker Abduct hip flex frejka w cvr Abduct hip flex frejka covr Abduct hip flex pavlik harne Abduct control hip semi-flex Pelv band/spread bar thigh c HO abduction hip adjustable HO bi thighcuffs w sprdr bar HO abduction static plastic Pelvic & hip control thigh c Post-op hip abduct custom fa HO post-op hip abduction Combination bilateral HO Leg perthes orth toronto typ Legg perthes orth newington Legg perthes orthosis trilat Legg perthes orth scottish r Legg perthes patten bottom t Knee orthoses elas w stays Ko elastic with joints Elastic with condylar pads Ko elas w/ condyle pads & jo Ko elastic knee cap Ko immobilizer canvas longit Knee orth pos locking joint KO adj jnt pos rigid support Ko w/0 joint rigid molded to Rigid KO wo joints Ko derot ant cruciate custom KO single upright custom fit Ko w/adj jt rot cntrl molded Ko w/ adj flex/ext rotat cus Ko w adj flex/ext rotat mold KO adjustable w air chambers Ko swedish type

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

Added 1/1/07 to book

L1860

Ko supracondylar socket mold

A

3

0000

0.0000

M01

M01

M01

L1900 L1901 L1902 L1904 L1906 L1907 L1910 L1920 L1930 L1932 L1940 L1945 L1950 L1951 L1960 L1970 L1971 L1980 L1990 L2000 L2005 L2010 L2020 L2030 L2034 L2035 L2036 L2037 L2038 L2040 L2050 L2060 L2070 L2080 L2090 L2106 L2108 L2112 L2114 L2116 L2126 L2128 L2132 L2134 L2136 L2180 L2182 L2184 L2186 L2188 L2190 L2192

Afo sprng wir drsflx calf bd Prefab ankle orthosis Afo ankle gauntlet Afo molded ankle gauntlet Afo multiligamentus ankle su AFO supramalleolar custom Afo sing bar clasp attach sh Afo sing upright w/ adjust s Afo plastic Afo rig ant tib prefab TCF/= Afo molded to patient plasti Afo molded plas rig ant tib Afo spiral molded to pt plas AFO spiral prefabricated Afo pos solid ank plastic mo Afo plastic molded w/ankle j AFO w/ankle joint, prefab Afo sing solid stirrup calf Afo doub solid stirrup calf Kafo sing fre stirr thi/calf KAFO sng/dbl mechanical act Kafo sng solid stirrup w/o j Kafo dbl solid stirrup band/ Kafo dbl solid stirrup w/o j KAFO pla sin up w/wo k/a cus KAFO plastic pediatric size Kafo plas doub free knee mol Kafo plas sing free knee mol Kafo w/o joint multi-axis an Hkafo torsion bil rot straps Hkafo torsion cable hip pelv Hkafo torsion ball bearing j Hkafo torsion unilat rot str Hkafo unilat torsion cable Hkafo unilat torsion ball br Afo tib fx cast plaster mold Afo tib fx cast molded to pt Afo tibial fracture soft Afo tib fx semi-rigid Afo tibial fracture rigid Kafo fem fx cast thermoplas Kafo fem fx cast molded to p Kafo femoral fx cast soft Kafo fem fx cast semi-rigid Kafo femoral fx cast rigid Plas shoe insert w ank joint Drop lock knee Limited motion knee joint Adj motion knee jnt lerman t Quadrilateral brim Waist belt Pelvic band & belt thigh fla

A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A

3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 1 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

82 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A E E E E E E A A A A A A A A A A E A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 1 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 1 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 1 1 3 1 3 3 1 1 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 M01 0.00 M01 M01 0.00 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

Children's Hospital Outpatient Fee M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 M01 0.00 M01 M01 0.00 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

Critical PDD Access Update to Hospital ACS Outpatient Fee M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 M01 0.00 M01 M01 0.00 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 11/30/07 11/30/07

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

L2200 L2210 L2220 L2230 L2232 L2240 L2250 L2260 L2265 L2270 L2275 L2280 L2300 L2310 L2320 L2330 L2335 L2340 L2350 L2360 L2370 L2375 L2380 L2385 L2387 L2390 L2395 L2397 L2405 L2415 L2425 L2430 L2492 L2500 L2510 L2520 L2525 L2526 L2530 L2540 L2550 L2570 L2580 L2600 L2610 L2620 L2622 L2624 L2627 L2628 L2630 L2640 L2650 L2660 L2670 L2680 L2750 L2755 L2760 L2768 L2770 L2780 L2785 L2795 L2800 L2810 L2820 L2830 L2840 L2850 L2860 L2999 L3000 L3001 L3002 L3003 L3010 L3020 L3030 L3031 L3040 L3050 L3060 L3070 L3080 L3090 L3100 L3140 L3150 L3160 L3170 L3201 L3202 L3203 L3204 L3206 L3207 L3208 L3209 L3211 L3212 L3213 L3214 L3215 L3216 L3217 L3219 L3221 L3222 L3224 L3225 L3230 L3250 L3251 L3252 L3253 L3254 L3255 L3257 L3260 L3265 L3300 L3310 L3320 L3330 L3332 L3334 L3340 L3350 L3360 L3370 L3380 L3390 L3400 L3410 L3420 L3430 L3440 L3450 L3455 L3460 L3465 L3470 L3480 L3485 L3500 L3510 L3520 L3530 L3540 L3550 L3560 L3570 L3580 L3590 L3595 L3600 L3610 L3620 L3630

Limited ankle motion ea jnt Dorsiflexion assist each joi Dorsi & plantar flex ass/res Split flat caliper stirr & p Rocker bottom, contact AFO Round caliper and plate atta Foot plate molded stirrup at Reinforced solid stirrup Long tongue stirrup Varus/valgus strap padded/li Plastic mod low ext pad/line Molded inner boot Abduction bar jointed adjust Abduction bar-straight Non-molded lacer Lacer molded to patient mode Anterior swing band Pre-tibial shell molded to p Prosthetic type socket molde Extended steel shank Patten bottom Torsion ank & half solid sti Torsion straight knee joint Straight knee joint heavy du Add LE poly knee custom KAFO Offset knee joint each Offset knee joint heavy duty Suspension sleeve lower ext Knee joint drop lock ea jnt Knee joint cam lock each joi Knee disc/dial lock/adj flex Knee jnt ratchet lock ea jnt Knee lift loop drop lock rin Thi/glut/ischia wgt bearing Th/wght bear quad-lat brim m Th/wght bear quad-lat brim c Th/wght bear nar m-l brim mo Th/wght bear nar m-l brim cu Thigh/wght bear lacer non-mo Thigh/wght bear lacer molded Thigh/wght bear high roll cu Hip clevis type 2 posit jnt Pelvic control pelvic sling Hip clevis/thrust bearing fr Hip clevis/thrust bearing lo Pelvic control hip heavy dut Hip joint adjustable flexion Hip adj flex ext abduct cont Plastic mold recipro hip & c Metal frame recipro hip & ca Pelvic control band & belt u Pelvic control band & belt b Pelv & thor control gluteal Thoracic control thoracic ba Thorac cont paraspinal uprig Thorac cont lat support upri Plating chrome/nickel pr bar Carbon graphite lamination Extension per extension per Ortho sidebar disconnect Low ext orthosis per bar/jnt Non-corrosive finish Drop lock retainer each Knee control full kneecap Knee cap medial or lateral p Knee control condylar pad Soft interface below knee se Soft interface above knee se Tibial length sock fx or equ Femoral lgth sock fx or equa Torsion mechanism knee/ankle Lower extremity orthosis NOS Ft insert ucb berkeley shell Foot insert remov molded spe Foot insert plastazote or eq Foot insert silicone gel eac Foot longitudinal arch suppo Foot longitud/metatarsal sup Foot arch support remov prem Foot lamin/prepreg composite Ft arch suprt premold longit Foot arch supp premold metat Foot arch supp longitud/meta Arch suprt att to sho longit Arch supp att to shoe metata Arch supp att to shoe long/m Hallus-valgus nght dynamic s Abduction rotation bar shoe Abduct rotation bar w/o shoe Shoe styled positioning dev Foot plastic heel stabilizer Oxford w supinat/pronat inf Oxford w/ supinat/pronator c Oxford w/ supinator/pronator Hightop w/ supp/pronator inf Hightop w/ supp/pronator chi Hightop w/ supp/pronator jun Surgical boot each infant Surgical boot each child Surgical boot each junior Benesch boot pair infant Benesch boot pair child Benesch boot pair junior Orthopedic ftwear ladies oxf Orthoped ladies shoes dpth i Ladies shoes hightop depth i Orthopedic mens shoes oxford Orthopedic mens shoes dpth i Mens shoes hightop depth inl Woman's shoe oxford brace Man's shoe oxford brace Custom shoes depth inlay Custom mold shoe remov prost Shoe molded to pt silicone s Shoe molded plastazote cust Shoe molded plastazote cust Orth foot non-stndard size/w Orth foot non-standard size/ Orth foot add charge split s Ambulatory surgical boot eac Plastazote sandal each Sho lift taper to metatarsal Shoe lift elev heel/sole neo Shoe lift elev heel/sole cor Lifts elevation metal extens Shoe lifts tapered to one-ha Shoe lifts elevation heel /i Shoe wedge sach Shoe heel wedge Shoe sole wedge outside sole Shoe sole wedge between sole Shoe clubfoot wedge Shoe outflare wedge Shoe metatarsal bar wedge ro Shoe metatarsal bar between Full sole/heel wedge btween Sho heel count plast reinfor Heel leather reinforced Shoe heel sach cushion type Shoe heel new leather standa Shoe heel new rubber standar Shoe heel thomas with wedge Shoe heel thomas extend to b Shoe heel pad & depress for Shoe heel pad removable for Ortho shoe add leather insol Orthopedic shoe add rub insl O shoe add felt w leath insl Ortho shoe add half sole Ortho shoe add full sole O shoe add standard toe tap O shoe add horseshoe toe tap O shoe add instep extension O shoe add instep velcro clo O shoe convert to sof counte Ortho shoe add march bar Trans shoe calip plate exist Trans shoe caliper plate new Trans shoe solid stirrup exi Trans shoe solid stirrup new

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

Factor Code =N so SI needs to be 1 Factor Code =N so SI needs to be 1 Factor Code =N so SI needs to be 1

X X

11/30/07

X X

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

83 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only A A A A A A A A A A A 3 1 3 3 3 3 3 1 1 1 3

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee M01 0.00 M01 M01 M01 M01 M01 0.00 0.00 0.00 M01

Children's Hospital Outpatient Fee M01 0.00 M01 M01 M01 M01 M01 0.00 0.00 0.00 M01

Critical PDD Access Update to Hospital ACS Outpatient Fee M01 0.00 M01 M01 M01 M01 M01 0.00 0.00 0.00 M01

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

L3640 L3649 L3650 L3651 L3652 L3660 L3670 L3671 L3672 L3673 L3675

Shoe dennis browne splint bo Orthopedic shoe modifica NOS Shlder fig 8 abduct restrain Prefab shoulder orthosis Prefab dbl shoulder orthosis Abduct restrainer canvas&web Acromio/clavicular canvas&we SO cap design w/o jnts CF SO airplane w/o jnts CF SO airplane w/joint CF Canvas vest SO

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

L3677 L3700 L3701 L3702 L3710 L3720 L3730 L3740 L3760 L3762

SO hard plastic stabilizer Elbow orthoses elas w stays Prefab elbow orthosis EO w/o joints CF Elbow elastic with metal joi Forearm/arm cuffs free motio Forearm/arm cuffs ext/flex a Cuffs adj lock w/ active con EO withjoint, Prefabricated Rigid EO wo joints

E A A A A A A A A A

1 3 3 3 3 3 3 3 3 3

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01

0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01

0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01

11/30/07

Si=1 effective 12/01/07 ON HOLD UNTIL NOTICE FROM ANGIE

L3763

EWHO rigid w/o jnts CF

A

3

0000

0.0000

M01

M01

M01

11/30/07

L3764

EWHO w/joint(s) CF

A

3

0000

0.0000

M01

M01

M01

11/30/07

L3765

EWHFO rigid w/o jnts CF

A

3

0000

0.0000

M01

M01

M01

11/30/07

L3766

EWHFO w/joint(s) CF

A

3

0000

0.0000

M01

M01

M01

11/30/07

SI = 3 effective 12/01/07 ON HOLD UNTIL NOTICE FROM ANGIE SI = 3 effective 12/01/07 ON HOLD UNTIL NOTICE FROM ANGIE SI = 3 effective 12/01/07 ON HOLD UNTIL NOTICE FROM ANGIE SI = 3 effective 12/01/07 ON HOLD UNTIL NOTICE FROM ANGIE

L3806 L3807 L3808

WHFO w/joint(s) custom fab WHFO,no joint, prefabricated WHFO, rigid w/o joints

A A A

3 3 3

0000 0000 0000

0.0000 0.0000 0.0000

M01 M01 M01

M01 M01 M01

M01 M01 M01

Added 1/1/07 to book Added 1/1/07 to book

L3890 L3900 L3901 L3904 L3905 L3906 L3908 L3909 L3911 L3912 L3913 L3915 L3917 L3919 L3921 L3923 L3925 L3927 L3929 L3931

Torsion mechanism wrist/elbo Hinge extension/flex wrist/f Hinge ext/flex wrist finger Whfo electric custom fitted WHO w/nontorsion jnt(s) CF Wrist gauntlet molded to pt Wrist cock-up non-molded Prefab wrist orthosis Prefab hand finger orthosis Flex glove w/elastic finger HFO w/o joints CF WHO w nontor jnt(s) prefab Prefab metacarpl fx orthosis HO w/o joints CF HFO w/joint(s) CF HFO, no joint, prefabricated FO pip/dip with joint/spring FO pip/dip w/o joint/spring HFO nontorsion joint, prefab WHFO nontorsion joint prefab

B A A A A A A A A A A A A A A A A A A A

B 3 3 3 1 3 3 3 3 3 1 1 3 1 1 3 3 1 3 3

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

0.00 M01 M01 M01 0.00 M01 M01 M01 M01 M01 0.00 0.00 M01 0.00 0.00 M01 M01 0.00 M01 M01

0.00 M01 M01 M01 0.00 M01 M01 M01 M01 M01 0.00 0.00 M01 0.00 0.00 M01 M01 0.00 M01 M01

0.00 M01 M01 M01 0.00 M01 M01 M01 M01 M01 0.00 0.00 M01 0.00 0.00 M01 M01 0.00 M01 M01 Verified with Angies Sched. Per Angie Not Allowed Verified with Angies Sched. Verified with Angies Sched. SI = 3 effective 12/01/07 ON HOLD UNTIL NOTICE FROM ANGIE SI = 3 effective 12/01/07 ON HOLD UNTIL NOTICE FROM ANGIE X X X X

Added 1/1/07 to book

L3933

FO w/o joints CF

A

3

0000

0.0000

M01

M01

M01

11/30/07

L3935

FO nontorsion joint CF

A

3

0000

0.0000

M01

M01

M01

11/30/07

L3956 L3960

Add joint upper ext orthosis Sewho airplan desig abdu pos

A A

3 3

0000 0000

0.0000 0.0000

M01 M01

M01 M01

M01 M01 SI = 3 effective 12/01/07 ON HOLD UNTIL NOTICE FROM ANGIE

L3961 L3962 L3964 L3965 L3966

SEWHO cap design w/o jnts CF Sewho erbs palsey design abd Seo mobile arm sup att to wc Arm supp att to wc rancho ty Mobile arm supports reclinin

A A Y Y Y

3 3 Y Y Y

0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000

M01 M01 0.00 0.00 0.00

M01 M01 0.00 0.00 0.00

M01 M01 0.00 0.00 0.00

11/30/07

L3967 L3968 L3969 L3970

SEWHO airplane w/o jnts CF Friction dampening arm supp Monosuspension arm/hand supp Elevat proximal arm support

A Y Y Y

3 Y Y Y

0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000

M01 0.00 0.00 0.00

M01 0.00 0.00 0.00

M01 0.00 0.00 0.00

11/30/07

SI = 3 effective 12/01/07 ON HOLD UNTIL NOTICE FROM ANGIE

L3971 L3972

SEWHO cap design w/jnt(s) CF Offset/lat rocker arm w/ ela

A Y

3 Y

0000 0000

0.0000 0.0000

M01 0.00

M01 0.00

M01 0.00

11/30/07

SI = 3 effective 12/01/07 ON HOLD UNTIL NOTICE FROM ANGIE SI = 3 effective 12/01/07 ON HOLD UNTIL NOTICE FROM ANGIE SI = 3 effective 12/01/07 ON HOLD UNTIL NOTICE FROM ANGIE SI = 3 effective 12/01/07 ON HOLD UNTIL NOTICE FROM ANGIE SI = 3 effective 12/01/07 ON HOLD UNTIL NOTICE FROM ANGIE SI = 3 effective 12/01/07 ON HOLD UNTIL NOTICE FROM ANGIE

L3973 L3974

SEWHO airplane w/jnt(s) CF Mobile arm support supinator

A Y

3 Y

0000 0000

0.0000 0.0000

M01 0.00

M01 0.00

M01 0.00

11/30/07

L3975

SEWHFO cap design w/o jnt CF

A

3

0000

0.0000

M01

M01

M01

11/30/07

L3976

SEWHFO airplane w/o jnts CF

A

3

0000

0.0000

M01

M01

M01

11/30/07

L3977

SEWHFO cap desgn w/jnt(s) CF

A

3

0000

0.0000

M01

M01

M01

11/30/07

L3978 L3980 L3982 L3984

SEWHFO airplane w/jnt(s) CF Upp ext fx orthosis humeral Upper ext fx orthosis rad/ul Upper ext fx orthosis wrist

A A A A

3 3 3 3

0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000

M01 M01 M01 M01

M01 M01 M01 M01

M01 M01 M01 M01

11/30/07

L3995 L3999 L4000 L4002 L4010 L4020 L4030 L4040 L4045 L4050 L4055 L4060 L4070 L4080 L4090 L4100 L4110 L4130 L4205 L4210 L4350 L4360 L4370

Sock fracture or equal each Upper limb orthosis NOS Repl girdle milwaukee orth Replace strap, any orthosis Replace trilateral socket br Replace quadlat socket brim Replace socket brim cust fit Replace molded thigh lacer Replace non-molded thigh lac Replace molded calf lacer Replace non-molded calf lace Replace high roll cuff Replace prox & dist upright Repl met band kafo-afo prox Repl met band kafo-afo calf/ Repl leath cuff kafo prox th Repl leath cuff kafo-afo cal Replace pretibial shell Ortho dvc repair per 15 min Orth dev repair/repl minor p Ankle control orthosi prefab Pneumati walking boot prefab Pneumatic full leg splint

A A A A A A A A A A A A A A A A A A A A A A A

3 1 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

84 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

Children's Hospital Outpatient Fee M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

Critical PDD Access Update to Hospital ACS Outpatient Fee M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

L4380 L4386 L4392 L4394 L4396 L4398 L5000 L5010 L5020 L5050 L5060 L5100 L5105 L5150 L5160 L5200 L5210 L5220 L5230 L5250 L5270 L5280 L5301 L5311 L5321 L5331 L5341 L5400 L5410 L5420 L5430 L5450 L5460 L5500 L5505 L5510 L5520 L5530 L5535 L5540 L5560 L5570 L5580 L5585 L5590 L5595 L5600 L5610 L5611 L5613 L5614 L5616 L5617 L5618 L5620 L5622 L5624 L5626 L5628 L5629 L5630 L5631 L5632 L5634 L5636 L5637 L5638 L5639 L5640 L5642 L5643 L5644 L5645 L5646 L5647 L5648 L5649 L5650 L5651 L5652 L5653 L5654 L5655 L5656 L5658 L5661 L5665 L5666 L5668 L5670 L5671 L5672 L5673 L5676 L5677 L5678 L5679 L5680 L5681 L5682 L5683 L5684 L5685 L5686 L5688 L5690 L5692 L5694 L5695 L5696 L5697 L5698 L5699 L5700 L5701 L5702 L5703 L5704 L5705 L5706 L5707 L5710 L5711 L5712 L5714 L5716 L5718 L5722 L5724 L5726 L5728 L5780 L5781 L5782 L5785 L5790 L5795 L5810 L5811 L5812 L5814 L5816 L5818 L5822 L5824 L5826 L5828 L5830 L5840 L5845 L5848 L5850 L5855 L5856 L5857 L5858 L5910 L5920 L5925 L5930 L5940 L5950 L5960

Pneumatic knee splint Non-pneum walk boot prefab Replace AFO soft interface Replace foot drop spint Static AFO Foot drop splint recumbent Sho insert w arch toe filler Mold socket ank hgt w/ toe f Tibial tubercle hgt w/ toe f Ank symes mold sckt sach ft Symes met fr leath socket ar Molded socket shin sach foot Plast socket jts/thgh lacer Mold sckt ext knee shin sach Mold socket bent knee shin s Kne sing axis fric shin sach No knee/ankle joints w/ ft b No knee joint with artic ali Fem focal defic constant fri Hip canad sing axi cons fric Tilt table locking hip sing Hemipelvect canad sing axis BK mold socket SACH ft endo Knee disart, SACH ft, endo AK open end SACH Hip disart canadian SACH ft Hemipelvectomy canadian SACH Postop dress & 1 cast chg bk Postop dsg bk ea add cast ch Postop dsg & 1 cast chg ak/d Postop dsg ak ea add cast ch Postop app non-wgt bear dsg Postop app non-wgt bear dsg Init bk ptb plaster direct Init ak ischal plstr direct Prep BK ptb plaster molded Perp BK ptb thermopls direct Prep BK ptb thermopls molded Prep BK ptb open end socket Prep BK ptb laminated socket Prep AK ischial plast molded Prep AK ischial direct form Prep AK ischial thermo mold Prep AK ischial open end Prep AK ischial laminated Hip disartic sach thermopls Hip disart sach laminat mold Above knee hydracadence Ak 4 bar link w/fric swing Ak 4 bar ling w/hydraul swig 4-bar link above knee w/swng Ak univ multiplex sys frict AK/BK self-aligning unit ea Test socket symes Test socket below knee Test socket knee disarticula Test socket above knee Test socket hip disarticulat Test socket hemipelvectomy Below knee acrylic socket Syme typ expandabl wall sckt Ak/knee disartic acrylic soc Symes type ptb brim design s Symes type poster opening so Symes type medial opening so Below knee total contact Below knee leather socket Below knee wood socket Knee disarticulat leather so Above knee leather socket Hip flex inner socket ext fr Above knee wood socket Bk flex inner socket ext fra Below knee cushion socket Below knee suction socket Above knee cushion socket Isch containmt/narrow m-l so Tot contact ak/knee disart s Ak flex inner socket ext fra Suction susp ak/knee disart Knee disart expand wall sock Socket insert symes Socket insert below knee Socket insert knee articulat Socket insert above knee Multi-durometer symes Multi-durometer below knee Below knee cuff suspension Socket insert w/o lock lower Bk molded supracondylar susp BK/AK locking mechanism Bk removable medial brim sus Socket insert w lock mech Bk knee joints single axis p Bk knee joints polycentric p Bk joint covers pair Socket insert w/o lock mech Bk thigh lacer non-molded Intl custm cong/latyp insert Bk thigh lacer glut/ischia m Initial custom socket insert Bk fork strap Below knee sus/seal sleeve Bk back check Bk waist belt webbing Bk waist belt padded and lin Ak pelvic control belt light Ak pelvic control belt pad/l Ak sleeve susp neoprene/equa Ak/knee disartic pelvic join Ak/knee disartic pelvic band Ak/knee disartic silesian ba Shoulder harness Replace socket below knee Replace socket above knee Replace socket hip Symes ankle w/o (SACH) foot Custom shape cover BK Custom shape cover AK Custom shape cvr knee disart Custom shape cvr hip disart Kne-shin exo sng axi mnl loc Knee-shin exo mnl lock ultra Knee-shin exo frict swg & st Knee-shin exo variable frict Knee-shin exo mech stance ph Knee-shin exo frct swg & sta Knee-shin pneum swg frct exo Knee-shin exo fluid swing ph Knee-shin ext jnts fld swg e Knee-shin fluid swg & stance Knee-shin pneum/hydra pneum Lower limb pros vacuum pump HD low limb pros vacuum pump Exoskeletal bk ultralt mater Exoskeletal ak ultra-light m Exoskel hip ultra-light mate Endoskel knee-shin mnl lock Endo knee-shin mnl lck ultra Endo knee-shin frct swg & st Endo knee-shin hydral swg ph Endo knee-shin polyc mch sta Endo knee-shin frct swg & st Endo knee-shin pneum swg frc Endo knee-shin fluid swing p Miniature knee joint Endo knee-shin fluid swg/sta Endo knee-shin pneum/swg pha Multi-axial knee/shin system Knee-shin sys stance flexion Knee-shin sys hydraul stance Endo ak/hip knee extens assi Mech hip extension assist Elec knee-shin swing/stance Elec knee-shin swing only Stance phase only Endo below knee alignable sy Endo ak/hip alignable system Above knee manual lock High activity knee frame Endo bk ultra-light material Endo ak ultra-light material Endo hip ultra-light materia

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

85 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 1 1 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

Children's Hospital Outpatient Fee M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

Critical PDD Access Update to Hospital ACS Outpatient Fee M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

L5962 L5964 L5966 L5968 L5970 L5971 L5972 L5974 L5975 L5976 L5978 L5979 L5980 L5981 L5982 L5984 L5985 L5986 L5987 L5988 L5990 L5993 L5994 L5995 L5999 L6000 L6010 L6020 L6025 L6050 L6055 L6100 L6110 L6120 L6130 L6200 L6205 L6250 L6300 L6310 L6320 L6350 L6360 L6370 L6380 L6382 L6384 L6386 L6388 L6400 L6450 L6500 L6550 L6570 L6580 L6582 L6584 L6586 L6588 L6590 L6600 L6605 L6610 L6611 L6615 L6616 L6620

Below knee flex cover system Above knee flex cover system Hip flexible cover system Multiaxial ankle w dorsiflex Foot external keel sach foot SACH foot, replacement Flexible keel foot Foot single axis ankle/foot Combo ankle/foot prosthesis Energy storing foot Ft prosth multiaxial ankl/ft Multi-axial ankle/ft prosth Flex foot system Flex-walk sys low ext prosth Exoskeletal axial rotation u Endoskeletal axial rotation Lwr ext dynamic prosth pylon Multi-axial rotation unit Shank ft w vert load pylon Vertical shock reducing pylo User adjustable heel height Heavy duty feature, foot Heavy duty feature, knee Lower ext pros heavyduty fea Lowr extremity prosthes NOS Par hand robin-aids thum rem Hand robin-aids little/ring Part hand robin-aids no fing Part hand disart myoelectric Wrst MLd sck flx hng tri pad Wrst mold sock w/exp interfa Elb mold sock flex hinge pad Elbow mold sock suspension t Elbow mold doub splt soc ste Elbow stump activated lock h Elbow mold outsid lock hinge Elbow molded w/ expand inter Elbow inter loc elbow forarm Shlder disart int lock elbow Shoulder passive restor comp Shoulder passive restor cap Thoracic intern lock elbow Thoracic passive restor comp Thoracic passive restor cap Postop dsg cast chg wrst/elb Postop dsg cast chg elb dis/ Postop dsg cast chg shlder/t Postop ea cast chg & realign Postop applicat rigid dsg on Below elbow prosth tiss shap Elb disart prosth tiss shap Above elbow prosth tiss shap Shldr disar prosth tiss shap Scap thorac prosth tiss shap Wrist/elbow bowden cable mol Wrist/elbow bowden cbl dir f Elbow fair lead cable molded Elbow fair lead cable dir fo Shdr fair lead cable molded Shdr fair lead cable direct Polycentric hinge pair Single pivot hinge pair Flexible metal hinge pair Additional switch, ext power Disconnect locking wrist uni Disconnect insert locking wr Flexion/extension wrist unit

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

Added 1/1/07 to book Added 1/1/07 to book

Added 1/1/07 to book

L6621 L6623 L6624 L6625 L6628 L6629 L6630 L6632 L6635 L6637 L6638 L6639 L6640 L6641 L6642 L6645 L6646 L6647 L6648 L6650 L6655 L6660 L6665 L6670 L6672 L6675 L6676

Flex/ext wrist w/wo friction Spring-ass rot wrst w/ latch Flex/ext/rotation wrist unit Rotation wrst w/ cable lock Quick disconn hook adapter o Lamination collar w/ couplin Stainless steel any wrist Latex suspension sleeve each Lift assist for elbow Nudge control elbow lock Elec lock on manual pw elbow Heavy duty elbow feature Shoulder abduction joint pai Excursion amplifier pulley t Excursion amplifier lever ty Shoulder flexion-abduction j Multipo locking shoulder jnt Shoulder lock actuator Ext pwrd shlder lock/unlock Shoulder universal joint Standard control cable extra Heavy duty control cable Teflon or equal cable lining Hook to hand cable adapter Harness chest/shlder saddle Harness figure of 8 sing con Harness figure of 8 dual con

A A A A A A A A A A A A A A A A A A A A A A A A A A A

3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

11/30/07

SI = 3 effective 12/01/07 ON HOLD UNTIL NOTICE FROM ANGIE Added 1/1/07 to book

Added 1/1/07 to book

L6677 L6680 L6682 L6684 L6686 L6687 L6688 L6689 L6690 L6691 L6692 L6693 L6694 L6695 L6696 L6697 L6698 L6703 L6704 L6706 L6707 L6708 L6709 L6805 L6810 L6881 L6882 L6883 L6884 L6885 L6890 L6895 L6900 L6905 L6910 L6915 L6920 L6925 L6930 L6935 L6940 L6945 L6950 L6955 L6960 L6965 L6970 L6975 L7007 L7008 L7009 L7040 L7045 L7170 L7180 L7181 L7185 L7186 L7190 L7191 L7260 L7261 L7266 L7272 L7274

UE triple control harness Test sock wrist disart/bel e Test sock elbw disart/above Test socket shldr disart/tho Suction socket Frame typ socket bel elbow/w Frame typ sock above elb/dis Frame typ socket shoulder di Frame typ sock interscap-tho Removable insert each Silicone gel insert or equal Lockingelbow forearm cntrbal Elbow socket ins use w/lock Elbow socket ins use w/o lck Cus elbo skt in for con/atyp Cus elbo skt in not con/atyp Below/above elbow lock mech Term dev, passive hand mitt Term dev, sport/rec/work att Term dev mech hook vol open Term dev mech hook vol close Term dev mech hand vol open Term dev mech hand vol close Modifier wrist flexion unit Pincher tool otto bock or eq Autograsp feature ul term dv Microprocessor control uplmb Replc sockt below e/w disa Replc sockt above elbow disa Replc sockt shldr dis/interc Prefab glove for term device Custom glove for term device Hand restorat thumb/1 finger Hand restoration multiple fi Hand restoration no fingers Hand restoration replacmnt g Wrist disarticul switch ctrl Wrist disart myoelectronic c Below elbow switch control Below elbow myoelectronic ct Elbow disarticulation switch Elbow disart myoelectronic c Above elbow switch control Above elbow myoelectronic ct Shldr disartic switch contro Shldr disartic myoelectronic Interscapular-thor switch ct Interscap-thor myoelectronic Adult electric hand Pediatric electric hand Adult electric hook Prehensile actuator hosmer s Electron hook child michigan Electronic elbow hosmer swit Electronic elbow sequential Electronic elbo simultaneous Electron elbow adolescent sw Electron elbow child switch Elbow adolescent myoelectron Elbow child myoelectronic ct Electron wrist rotator otto Electron wrist rotator utah Servo control steeper or equ Analogue control unb or equa Proportional ctl 12 volt uta

A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A

3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 1 3 1 3 3 3 3 3 3 1 1 1 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 0.00 M01 M01 M01 M01 M01 M01 0.00 0.00 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 0.00 M01 M01 M01 M01 M01 M01 0.00 0.00 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 0.00 M01 M01 M01 M01 M01 M01 0.00 0.00 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

11/30/07

SI = 3 effective 12/01/07 ON HOLD UNTIL NOTICE FROM ANGIE

Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book

Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

86 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only A A A A A A 3 3 3 3 3 3

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee M01 M01 M01 M01 M01 M01

Children's Hospital Outpatient Fee M01 M01 M01 M01 M01 M01

Critical PDD Access Update to Hospital ACS Outpatient Fee M01 M01 M01 M01 M01 M01

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

L7360 L7362 L7364 L7366 L7367 L7368

Six volt bat otto bock/eq ea Battery chrgr six volt otto Twelve volt battery utah/equ Battery chrgr 12 volt utah/e Replacemnt lithium ionbatter Lithium ion battery charger

0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

L7400

Add UE prost be/wd, ultlite

A

3

0000

0.0000

M01

M01

M01

11/30/07

L7401

Add UE prost a/e ultlite mat

A

3

0000

0.0000

M01

M01

M01

11/30/07

L7402

Add UE prost s/d ultlite mat

A

3

0000

0.0000

M01

M01

M01

11/30/07

L7403

Add UE prost b/e acrylic

A

3

0000

0.0000

M01

M01

M01

11/30/07

L7404

Add UE prost a/e acrylic

A

3

0000

0.0000

M01

M01

M01

11/30/07

L7405 L7499 L7500 L7510 L7520 L7600 L7611 L7612 L7613 L7614 L7621 L7622 L7900 L8000 L8001 L8002 L8010 L8015 L8020 L8030 L8035 L8039 L8040 L8041 L8042 L8043 L8044 L8045 L8046 L8047 L8048 L8049 L8300 L8310 L8320 L8330 L8400 L8410 L8415 L8417 L8420 L8430 L8435 L8440 L8460 L8465 L8470 L8480 L8485 L8499 L8500 L8501 L8505 L8507 L8509 L8510 L8511 L8512 L8513 L8514 L8515 L8600 L8603 L8606 L8609 L8610 L8612 L8613 L8614 L8615 L8616 L8617 L8618 L8619 L8621 L8622 L8623 L8624 L8630 L8631 L8641 L8642 L8658 L8659 L8670 L8680 L8681 L8682 L8683 L8684 L8685 L8686 L8687 L8688 L8689 L8690 L8691 L8695 L8699 L9900 M0064 M0075 M0076 M0100 M0300 M0301 P2028 P2029 P2031 P2033 P2038 P3000 P3001 P7001 P9010 P9011 P9012 P9016 P9017 P9019 P9020 P9021 P9022 P9023 P9031 P9032

Add UE prost s/d acrylic Upper extremity prosthes NOS Prosthetic dvc repair hourly Prosthetic device repair rep Repair prosthesis per 15 min Prosthetic donning sleeve Ped term dev, hook, vol open Ped term dev, hook, vol clos Ped term dev, hand, vol open Ped term dev, hand, vol clos Hook/hand, hvy dty, vol open Hook/hand, hvy dty, vol clos Male vacuum erection system Mastectomy bra Breast prosthesis bra & form Brst prsth bra & bilat form Mastectomy sleeve Ext breastprosthesis garment Mastectomy form Breast prosthesis silicone/e Custom breast prosthesis Breast prosthesis NOS Nasal prosthesis Midfacial prosthesis Orbital prosthesis Upper facial prosthesis Hemi-facial prosthesis Auricular prosthesis Partial facial prosthesis Nasal septal prosthesis Unspec maxillofacial prosth Repair maxillofacial prosth Truss single w/ standard pad Truss double w/ standard pad Truss addition to std pad wa Truss add to std pad scrotal Sheath below knee Sheath above knee Sheath upper limb Pros sheath/sock w gel cushn Prosthetic sock multi ply BK Prosthetic sock multi ply AK Pros sock multi ply upper lm Shrinker below knee Shrinker above knee Shrinker upper limb Pros sock single ply BK Pros sock single ply AK Pros sock single ply upper l Unlisted misc prosthetic ser Artificial larynx Tracheostomy speaking valve Artificial larynx, accessory Trach-esoph voice pros pt in Trach-esoph voice pros md in Voice amplifier Indwelling trach insert Gel cap for trach voice pros Trach pros cleaning device Repl trach puncture dilator Gel cap app device for trach Implant breast silicone/eq Collagen imp urinary 2.5 ml Synthetic implnt urinary 1ml Artificial cornea Ocular implant Aqueous shunt prosthesis Ossicular implant Cochlear device/system Coch implant headset replace Coch implant microphone repl Coch implant trans coil repl Coch implant tran cable repl Replace cochlear processor Repl zinc air battery Repl alkaline battery Lith ion batt CID,non-earlvl Lith ion batt CID, ear level Metacarpophalangeal implant MCP joint repl 2 pc or more Metatarsal joint implant Hallux implant Interphalangeal joint spacer Interphalangeal joint repl Vascular graft, synthetic Implt neurostim elctr each Pt prgrm for implt neurostim Implt neurostim radiofq rec Radiofq trsmtr for implt neu Radiof trsmtr implt scrl neu Implt nrostm pls gen sng rec Implt nrostm pls gen sng non Implt nrostm pls gen dua rec Implt nrostm pls gen dua non External recharging system Aud osseo dev, int/ext comp Aud osseo dev, int/ext comp External recharg sys extern Prosthetic implant NOS O&P supply/accessory/service Visit for drug monitoring Cellular therapy Prolotherapy Intragastric hypothermia IV chelationtherapy Fabric wrapping of aneurysm Cephalin floculation test Congo red blood test Hair analysis Blood thymol turbidity Blood mucoprotein Screen pap by tech w md supv Screening pap smear by phys Culture bacterial urine Whole blood for transfusion Blood split unit Cryoprecipitate each unit RBC leukocytes reduced Plasma 1 donor frz w/in 8 hr Platelets, each unit Plaelet rich plasma unit Red blood cells unit Washed red blood cells unit Frozen plasma, pooled, sd Platelets leukocytes reduced Platelets, irradiated

A A A A A E A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A N N N N N N N N A A A A A A A A A N N N N N N N B A N A A B B B B A H A A N A Q E E E E E A A E A A A B E K K K K K K K K K K K K

3 1 3 3 3 1 1 1 1 1 1 1 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 1 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 1 3 3 3 3 3 3 3 3 3 3 3 N N 1 N N N N N 3 3 3 3 3 3 3 3 3 N 1 N N N 1 N B 3 N 3 3 B B B B 3 H 3 3 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 K K K K K K K K K K K K

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 1032 0000 0000 0000 0000 0606 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0950 0967 0952 0954 9508 0957 0958 0959 0960 0949 1013 9500

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 1.3226 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 4.0011 2.3409 0.6474 2.9069 1.0524 1.0911 5.7070 2.0356 4.3494 1.1598 1.6879 1.9110

M01 0.00 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 M01 M01 0.00 0.00 0.00 0.00 M01

M01 0.00 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 M01 M01 0.00 0.00 0.00 0.00 M01

M01 0.00 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 0.00 M01 M01 0.00 0.00 0.00 0.00 M01

11/30/07

SI = 3 effective 12/01/07 ON HOLD UNTIL NOTICE FROM ANGIE SI = 3 effective 12/01/07 ON HOLD UNTIL NOTICE FROM ANGIE SI = 3 effective 12/01/07 ON HOLD UNTIL NOTICE FROM ANGIE SI = 3 effective 12/01/07 ON HOLD UNTIL NOTICE FROM ANGIE SI = 3 effective 12/01/07 ON HOLD UNTIL NOTICE FROM ANGIE SI = 3 effective 12/01/07 ON HOLD UNTIL NOTICE FROM ANGIE

Per Angie Not Allowed Per Angie Not Allowed Per Angie Not Allowed Per Angie Not Allowed Per Angie Not Allowed Per Angie Not Allowed

X X X X X X X

APC by Report APC by Report APC by Report M01 M01 M01 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 191.13 111.82 30.93 138.86 50.27 52.12 272.62 97.24 207.77 55.40 80.63 91.29 435.80 254.97 70.51 316.62 114.63 118.84 621.61 221.72 473.74 126.33 183.85 208.15 499.50 292.24 80.82 362.90 131.38 136.21 712.46 254.12 542.98 144.79 210.72 238.57

Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book

X

change valid sex to F change valid sex to F Blood products - Rev codes (38X, 39X) covered Blood products - Rev codes (38X, 39X) covered Blood products - Rev codes (38X, 39X) covered Blood products - Rev codes (38X, 39X) covered Blood products - Rev codes (38X, 39X) covered Blood products - Rev codes (38X, 39X) covered Blood products - Rev codes (38X, 39X) covered Blood products - Rev codes (38X, 39X) covered Blood products - Rev codes (38X, 39X) covered Blood products - Rev codes (38X, 39X) covered Blood products - Rev codes (38X, 39X) covered Blood products - Rev codes (38X, 39X) covered

x x

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

87 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee

Children's Hospital Outpatient Fee

Critical PDD Access Update to Hospital ACS Outpatient Fee

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

P9033 P9034 P9035 P9036 P9037 P9038 P9039 P9040 P9041 P9043 P9044 P9045 P9046 P9047 P9048 P9050 P9051 P9052 P9053 P9054 P9055 P9056 P9057 P9058 P9059 P9060 P9603 P9604 P9612 P9615 Q0035 Q0081 Q0083 Q0084 Q0085 Q0091 Q0092 Q0111 Q0112 Q0113 Q0114 Q0115 Q0144 Q0163 Q0164 Q0165 Q0166 Q0167 Q0168 Q0169 Q0170 Q0171 Q0172 Q0173 Q0174 Q0175 Q0176 Q0177 Q0178 Q0179 Q0180 Q0181 Q0480 Q0481 Q0482 Q0483 Q0484 Q0485 Q0486 Q0487 Q0488 Q0489 Q0490 Q0491 Q0492 Q0493 Q0494 Q0495 Q0496 Q0497 Q0498 Q0499 Q0500 Q0501 Q0502 Q0503 Q0504 Q0505 Q0510 Q0511 Q0512 Q0513 Q0514 Q0515 Q1003 Q1004 Q1005 Q2004 Q2009 Q2017 Q3001 Q3014 Q3025 Q3026 Q3031 Q4001 Q4002 Q4003 Q4004 Q4005 Q4006 Q4007 Q4008 Q4009 Q4010 Q4011 Q4012 Q4013 Q4014 Q4015 Q4016 Q4017 Q4018 Q4019 Q4020 Q4021 Q4022 Q4023 Q4024 Q4025 Q4026 Q4027 Q4028 Q4029 Q4030 Q4031

Platelets leukoreduced irrad Platelets, pheresis Platelet pheres leukoreduced Platelet pheresis irradiated Plate pheres leukoredu irrad RBC irradiated RBC deglycerolized RBC leukoreduced irradiated Albumin (human),5%, 50ml Plasma protein fract,5%,50ml Cryoprecipitatereducedplasma Albumin (human), 5%, 250 ml Albumin (human), 25%, 20 ml Albumin (human), 25%, 50ml Plasmaprotein fract,5%,250ml Granulocytes, pheresis unit Blood, l/r, cmv-neg Platelets, hla-m, l/r, unit Plt, pher, l/r cmv-neg, irr Blood, l/r, froz/degly/wash Plt, aph/pher, l/r, cmv-neg Blood, l/r, irradiated RBC, frz/deg/wsh, l/r, irrad RBC, l/r, cmv-neg, irrad Plasma, frz between 8-24hour Fr frz plasma donor retested One-way allow prorated miles One-way allow prorated trip Catheterize for urine spec Urine specimen collect mult Cardiokymography Infusion ther other than che Chemo by other than infusion Chemotherapy by infusion Chemo by both infusion and o Obtaining screen pap smear Set up port xray equipment Wet mounts/ w preparations Potassium hydroxide preps Pinworm examinations Fern test Post-coital mucous exam Azithromycin dihydrate, oral Diphenhydramine HCl 50mg Prochlorperazine maleate 5mg Prochlorperazine maleate10mg Granisetron HCl 1 mg oral Dronabinol 2.5mg oral Dronabinol 5mg oral Promethazine HCl 12.5mg oral Promethazine HCl 25 mg oral Chlorpromazine HCl 10mg oral Chlorpromazine HCl 25mg oral Trimethobenzamide HCl 250mg Thiethylperazine maleate10mg Perphenazine 4mg oral Perphenazine 8mg oral Hydroxyzine pamoate 25mg Hydroxyzine pamoate 50mg Ondansetron HCl 8mg oral Dolasetron mesylate oral Unspecified oral anti-emetic Driver pheumatic vad, rep Microprocsr cu elec vad, rep Microprcsr cu combo vad, rep Monitor elec vad, rep Monitor elec or comb vad rep Monitor cable elec vad, rep Mon cable elec/pneum vad rep Leads any type vad, rep only Pwr pack base elec vad, rep Pwr pck base combo vad, rep Emr pwr source elec vad, rep Emr pwr source combo vad rep Emr pwr cbl elec vad, rep emr pwr cbl combo vad, rep Emr hd pmp elec/combo, rep Charger elec/combo vad, rep Battery elec/combo vad, rep Bat clps elec/comb vad, rep Holster elec/combe vad, rep Belt/vest elec/combo vad rep Filters elec/combo vad, rep Shwr cov elec/combo vad, rep Mobility cart pheum vad, rep Battery pheum vad replacemnt Pwr adpt pheum vad, rep veh Miscl supply/accessory vad Dispens fee immunosupressive Sup fee antiem,antica,immuno Px sup fee anti-can sub pres Disp fee inhal drugs/30 days Disp fee inhal drugs/90 days Sermorelin acetate injection Ntiol category 3 Ntiol category 4 Ntiol category 5 Bladder calculi irrig sol Fosphenytoin, 50 mg Teniposide, 50 mg Brachytherapy Radioelements Telehealth facility fee IM inj interferon beta 1-a Subc inj interferon beta-1a Collagen skin test Cast sup body cast plaster Cast sup body cast fiberglas Cast sup shoulder cast plstr Cast sup shoulder cast fbrgl Cast sup long arm adult plst Cast sup long arm adult fbrg Cast sup long arm ped plster Cast sup long arm ped fbrgls Cast sup sht arm adult plstr Cast sup sht arm adult fbrgl Cast sup sht arm ped plaster Cast sup sht arm ped fbrglas Cast sup gauntlet plaster Cast sup gauntlet fiberglass Cast sup gauntlet ped plster Cast sup gauntlet ped fbrgls Cast sup lng arm splint plst Cast sup lng arm splint fbrg Cast sup lng arm splnt ped p Cast sup lng arm splnt ped f Cast sup sht arm splint plst Cast sup sht arm splint fbrg Cast sup sht arm splnt ped p Cast sup sht arm splnt ped f Cast sup hip spica plaster Cast sup hip spica fiberglas Cast sup hip spica ped plstr Cast sup hip spica ped fbrgl Cast sup long leg plaster Cast sup long leg fiberglass Cast sup lng leg ped plaster

K K K K K K K K K K K K K K K K K K K K K K K K K K A A A N X B B B B T N A A A A A E N N B K N B N B N B N N N B N B K K E A A A A A A A A A A A A A A A A A A A A A A A A A A B B B B B K N E E N K K B A K E N B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B

K K K K K K K K K K K K K K K K K K K K K K K K K K 1 1 1 1 1 1 1 1 1 T 1 3 3 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 K K 1 3 K 1 1 B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B

0968 9507 9501 9502 1019 9505 9504 0969 0961 0956 1009 0963 0964 0965 0966 9506 1010 1011 1020 1016 1017 1018 1021 1022 0955 9503 0000 0000 0000 0000 0100 0000 0000 0000 0000 0191 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0765 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0769 0763 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 3050 0000 0000 0000 0000 7028 7035 0000 0000 9022 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

2.1971 6.9242 7.8426 6.5581 9.8923 3.0643 5.4516 3.7722 0.3413 1.4739 1.3139 1.0987 0.4118 1.1362 3.3792 21.7847 2.3221 10.1413 10.7787 3.4353 7.6733 2.3099 5.8716 4.1363 1.2235 0.8264 0.0000 0.0000 0.0000 0.0000 2.5547 0.0000 0.0000 0.0000 0.0000 0.1309 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.7811 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.1426 0.7461 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0272 0.0000 0.0000 0.0000 0.0000 0.0559 4.3858 0.0000 0.0000 1.9021 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

104.96 330.77 374.64 313.28 472.56 146.38 260.42 180.20 16.30 70.41 62.77 52.48 19.67 54.28 161.42 1,040.66 110.93 484.45 514.90 164.10 366.55 110.34 280.49 197.59 58.45 39.48 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 6.25 0.00 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2.67 209.51 0.00 M01 90.86 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

239.31 754.18 854.22 714.31 1,077.47 333.76 593.79 410.87 37.17 160.54 143.11 119.67 44.85 123.75 368.06 2,372.79 252.92 1,104.59 1,174.02 374.17 835.78 251.59 639.53 450.53 133.26 90.01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 14.26 0.00 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 6.09 477.70 0.00 M01 207.17 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

274.29 864.42 979.07 818.71 1,234.95 382.55 680.58 470.92 42.61 184.00 164.03 137.16 51.41 141.84 421.86 2,719.60 289.89 1,266.04 1,345.61 428.86 957.93 288.37 733.01 516.38 152.74 103.17 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 16.34 0.00 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 6.98 547.52 0.00 M01 237.45 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Blood products - Rev codes (38X, 39X) covered Blood products - Rev codes (38X, 39X) covered Blood products - Rev codes (38X, 39X) covered Blood products - Rev codes (38X, 39X) covered Blood products - Rev codes (38X, 39X) covered Blood products - Rev codes (38X, 39X) covered Blood products - Rev codes (38X, 39X) covered Blood products - Rev codes (38X, 39X) covered Blood products - Rev codes (38X, 39X) covered Blood products - Rev codes (38X, 39X) covered Blood products - Rev codes (38X, 39X) covered Blood products - Rev codes (38X, 39X) covered Blood products - Rev codes (38X, 39X) covered Blood products - Rev codes (38X, 39X) covered Blood products - Rev codes (38X, 39X) covered Blood products - Rev codes (38X, 39X) covered Blood products - Rev codes (38X, 39X) covered Blood products - Rev codes (38X, 39X) covered Blood products - Rev codes (38X, 39X) covered Blood products - Rev codes (38X, 39X) covered Blood products - Rev codes (38X, 39X) covered Blood products - Rev codes (38X, 39X) covered Blood products - Rev codes (38X, 39X) covered Blood products - Rev codes (38X, 39X) covered Blood products - Rev codes (38X, 39X) covered Blood products - Rev codes (38X, 39X) covered

SI change 1/1/07 (TR 1155)

*

* *

*

SI change 1/1/07 (TR 1155) X X

* *

*

2/13/2008

April 1, 2008 Fee Schedule - Draft and Preliminary

88 of 93

Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only B B B B B B B B B B B B B B B B B B B B Y A B B B B B B B B B B B B B B B B B B B 1 1 1 1 1

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Children's Hospital Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Critical PDD Access Update to Hospital ACS Outpatient Fee 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

Q4032 Q4033 Q4034 Q4035 Q4036 Q4037 Q4038 Q4039 Q4040 Q4041 Q4042 Q4043 Q4044 Q4045 Q4046 Q4047 Q4048 Q4049 Q4050 Q4051 Q4080 Q4081 Q4082

Cast sup lng leg ped fbrgls Cast sup lng leg cylinder pl Cast sup lng leg cylinder fb Cast sup lngleg cylndr ped p Cast sup lngleg cylndr ped f Cast sup shrt leg plaster Cast sup shrt leg fiberglass Cast sup shrt leg ped plster Cast sup shrt leg ped fbrgls Cast sup lng leg splnt plstr Cast sup lng leg splnt fbrgl Cast sup lng leg splnt ped p Cast sup lng leg splnt ped f Cast sup sht leg splnt plstr Cast sup sht leg splnt fbrgl Cast sup sht leg splnt ped p Cast sup sht leg splnt ped f Finger splint, static Cast supplies unlisted Splint supplies misc Iloprost non-comp unit dose Epoetin alfa, 100 units ESRD Drug/bio NOC part B drug CAP

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

Description Change Added 1/1/07 to book Added 1/1/07 to book

x

Q5001 Q5002 Q5003 Q5004 Q5005 Q5006 Q5007 Q5008 Q5009

Hospice in patient home Hospice in assisted living Hospice in LT/non-skilled NF Hospice in SNF Hospice, inpatient hospital Hospice in hospice facility Hospice in LTCH Hospice in inpatient psych Hospice care, NOS

B B B B B B B B B

1 1 1 1 1 1 1 1 1

0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book Added 1/1/07 to book

Q9951 Q9953 Q9954 Q9955 Q9956 Q9957 Q9958 Q9959 Q9960 Q9961 Q9962 Q9963 Q9964 Q9965 Q9966 Q9967 R0070 R0075 R0076

LOCM >= 400 mg/ml iodine,1ml Inj Fe-based MR contrast, 1ml Oral MR contrast, 100 ml Inj perflexane lip micros,ml Inj octafluoropropane mic,ml Inj perflutren lip micros,ml HOCM <=149 mg/ml iodine, 1ml HOCM 150-199mg/ml iodine,1ml HOCM 200-249mg/ml iodine,1ml HOCM 250-299mg/ml iodine,1ml HOCM 300-349mg/ml iodine,1ml HOCM 350-399mg/ml iodine,1ml HOCM >= 400 mg/ml iodine,1ml LOCM 100-199mg/ml iodine,1ml LOCM 200-299mg/ml iodine,1ml LOCM 300-399mg/ml iodine,1ml Transport portable x-ray Transport port x-ray multipl Transport portable EKG

N N N N N N N N N N N N N N N N B B B

1 1 1 1 1 N 1 1 1 1 1 1 1 N N N B B 1

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

X X X X X X SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) SI change 1/1/07 (TR 1155) X X X

V2020 V2025 V2100 V2101 V2102 V2103 V2104 V2105 V2106 V2107 V2108 V2109 V2110 V2111 V2112 V2113 V2114 V2115 V2118 V2121 V2199 V2200 V2201 V2202 V2203 V2204 V2205 V2206 V2207 V2208 V2209 V2210 V2211 V2212 V2213 V2214 V2215 V2218 V2219 V2220 V2221 V2299 V2300 V2301 V2302 V2303 V2304 V2305 V2306 V2307 V2308 V2309 V2310 V2311 V2312 V2313 V2314 V2315 V2318 V2319 V2320 V2321 V2399 V2410 V2430 V2499 V2500 V2501 V2502 V2503 V2510 V2511 V2512 V2513 V2520

Vision svcs frames purchases Eyeglasses delux frames Lens spher single plano 4.00 Single visn sphere 4.12-7.00 Singl visn sphere 7.12-20.00 Spherocylindr 4.00d/12-2.00d Spherocylindr 4.00d/2.12-4d Spherocylinder 4.00d/4.25-6d Spherocylinder 4.00d/>6.00d Spherocylinder 4.25d/12-2d Spherocylinder 4.25d/2.12-4d Spherocylinder 4.25d/4.25-6d Spherocylinder 4.25d/over 6d Spherocylindr 7.25d/.25-2.25 Spherocylindr 7.25d/2.25-4d Spherocylindr 7.25d/4.25-6d Spherocylinder over 12.00d Lens lenticular bifocal Lens aniseikonic single Lenticular lens, single Lens single vision not oth c Lens spher bifoc plano 4.00d Lens sphere bifocal 4.12-7.0 Lens sphere bifocal 7.12-20. Lens sphcyl bifocal 4.00d/.1 Lens sphcy bifocal 4.00d/2.1 Lens sphcy bifocal 4.00d/4.2 Lens sphcy bifocal 4.00d/ove Lens sphcy bifocal 4.25-7d/. Lens sphcy bifocal 4.25-7/2. Lens sphcy bifocal 4.25-7/4. Lens sphcy bifocal 4.25-7/ov Lens sphcy bifo 7.25-12/.25Lens sphcyl bifo 7.25-12/2.2 Lens sphcyl bifo 7.25-12/4.2 Lens sphcyl bifocal over 12. Lens lenticular bifocal Lens aniseikonic bifocal Lens bifocal seg width over Lens bifocal add over 3.25d Lenticular lens, bifocal Lens bifocal speciality Lens sphere trifocal 4.00d Lens sphere trifocal 4.12-7. Lens sphere trifocal 7.12-20 Lens sphcy trifocal 4.0/.12Lens sphcy trifocal 4.0/2.25 Lens sphcy trifocal 4.0/4.25 Lens sphcyl trifocal 4.00/>6 Lens sphcy trifocal 4.25-7/. Lens sphc trifocal 4.25-7/2. Lens sphc trifocal 4.25-7/4. Lens sphc trifocal 4.25-7/>6 Lens sphc trifo 7.25-12/.25Lens sphc trifo 7.25-12/2.25 Lens sphc trifo 7.25-12/4.25 Lens sphcyl trifocal over 12 Lens lenticular trifocal Lens aniseikonic trifocal Lens trifocal seg width > 28 Lens trifocal add over 3.25d Lenticular lens, trifocal Lens trifocal speciality Lens variab asphericity sing Lens variable asphericity bi Variable asphericity lens Contact lens pmma spherical Cntct lens pmma-toric/prism Contact lens pmma bifocal Cntct lens pmma color vision Cntct gas permeable sphericl Cntct toric prism ballast Cntct lens gas permbl bifocl Contact lens extended wear Contact lens hydrophilic

A E A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A A

3 1 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 1 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 1 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 1 3 3 3 3 3 3 3 3 3 3 3 3 3

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000

M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01

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Updated Procedure Code List Effective Date: January 1, 2008 Conversion Factors: $47.77 General Acute Care Hospitals $108.92 Children's Hospitals $124.84 Critical Access Hospitals Medicare's 2008 National Conversion Factor 63.694

3/1/08

CPT/ HCPCS

Description (short)

Medicare Status Wyoming Indicators 2008 Status CY 2008 Indicator FYI Only A A A A A A A A A A A A A A A A N N N A E A A A A A A A A E A B A A A B A A A F A E E N A A E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E E B E E E E T T V V 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 1 1 1 3 1 3 3 3 3 3 1 3 3 1 3 1 1 3 3 B 3 3 3 F 1 1 3 1 1 3 1 1 1 3 1 3 3 3 3 3 3 3 1 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 1 1 3 3 3 1 1 1 1 1 1 3 1 3 1 B 1 1 1 1 T T V V

APC

APC Relative Weights

Procedure Codes with a "calculated" APC Relative Weight

General Hospital Outpatient Fee M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 0.00 M01 0.00 M01 M01 M01 M01 M01 0.00 M01 M01 0.00 M01 0.00 0.00 M01 M01 0.00 M01 M01 M01

Children's Hospital Outpatient Fee M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 0.00 M01 0.00 M01 M01 M01 M01 M01 0.00 M01 M01 0.00 M01 0.00 0.00 M01 M01 0.00 M01 M01 M01

Critical PDD Access Update to Hospital ACS Outpatient Fee M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 0.00 M01 0.00 M01 M01 M01 M01 M01 0.00 M01 M01 0.00 M01 0.00 0.00 M01 M01 0.00 M01 M01 M01

PDD Update for Type 1 (Y/Blank)

Comments

Medicare Change from 1227-2007 Schedule

V2521 V2522 V2523 V2530 V2531 V2599 V2600 V2610 V2615 V2623 V2624 V2625 V2626 V2627 V2628 V2629 V2630 V2631 V2632 V2700 V2702 V2710 V2715 V2718 V2730 V2744 V2745 V2750 V2755 V2756 V2760 V2761 V2762 V2770 V2780 V2781 V2782 V2783 V2784 V2785 V2786 V2787 V2788 V2790 V2797 V2799 V5008 V5010 V5011 V5014 V5020 V5030 V5040 V5050 V5060 V5070 V5080 V5090 V5095 V5100 V5110 V5120 V5130 V5140 V5150 V5160 V5170 V5180 V5190 V5200 V5210 V5220 V5230 V5240 V5241 V5242 V5243 V5244 V5245 V5246 V5247 V5248 V5249 V5250 V5251 V5252 V5253 V5254 V5255 V5256 V5257 V5258 V5259 V5260 V5261 V5262 V5263 V5264 V5265 V5266 V5267 V5268 V5269 V5270 V5271 V5272 V5273 V5274 V5275 V5298 V5299 V5336 V5362 V5363 V5364 XXXXX XXXXX XXXXX XXXXX

Cntct lens hydrophilic toric Cntct lens hydrophil bifocl Cntct lens hydrophil extend Contact lens gas impermeable Contact lens gas permeable Contact lens/es other type Hand held low vision aids Single lens spectacle mount Telescop/othr compound lens Plastic eye prosth custom Polishing artifical eye Enlargemnt of eye prosthesis Reduction of eye prosthesis Scleral cover shell Fabrication & fitting Prosthetic eye other type Anter chamber intraocul lens Iris support intraoclr lens Post chmbr intraocular lens Balance lens Deluxe lens feature Glass/plastic slab off prism Prism lens/es Fresnell prism press-on lens Special base curve Tint photochromatic lens/es Tint, any color/solid/grad Anti-reflective coating UV lens/es Eye glass case Scratch resistant coating Mirror coating Polarization, any lens Occluder lens/es Oversize lens/es Progressive lens per lens Lens, 1.54-1.65 p/1.60-1.79g Lens, >= 1.66 p/>=1.80 g Lens polycarb or equal Corneal tissue processing Occupational multifocal lens Astigmatism-correct function Presbyopia-correct function Amniotic membrane Vis item/svc in other code Miscellaneous vision service Hearing screening Assessment for hearing aid Hearing aid fitting/checking Hearing aid repair/modifying Conformity evaluation Body-worn hearing aid air Body-worn hearing aid bone Hearing aid monaural in ear Behind ear hearing aid Glasses air conduction Glasses bone conduction Hearing aid dispensing fee Implant mid ear hearing pros Body-worn bilat hearing aid Hearing aid dispensing fee Body-worn binaur hearing aid In ear binaural hearing aid Behind ear binaur hearing ai Glasses binaural hearing aid Dispensing fee binaural Within ear cros hearing aid Behind ear cros hearing aid Glasses cros hearing aid Cros hearing aid dispens fee In ear bicros hearing aid Behind ear bicros hearing ai Glasses bicros hearing aid Dispensing fee bicros Dispensing fee, monaural Hearing aid, monaural, cic Hearing aid, monaural, itc Hearing aid, prog, mon, cic Hearing aid, prog, mon, itc Hearing aid, prog, mon, ite Hearing aid, prog, mon, bte Hearing aid, binaural, cic Hearing aid, binaural, itc Hearing aid, prog, bin, cic Hearing aid, prog, bin, itc Hearing aid, prog, bin, ite Hearing aid, prog, bin, bte Hearing id, digit, mon, cic Hearing aid, digit, mon, itc Hearing aid, digit, mon, ite Hearing aid, digit, mon, bte Hearing aid, digit, bin, cic Hearing aid, digit, bin, itc Hearing aid, digit, bin, ite Hearing aid, digit, bin, bte Hearing aid, disp, monaural Hearing aid, disp, binaural Ear mold/insert Ear mold/insert, disp Battery for hearing device Hearing aid supply/accessory ALD Telephone Amplifier Alerting device, any type ALD, TV amplifier, any type ALD, TV caption decoder Tdd ALD for cochlear implant ALD unspecified Ear impression Hearing aid noc Hearing service Repair communication device Speech screening Language screening Dysphagia screening Cardiac Electrophys Eval and Ablation Composite LDR Prostate Brachy Composite Level I Extended Assessment & Mngt Composite Level II Extended Assessment & Mngt Composite

0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 0000 8000 8001 8002 8003

0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 0.0000 134.1189 53.8937 5.5113 10.027

APC by Report APC by Report APC by Report 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 0.00 0.00 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 M01 M01 M01 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 M01 M01 M01 0.00 0.00 0.00 M01 M01 M01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 6,406.86 14,608.23 16,743.40 2,574.50 5,870.10 6,728.09 263.27 600.29 688.03 478.99 1,092.14 1,251.77

X

X X X X

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Descriptions for Cells with "N/A" in Updated Fee Schedule Column Medicare Status Indicators: October 2007 Number of Codes 442 19 Medicare Status Indicators: 2008 (New Column) Wyoming Status Indicators: 2007 Status Indicator Wyoming Status Indicators: 2007 Detailed Status Indicator Preliminary Wyoming Status Indicators: 2007 Status Indicator (New Column) Preliminary Wyoming Status Indicators: Detailed 2007 Status Indicator (New Column) Medicare APC: 2007 Medicare APC: 2008 (New Column) Medicare APC Relative Weights: 2007 Medicare APC Relative Weights: 2008 (New Column) 2008 Medicare National Payment Rates (New Column) Procedure Codes with a "calculated" APC Relative Weight Wyoming General Hospital Outpatient Fee: 2007 Wyoming General Hospital Outpatient Fee: 2008 (New Column) Wyoming Childrens Hospital Outpatient Fee: 2007 Wyoming Childrens Hospital Outpatient Fee: 2008 (New Column) Wyoming Critical Access Hospital Outpatient Fee: 2007 Wyoming Critical Access Hospital Outpatient Fee: 2008 (New Column) 442 0 442 0 0 0 442 0 442 0 442 0 New Procedure Codes in 2008 - no Medicare 2007 APCs New Procedure Codes in 2008 - no Medicare 2007 APCs New Procedure Codes in 2008 - no Medicare 2007 APCs New Procedure Codes in 2008 - no Medicare 2007 APCs New Procedure Codes in 2008 - no Medicare 2007 APCs 0 161 442 442 0 Reason New Procedure Codes in 2008 - no Medicare 2007 status indicators Procedure Codes in Wyoming's original fee schedule (dated 12/27/07), but not listed in the 2008 Medicare fee schedule Procedure Codes in Wyoming's original fee schedule (dated 12/27/07), but not listed in the 2008 Medicare fee schedule New Procedure Codes in 2008 - no Medicare 2007 status indicators New Procedure Codes in 2008 - no Medicare 2007 status indicators

Compatibility Report for Oct 2007 Fee Schedule INTERNAL sent to ACS XX.XX.07.xls Run on 11/29/2007 8:07 The following features in this workbook are not supported by earlier versions of Excel. These features may be lost or degraded when you save this workbook in an earlier file format. Minor loss of fidelity A table style is applied to a table in this workbook. Table style formatting cannot be displayed in earlier versions of Excel.

# of occurrences 1 'Sheet1'!L3550:L3 551


				
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