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									      Comparision of Echocardiography and Vascular Ultrasound Physician Fee Schedule Payments
The 2010 Medicare Physician Fee Schedule final rule was released by the Centers for Medicare and Medicaid Services (CMS) on Friday, Oct. 30 2009. Included in the
rule are several provisions that will significantly reduce payments for echocardiography and vascular ultrasound procedures. Effective Jan.1, 2010, the conversion factor
will be $28.4061. This is a 21.2 percent decrease from the current 2009 conversion factor of $36.066. Congressional legislation is currently being debated to repeal the
Sustainable Growth Rate (SGR) formula which is used in the calculation of the conversion factor. The repeal if passed, will be part of a health reform bill or as a separate
bill. In addition to the conversion factor reduction and despite the extraordinary opposition to the proposed reductions in cardiology services, CMS incorporated the AMA
Physician Practice Information Survey into its rate-setting formula. The impact on TTE with spectral and color Doppler (CPT 93306) will be a reduction of about 10% of
the total Relative Value Units(RVUs) assigned to 93306 in 2010; these reductions are scheduled to continue for four years.

Below is a table that illustrates the national payment reductions for 2010 and the fully implemented practice expense reduction if the conversion factor remains at the
$28.4061.
CY 2009 Comparison to 2010 Physician Fee Schedule Medicare Payments (Conversion Factor $28.4061)

                                                         CPT CODE &         2009          2010          DIFF                      2013 FULLY DIFF $$$           DIFF %%%
                    DESCRIPTION                                                                                    DIFF %%%
                                                          MODIFIER        PAYMENT       PAYMENT         $$$                     IMPLEMENTED from 2009           from 2009


            ECHOCARDIOGRAPHY
3 DIMENSIONAL RENDERING
3D rendering with interpretation and reporting of            76376           $80           $57          ($23)         -29%             $41            ($39)        -49%
computed tomography, magnetic resonance imaging,
ultrasound, or other tomographic modality; not                 -26           $11            $8           ($3)         -25%              $8            ($3)         -30%
requiring image post-processing on an independent
workstation                                                    -TC           $69           $49          ($20)         -30%             $34            ($35)        -51%

                                                             76377           $114          $75          ($39)         -34%             $58            ($56)        -49%
3D rendering with interpretation and reporting of
computed tomography, magnetic resonance imaging,
                                                               -26           $42           $31          ($11)         -26%             $30            ($12)        -28%
ultrasound, or other tomographic modality; requiring
image post-processing on an independent workstation
                                                               -TC           $71           $44          ($27)         -38%             $28            ($43)        -61%
ECHOCARDIOGRAM, FETAL HEART
Echocardiography, fetal, cardiovascular system, real         76825           $207          $161         ($46)         -22%            $161            ($46)        -22%
time with image documentation (2D) with or without M-         -26             $83          $64          ($19)         -22%             $66            ($17)        -21%
mode recording; complete                                      -TC            $124          $97          ($27)         -22%             $95            ($29)        -23%
Echocardiography, fetal, cardiovascular system, real         76826           $114          $91          ($23)         -20%             $95            ($19)        -17%
time with image documentation (2D) with or without M-          -26           $40           $32           ($8)         -20%             $33            ($7)         -18%
mode recording; follow up or repeat study                     -TC            $74           $59          ($15)         -20%             $62            ($12)        -16%
                                                             76827           $72           $52          ($20)         -28%             $45            ($27)        -37%
Doppler echocardiography, fetal, pulsed wave and/or
                                                              -26            $28           $22           ($6)         -20%             $23             ($5)        -19%
continuous wave with spectral display; complete
                                                              -TC            $44           $30          ($14)         -33%             $23            ($21)        -48%
Doppler echocardiography, fetal, pulsed wave and/or          76828           $53           $39          ($14)         -27%             $34            ($19)        -35%
continuous wave with spectral display; follow-up or           -26            $28           $22           ($6)         -23%             $22             ($6)        -21%
repeat study                                                  -TC            $26           $17           ($9)         -34%             $12            ($14)        -53%
                                                        CPT CODE &     2009       2010    DIFF                  2013 FULLY DIFF $$$   DIFF %%%
                   DESCRIPTION                                                                     DIFF %%%
                                                         MODIFIER    PAYMENT    PAYMENT   $$$                 IMPLEMENTED from 2009   from 2009


ECHOCARDIOGRAM, STRESS

Echocardiography, transthoracic, real-time with image     93350       $212       $160     ($52)      -24%         $145       ($67)      -32%
documentation (2D), includes M-mode recording, when
performed, during rest and cardiovascular stress test
                                                           -26         $80        $61     ($19)      -23%         $56        ($24)      -30%
using treadmill, bicycle exercise and/or
pharmacologically induced stress, with interpretation
and report                                                 -TC        $131        $99     ($32)      -25%         $89        ($42)      -32%

Echocardiography, transthoracic, real-time with image
                                                          93351       $277       $191     ($86)      -31%         $168      ($109)      -39%
documentation (2D), includes M-mode recording, when
performed, during rest and cardiovascular stress test
using treadmill, bicycle exercise and/or
                                                           -26         ------     $75     ------     ------       $68        ------     ------
pharmacologically induced stress, with interpretation
and report; including performance of continuous
electrocardiographic monitoring, with physician
                                                           -TC         ------    $116     ------     ------       $101       ------     ------
supervision

Use of echocardiographic contrast agent during stress
echocardiography (List separately in addition to code     93352        $39        $28     ($11)      -27%         $23        ($16)      -40%
for primary procedure)
                                                        CPT CODE &     2009      2010    DIFF                 2013 FULLY DIFF $$$   DIFF %%%
                    DESCRIPTION                                                                  DIFF %%%
                                                         MODIFIER    PAYMENT   PAYMENT   $$$                IMPLEMENTED from 2009   from 2009


STRESS TEST
Cardiovascular stress test using maximal or
submaximal treadmill or bicycle exercise, continuous
electrocardiographic monitoring, and/or                   93015       $100       $73     ($27)     -27%         $61        ($39)      -39%
pharmacological stress; with physician supervision,
with interpretation and report
Cardiovascular stress test using maximal or
submaximal treadmill or bicycle exercise, continuous
electrocardiographic monitoring, and/or                   93016        $25       $19     ($6)      -25%         $17        ($8)       -31%
pharmacological stress; physician supervision only,
without interpretation and report.
Cardiovascular stress test using maximal or
submaximal treadmill or bicycle exercise, continuous
electrocardiographic monitoring, and/or                   93017        $60       $42     ($18)     -30%         $32        ($28)      -47%
pharmacological stress; tracing only, without
interpretation and report.

Cardiovascular stress test using maximal or
submaximal treadmill or bicycle exercise, continuous
                                                          93018        $16       $13     ($4)      -22%         $12        ($4)       -27%
electrocardiographic monitoring, and/or
pharmacological stress;interpretation and report only
                                                          CPT CODE &     2009      2010    DIFF                 2013 FULLY DIFF $$$   DIFF %%%
                    DESCRIPTION                                                                    DIFF %%%
                                                           MODIFIER    PAYMENT   PAYMENT   $$$                IMPLEMENTED from 2009   from 2009


ECHOCARDIOGRAM, TRANSESOPHAGEAL – ADULT AND CONGENITAL

Transesophageal echocardiography (TEE) real time            93312       $326      $245     ($81)     -25%         $224      ($102)      -31%
with image documentation (2D) (with or without M-
                                                             -26        $116       $89     ($27)     -23%         $83        ($33)      -29%
mode recording); including probe placement, image
acquisition, interpretation and report                       -TC        $210      $156     ($54)     -26%         $141       ($69)      -33%
Transesophageal echocardiography (TEE) real time
with image documentation (2D) (with or without M-           93313        $41       $33     ($8)      -20%         $33        ($8)       -19%
mode recording); placement of transesophageal probe
only.
Transesophageal Echocardiography (TEE) real time            93314       $280      $212     ($68)     -24%         $199       ($81)      -29%
with image documentation (2D) (with or without M-
                                                             -26         $66       $51     ($15)     -23%         $48        ($18)      -28%
mode recording); image acquisition, interpretation and
report only.                                                 -TC        $215      $161     ($54)     -25%         $151       ($64)      -30%

                                                            93315        $0        $0      $0        0%            $0        $0          0%
Transesophageal Echocardiography (TEE) for
congenital cardiac anomalies; including probe                -26        $149      $117     ($32)     -21%         $109       ($40)      -27%
placement, image acquisition, interpretation and report
                                                             -TC         $0        $0      $0        0%            $0        $0          0%
Transesophageal Echocardiography (TEE) for
congenital cardiac anomalies; placement of                  93316        $45       $36     ($9)      -21%         $35        ($10)      -23%
transesophageal probe only
Transesophageal Echocardiography (TEE) for                  93317         $0        $0      $0        0%          $0          $0         0%
congenital cardiac anomalies; image acquisition,             -26         $92       $74     ($18)     -19%         $72        ($20)      -22%
interpretation and report only.                              -TC          $0        $0      $0        0%          $0          $0         0%

Echocardiography, transesophageal (TEE) for                 93318        $0        $0      $0        0%            $0        $0          0%
monitoring purposes, including probe placement, real
time 2-dimensional image acquisition and interpretation
                                                             -26        $113       $91     ($22)     -20%         $88        ($25)      -22%
leading to ongoing (continuous) assessment of
(dynamically changing) cardiac pumping function and
to therapeutic measures on an immediate time basis.          -TC         $0        $0      $0        0%            $0        $0          0%
                                                         CPT CODE &     2009      2010    DIFF                 2013 FULLY DIFF $$$   DIFF %%%
                    DESCRIPTION                                                                   DIFF %%%
                                                          MODIFIER    PAYMENT   PAYMENT   $$$                IMPLEMENTED from 2009   from 2009


ECHOCARDIOGRAM, TRANSTHORACIC – ADULT AND CONGENITAL
                                                    93303              $218      $161     ($57)     -26%         $139       ($79)      -36%
Transthoracic echocardiography (TTE) for congenital
                                                     -26                $69      $53      ($16)     -23%          $50       ($19)      -27%
cardiac anomalies; complete
                                                     -TC               $149      $107     ($42)     -28%          $89       ($60)      -40%
                                                    93304              $135      $101     ($34)     -25%          $93       ($42)      -31%
Transthoracic echocardiography (TTE) for congenital
                                                     -26                $39      $30       ($9)     -22%          $29       ($10)      -26%
cardiac anomalies; follow-up or limited study
                                                     -TC                $96      $71      ($25)     -26%          $64       ($32)      -34%

Echocardiography, transthoracic, real-time with image      93306       $268      $188     ($80)     -30%         $137      ($131)      -49%
documentation (2D), includes M-mode recording, when
performed, complete, with spectral Doppler                  -26         $72       $55     ($17)     -23%         $50        ($22)      -30%
echocardiography, and with color flow Doppler
echocardiography                                            -TC        $196      $133     ($63)     -32%         $86       ($110)      -56%

Echocardiography, transthoracic, real-time with image      93307       $177      $121     ($56)     -31%         $80        ($97)      -55%
documentation (2D), includes M-mode recording, when
                                                            -26         $50       $38     ($12)     -23%         $36        ($14)      -29%
performed, complete, without spectral or color Doppler
echocardiography
                                                            -TC        $127       $83     ($44)     -35%         $45        ($82)      -65%

                                                           93308       $112       $82     ($30)     -27%         $69        ($43)      -39%
Echocardiography, transthoracic, real-time with image
documentation (2D), includes M-mode recording, when         -26         $29       $22     ($7)      -24%         $20        ($9)       -29%
performed, follow-up or limited study
                                                            -TC         $83       $59     ($24)     -28%         $48        ($35)      -42%
DOPPLER
Doppler echocardiography, pulsed wave and/or               93320        $78       $53     ($25)     -32%         $33        ($45)      -58%
continuous wave with spectral display (List separately
                                                            -26         $21       $16     ($5)      -24%         $15        ($6)       -30%
in addition to codes for echocardiographic imaging);
complete.                                                   -TC         $58       $37     ($21)     -36%         $18        ($40)      -69%

Doppler echocardiography, pulsed wave and/or               93321        $35       $24     ($11)     -32%         $17        ($18)      -50%
continuous wave with spectral display (List separately
                                                            -26         $8        $7      ($1)      -18%          $6        ($2)       -25%
in addition to codes for echocardiographic imaging);
follow-up or limited study.
                                                            -TC         $27       $17     ($10)     -36%         $11        ($16)      -58%

                                                           93325        $54       $32     ($22)     -41%         $14        ($40)      -74%
Doppler echocardiography color flow velocity mapping
(List separately in addition to codes for                   -26         $4        $3      ($1)      -22%          $3        ($1)       -29%
echocardiographic imaging)
                                                            -TC         $50       $29     ($21)     -43%         $11        ($39)      -77%
                     VASCUALR
ABDOMINAL AORTIC ANEURYSM (AAA) SCREENING
Ultrasound B-scan and/or real time with image              G0389       $111       $84     ($27)     -24%         $76        ($35)      -31%
documentation; for abdominal aortic aneurysm (AAA)
screening
                                                    CPT CODE &      2009      2010    DIFF                 2013 FULLY DIFF $$$   DIFF %%%
                  DESCRIPTION                                                                 DIFF %%%
                                                     MODIFIER     PAYMENT   PAYMENT   $$$                IMPLEMENTED from 2009   from 2009
Ultrasound B-scan and/or real time with image
documentation; for abdominal aortic aneurysm (AAA)         -26      $30       $23      ($7)     -22%         $22         ($8)      -26%
screening                                                  -TC      $81       $61     ($20)     -25%         $54        ($27)      -33%
ABDOMINAL DUPLEX – AORTA, IVC, ILIAC, BYPASS GRAFTS
                                                          93978    $239      $178     ($61)     -25%         $170       ($69)      -29%
Duplex scan of aorta, inferior vena cava, iliac
                                                           -26      $34      $26       ($8)     -23%          $26        ($8)      -24%
vasculature or bypass grafts; complete study
                                                           -TC     $205      $152     ($53)     -26%         $144       ($61)      -30%
                                                          93979    $165      $123     ($42)     -25%         $116       ($49)      -29%
Duplex scan of aorta, inferior vena cava, iliac
                                                           -26      $22      $18       ($4)     -20%          $17        ($5)      -21%
vasculature or bypass grafts; unilateral or limited study
                                                           -TC     $142      $106     ($36)     -26%          $99       ($43)      -30%
ABDOMINAL DUPLEX – ARTERIAL INFLOW/VENOUS OUTFLOW
Duplex scan of arterial inflow and venous outflow of      93975    $378      $284     ($94)     -25%         $263      ($115)      -30%
abdominal, pelvic, scrotal contents and/or                 -26      $93      $72      ($21)     -22%          $70       ($23)      -25%
retroperitoneal organs; complete study                     -TC     $285      $212     ($73)     -26%         $193       ($92)      -32%
Duplex scan of arterial inflow and venous outflow of      93976    $218      $162     ($56)     -25%         $150       ($68)      -31%
abdominal, pelvic, scrotal contents and/or                 -26      $61      $48      ($13)     -21%          $47       ($14)      -24%
retroperitoneal organs; limited study                      -TC     $157      $114     ($43)     -27%         $103       ($54)      -34%
                                                            CPT CODE &     2009      2010    DIFF                 2013 FULLY DIFF $$$   DIFF %%%
                     DESCRIPTION                                                                     DIFF %%%
                                                             MODIFIER    PAYMENT   PAYMENT   $$$                IMPLEMENTED from 2009   from 2009


ARTERIAL - UPPER AND LOWER EXTREMITIES
Noninvasive physiologic studies of upper or lower             93922       $120       $92     ($28)     -24%         $89        ($31)      -26%
extremity arteries, single level, bilateral (eg,
ankle/brachial indices, Doppler waveform analysis,             -26         $13       $10     ($3)      -26%         $10        ($3)       -26%
volume plethysmography, transcutaneous oxygen
tension measurement)                                           -TC        $108       $82     ($26)     -24%         $79        ($29)      -27%

Non-invasive physiologic studies of upper or lower
                                                              93923       $186      $141     ($45)     -24%         $135       ($51)      -27%
extremity arteries, multiple levels or with provocative
functional maneuvers, complete bilateral study (eg,
segmental blood pressure measurements, segmental
Doppler waveform analysis, segmental volume                    -26         $23       $18     ($5)      -22%         $18        ($5)       -23%
plethysmography, segmental transcutaneous oxygen
tension measurements, measurements with postural
provocative tests, measurements with reactive
                                                               -TC        $163      $123     ($40)     -24%         $118       ($45)      -28%
hyperemia)

Non-invasive physiologic studies of lower extremity           93924       $229      $174     ($55)     -24%         $164       ($65)      -28%
arteries, at rest and following treadmill stress testing,      -26         $26      $20       ($6)     -22%          $20        ($6)      -25%
complete bilateral study                                       -TC        $203      $154     ($49)     -24%         $145       ($58)      -29%
                                                              93925       $308      $233     ($75)     -24%         $218       ($90)      -29%
Duplex scan of lower extremity arteries or arterial
                                                               -26         $30      $23       ($7)     -23%          $23        ($7)      -24%
bypass grafts; complete bilateral study
                                                               -TC        $279      $210     ($69)     -25%         $195       ($84)      -30%
                                                              93926       $197      $150     ($47)     -24%         $145       ($52)      -26%
Duplex scan of lower extremity arteries or arterial
                                                               -26         $20      $16       ($4)     -20%          $16        ($4)      -22%
bypass grafts; unilateral or limited study
                                                               -TC        $177      $134     ($43)     -24%         $129       ($48)      -27%
                                                              93930       $244      $183     ($61)     -25%         $174       ($70)      -29%
Duplex scan of upper extremity arteries or arterial
                                                               -26         $24      $18       ($6)     -23%          $18        ($6)      -24%
bypass grafts; complete bilateral study
                                                               -TC        $220      $164     ($56)     -25%         $156       ($64)      -29%
                                                              93931       $163      $122     ($41)     -25%         $115       ($48)      -29%
Duplex scan of upper extremity arteries or arterial
                                                               -26         $16      $12       ($4)     -24%          $12        ($4)      -24%
bypass grafts; unilateral or limited study
                                                               -TC        $148      $110     ($38)     -26%         $103       ($45)      -30%
                                                           CPT CODE &     2009      2010    DIFF                 2013 FULLY DIFF $$$   DIFF %%%
                     DESCRIPTION                                                                    DIFF %%%
                                                            MODIFIER    PAYMENT   PAYMENT   $$$                IMPLEMENTED from 2009   from 2009


CEREBROVASCULAR EXAM – EXTRACRANIAL

                                                             93875       $101       $77     ($24)     -24%         $74        ($27)      -27%
Noninvasive physiologic studies of extracranial
arteries, complete bilateral study (eg, periorbital flow
direction with arterial compression, ocular                   -26         $11       $9      ($2)      -20%          $9        ($2)       -20%
pneumoplethysmography, Doppler ultrasound spectral
analysis)
                                                              -TC         $90       $68     ($22)     -24%         $65        ($25)      -27%

                                                             93880       $248      $185     ($63)     -25%         $171       ($77)      -31%
Duplex scan of extracranial arteries; complete bilateral
                                                              -26         $31      $24       ($7)     -22%          $23        ($8)      -25%
study
                                                              -TC        $217      $161     ($56)     -26%         $148       ($69)      -32%
                                                             93882       $164      $125     ($39)     -24%         $126       ($38)      -23%
Duplex scan of extracranial arteries; unilateral or
                                                              -26         $21      $16       ($5)     -23%          $16        ($5)      -23%
limited study
                                                              -TC        $143      $109     ($34)     -24%         $109       ($34)      -24%
HEMODIALYSIS SHUNT
                                                             93990       $193      $150     ($43)     -22%         $154       ($39)      -20%
Duplex scan of hemodialysis access (including arterial
                                                              -26         $13      $10       ($3)     -24%          $10        ($3)      -21%
inflow, body of access and venous outflow)
                                                              -TC        $180      $140     ($40)     -22%         $144       ($36)      -20%

Vessel mapping of vessels for hemodialysis access            G0365       $193      $150     ($43)     -22%         $154       ($39)      -20%
(services for preoperative vessel mapping prior to
creation of hemodialysis access using an autogenous           -26         $12       $10     ($2)      -20%         $10        ($2)       -17%
hemodialysis conduit, including arterial inflow and
venous outflow) (Medicare only)                               -TC        $180      $140     ($40)     -22%         $144       ($36)      -20%
TRANSCRANIAL DOPPLER
                                                             93886       $298      $234     ($65)     -22%         $251       ($47)      -16%
Transcranial Doppler study of the intracranial arteries;
                                                              -26         $47      $37      ($10)     -22%          $37       ($10)      -21%
complete study
                                                              -TC        $251      $197     ($54)     -22%         $214       ($37)      -15%
                                                             93888       $203      $155     ($48)     -23%         $157       ($46)      -23%
Transcranial Doppler study of the intracranial arteries;
                                                              -26         $32      $25       ($7)     -23%          $25        ($7)      -23%
limited study
                                                              -TC        $171      $131     ($40)     -24%         $132       ($39)      -23%
                                                             93890       $262      $205     ($57)     -22%         $221       ($41)      -16%
Transcranial Doppler study of the intracranial arteries;
                                                              -26         $50      $39      ($11)     -22%          $40       ($10)      -20%
vasoreactivity study
                                                              -TC        $212      $165     ($47)     -22%         $182       ($30)      -14%
Transcranial Doppler study of the intracranial arteries;     93892       $287      $235     ($52)     -18%         $282        ($5)       -2%
emboli detection without intravenous microbubble              -26         $57      $45      ($12)     -22%          $46       ($11)      -20%
injection                                                     -TC        $230      $190     ($40)     -17%         $237         $7        3%
                                                             93893       $286      $230     ($56)     -20%         $263       ($23)       -8%
Transcranial Doppler study of the intracranial arteries;
                                                              -26         $57      $45      ($12)     -21%          $46       ($11)      -19%
emboli detection with intravenous microbubble injection
                                                              -TC        $229      $185     ($44)     -19%         $217       ($12)       -5%
                                                        CPT CODE &     2009      2010    DIFF                 2013 FULLY DIFF $$$   DIFF %%%
                    DESCRIPTION                                                                  DIFF %%%
                                                         MODIFIER    PAYMENT   PAYMENT   $$$                IMPLEMENTED from 2009   from 2009


VENOUS EXTREMITIES

Non-invasive physiologic studies of extremity veins,      93965       $123       $93     ($30)     -24%         $87        ($36)      -30%
complete bilateral study (eg, Doppler waveform
analysis with responses to compression and other           -26         $18       $14     ($4)      -23%         $14        ($4)       -24%
maneuvers, phleborheography, impedance
plethysmography)                                           -TC        $105       $80     ($25)     -24%         $73        ($32)      -30%
Duplex scan of extremity veins including responses to     93970       $254      $189     ($65)     -25%         $180       ($74)      -29%
compression and other maneuvers; complete bilateral        -26         $35      $27       ($8)     -22%          $27        ($8)      -24%
study                                                      -TC        $219      $162     ($57)     -26%         $153       ($66)      -30%
Duplex scan of extremity veins including responses to     93971       $168      $125     ($43)     -26%         $117       ($51)      -31%
compression and other maneuvers; unilateral or             -26         $23      $18       ($5)     -20%          $18        ($5)      -22%
limited study                                              -TC        $145      $107     ($38)     -27%          $99       ($46)      -32%
ASE 2010 Final MPFS Payments with CF $28.4061 and $36.0666                                                                                             November 16, 2009

      Comparision of Echocardiography and Vascular Ultrasound Physician Fee Schedule Payments
The 2010 Medicare Physician Fee Schedule final rule was released by the Centers for Medicare and Medicaid Services (CMS) on Friday, Oct. 30 2009. Included in the
rule are several provisions that will significantly reduce payments for echocardiography and vascular ultrasound procedures. Effective Jan.1, 2010, the conversion factor
will be $28.4061. This is a 21.2 percent decrease from the current 2009 conversion factor of $36.066. Congressional legislation is currently being debated to repeal the
Sustainable Growth Rate (SGR) formula which is used in the calculation of the conversion factor. The repeal if passed, will be part of a health reform bill or as a separate
bill. In addition to the conversion factor reduction and despite the extraordinary opposition to the proposed reductions in cardiology services, CMS incorporated the AMA
Physician Practice Information Survey into its rate-setting formula. The impact on TTE with spectral and color Doppler (CPT 93306) will be a reduction of about 10% of
the total Relative Value Units(RVUs) assigned to 93306 in 2010; these reductions are scheduled to continue for four years.

Below is a table that illustrates the national payment reductions for 2010 and the fully implemented practice expense reduction if the conversion factor remains at
$36.0666.
CY 2009 Comparison to 2010 Physician Fee Schedule Medicare Payments(Conversion Factor $36.0666)

                                                         CPT CODE &         2009          2010          DIFF                      2013 FULLY DIFF $$$           DIFF %%%
                    DESCRIPTION                                                                                    DIFF %%%
                                                          MODIFIER        PAYMENT       PAYMENT         $$$                     IMPLEMENTED from 2009           from 2009


                                                                          ECHOCARDIOGRAPHY
3 DIMENSIONAL RENDERING
3D rendering with interpretation and reporting of            76376           $80           $72           ($8)         -10%             $52            ($28)           -35%
computed tomography, magnetic resonance imaging,
ultrasound, or other tomographic modality; not                 -26           $11           $10           ($1)         -5%              $10            ($1)            -11%
requiring image post-processing on an independent
workstation                                                    -TC           $69           $62           ($7)         -11%             $43            ($26)           -38%

                                                             76377           $114          $95          ($19)         -16%             $73            ($41)           -36%
3D rendering with interpretation and reporting of
computed tomography, magnetic resonance imaging,
                                                               -26           $42           $40           ($2)         -6%              $38            ($4)            -9%
ultrasound, or other tomographic modality; requiring
image post-processing on an independent workstation
                                                               -TC           $71           $56          ($15)         -22%             $35            ($36)           -51%
ECHOCARDIOGRAM, FETAL HEART
Echocardiography, fetal, cardiovascular system, real         76825           $207          $205          ($2)         -1%             $204            ($3)            -1%
time with image documentation (2D) with or without M-         -26             $83          $82           ($1)         -1%              $83             $0             0%
mode recording; complete                                      -TC            $124          $123          ($1)         -1%             $121            ($3)            -3%
Echocardiography, fetal, cardiovascular system, real         76826           $114          $116          $2           2%              $120             $6             6%
time with image documentation (2D) with or without M-          -26           $40           $41           $1            2%              $41             $1             4%
mode recording; follow up or repeat study                     -TC            $74           $75           $1            1%              $79              $5             7%
                                                             76827           $72           $66           ($6)          -8%             $58            ($14)           -20%
Doppler echocardiography, fetal, pulsed wave and/or
                                                              -26            $28           $28           $0            2%              $29              $1             3%
continuous wave with spectral display; complete
                                                              -TC            $44           $38           ($6)         -15%             $29            ($15)           -34%
Doppler echocardiography, fetal, pulsed wave and/or          76828           $53           $49           ($4)          -7%             $44             ($9)           -18%
continuous wave with spectral display; follow-up or           -26            $28           $27           ($1)          -2%             $28              $0             0%
repeat study                                                  -TC            $26           $22           ($4)         -17%             $16            ($10)           -40%
ASE 2010 Final MPFS Payments with CF $28.4061 and $36.0666                                                                    November 16, 2009

                                                        CPT CODE &     2009       2010    DIFF                  2013 FULLY DIFF $$$   DIFF %%%
                   DESCRIPTION                                                                     DIFF %%%
                                                         MODIFIER    PAYMENT    PAYMENT   $$$                 IMPLEMENTED from 2009   from 2009


ECHOCARDIOGRAM, STRESS

Echocardiography, transthoracic, real-time with image        93350    $212       $203     ($9)       -4%          $184       ($28)      -13%
documentation (2D), includes M-mode recording, when
performed, during rest and cardiovascular stress test         -26      $80        $78     ($2)       -3%          $71        ($9)       -11%
using treadmill, bicycle exercise and/or
pharmacologically induced stress, with interpretation
                                                              -TC     $131       $126     ($5)       -4%          $113       ($18)      -14%


                                                             93351    $277       $242     ($35)      -13%         $214       ($63)      -23%
Echocardiography, transthoracic, real-time with image
documentation (2D), includes M-mode recording, when
performed, during rest and cardiovascular stress test         -26      ------     $95     ------     ------       $86        ------     ------
using treadmill, bicycle exercise and/or
pharmacologically induced stress, with interpretation
                                                              -TC      ------    $147     ------     ------       $128       ------     ------

Use of echocardiographic contrast agent during stress
echocardiography (List separately in addition to code        93352     $39        $36     ($3)       -8%          $30        ($9)       -24%
for primary procedure)
ASE 2010 Final MPFS Payments with CF $28.4061 and $36.0666                                                                 November 16, 2009

                                                        CPT CODE &     2009      2010    DIFF                2013 FULLY DIFF $$$   DIFF %%%
                    DESCRIPTION                                                                 DIFF %%%
                                                         MODIFIER    PAYMENT   PAYMENT   $$$               IMPLEMENTED from 2009   from 2009


STRESS TEST
Cardiovascular stress test using maximal or
submaximal treadmill or bicycle exercise, continuous
electrocardiographic monitoring, and/or                      93015    $100       $93     ($7)     -7%          $77        ($23)      -23%
pharmacological stress; with physician supervision,
with interpretation and report
Cardiovascular stress test using maximal or
submaximal treadmill or bicycle exercise, continuous
electrocardiographic monitoring, and/or                      93016     $25       $24     ($1)     -5%          $22        ($3)       -12%
pharmacological stress; physician supervision only,
without interpretation and report.
Cardiovascular stress test using maximal or
submaximal treadmill or bicycle exercise, continuous
electrocardiographic monitoring, and/or                      93017     $60       $53     ($7)     -12%         $40        ($20)      -33%
pharmacological stress; tracing only, without
interpretation and report.

Cardiovascular stress test using maximal or
submaximal treadmill or bicycle exercise, continuous
                                                             93018     $16       $16     ($0)     -1%          $15        ($1)       -8%
electrocardiographic monitoring, and/or
pharmacological stress;interpretation and report only
ASE 2010 Final MPFS Payments with CF $28.4061 and $36.0666                                                                    November 16, 2009

                                                          CPT CODE &     2009      2010    DIFF                 2013 FULLY DIFF $$$   DIFF %%%
                    DESCRIPTION                                                                    DIFF %%%
                                                           MODIFIER    PAYMENT   PAYMENT   $$$                IMPLEMENTED from 2009   from 2009


ECHOCARDIOGRAM, TRANSESOPHAGEAL – ADULT AND CONGENITAL

Transesophageal echocardiography (TEE) real time             93312      $326      $311     ($15)     -5%          $284       ($42)      -13%
with image documentation (2D) (with or without M-
                                                              -26       $116      $113     ($3)      -3%          $105       ($11)      -10%
mode recording); including probe placement, image
acquisition, interpretation and report                        -TC       $210      $198     ($12)     -6%          $179       ($31)      -15%
Transesophageal echocardiography (TEE) real time
with image documentation (2D) (with or without M-            93313       $41       $41     $0        1%           $42        $1          3%
mode recording); placement of transesophageal probe
only.
Transesophageal Echocardiography (TEE) real time             93314      $280      $269     ($11)     -4%          $252       ($28)      -10%
with image documentation (2D) (with or without M-
                                                              -26        $66       $65     ($1)      -2%          $61        ($5)       -8%
mode recording); image acquisition, interpretation and
report only.                                                  -TC       $215      $205     ($10)     -5%          $192       ($23)      -11%

                                                             93315       $0        $0      $0        0%            $0        $0          0%
Transesophageal Echocardiography (TEE) for
congenital cardiac anomalies; including probe                 -26       $149      $149     ($0)      0%           $138       ($11)      -7%
placement, image acquisition, interpretation and report
                                                              -TC        $0        $0      $0        0%            $0        $0          0%
Transesophageal Echocardiography (TEE) for
congenital cardiac anomalies; placement of                   93316       $45       $45     $0        0%           $44        ($1)       -2%
transesophageal probe only
Transesophageal Echocardiography (TEE) for                   93317        $0        $0     $0        0%           $0          $0        0%
congenital cardiac anomalies; image acquisition,              -26        $92       $94     $2        3%           $91        ($1)       -1%
interpretation and report only.                               -TC         $0        $0     $0        0%           $0          $0        0%

Echocardiography, transesophageal (TEE) for                  93318       $0        $0      $0        0%            $0        $0          0%
monitoring purposes, including probe placement, real
time 2-dimensional image acquisition and interpretation
                                                              -26       $113      $115     $2        2%           $111       ($2)       -1%
leading to ongoing (continuous) assessment of
(dynamically changing) cardiac pumping function and
to t                                                          -TC        $0        $0      $0        0%            $0        $0          0%
ASE 2010 Final MPFS Payments with CF $28.4061 and $36.0666                                                                   November 16, 2009

                                                         CPT CODE &     2009      2010    DIFF                 2013 FULLY DIFF $$$   DIFF %%%
                    DESCRIPTION                                                                   DIFF %%%
                                                          MODIFIER    PAYMENT   PAYMENT   $$$                IMPLEMENTED from 2009   from 2009


ECHOCARDIOGRAM, TRANSTHORACIC – ADULT AND CONGENITAL
                                                    93303              $218      $204     ($14)     -6%          $177       ($41)      -19%
Transthoracic echocardiography (TTE) for congenital
                                                     -26                $69      $68       ($1)     -2%           $64        ($5)       -7%
cardiac anomalies; complete
                                                     -TC               $149      $136     ($13)     -9%          $113       ($36)      -24%
                                                    93304              $135      $129      ($6)     -5%          $118       ($17)      -13%
Transthoracic echocardiography (TTE) for congenital
                                                     -26                $39      $39       ($0)     -1%           $37        ($2)       -6%
cardiac anomalies; follow-up or limited study
                                                     -TC                $96      $90       ($6)     -6%           $81       ($15)      -16%

Echocardiography, transthoracic, real-time with image        93306     $268      $238     ($30)     -11%         $173       ($95)      -35%
documentation (2D), includes M-mode recording, when
performed, complete, with spectral Doppler                    -26       $72       $70     ($2)      -3%          $64        ($8)       -11%
echocardiography, and with color flow Doppler
echocardiography                                              -TC      $196      $168     ($28)     -14%         $110       ($86)      -44%

Echocardiography, transthoracic, real-time with image        93307     $177      $154     ($23)     -13%         $102       ($75)      -43%
documentation (2D), includes M-mode recording, when
                                                              -26       $50       $49     ($1)      -3%          $45        ($5)       -10%
performed, complete, without spectral or color Doppler
echocardiography
                                                              -TC      $127      $105     ($22)     -17%         $57        ($70)      -55%

                                                             93308     $112      $104     ($8)      -8%          $87        ($25)      -22%
Echocardiography, transthoracic, real-time with image
documentation (2D), includes M-mode recording, when           -26       $29       $28     ($1)      -3%          $26        ($3)       -10%
performed, follow-up or limited study
                                                              -TC       $83       $75     ($8)      -9%          $61        ($22)      -26%
DOPPLER
Doppler echocardiography, pulsed wave and/or                 93320      $78       $67     ($11)     -14%         $42        ($36)      -46%
continuous wave with spectral display (List separately
                                                              -26       $21       $20     ($1)      -4%          $19        ($2)       -11%
in addition to codes for echocardiographic imaging);
complete.                                                     -TC       $58       $47     ($11)     -19%         $23        ($35)      -60%

Doppler echocardiography, pulsed wave and/or                 93321      $35       $30     ($5)      -13%         $22        ($13)      -37%
continuous wave with spectral display (List separately
                                                              -26       $8        $8      $0        4%            $8        ($0)       -5%
in addition to codes for echocardiographic imaging);
follow-up or limited study.
                                                              -TC       $27       $22     ($5)      -19%         $14        ($13)      -47%

                                                             93325      $54       $40     ($14)     -25%         $18        ($36)      -67%
Doppler echocardiography color flow velocity mapping
(List separately in addition to codes for                     -26       $4        $4      ($0)      -1%           $4        ($0)       -10%
echocardiographic imaging)
                                                              -TC       $50       $36     ($14)     -27%         $14        ($36)      -71%
ASE 2010 Final MPFS Payments with CF $28.4061 and $36.0666                                                                  November 16, 2009

                                                        CPT CODE &     2009      2010    DIFF                 2013 FULLY DIFF $$$   DIFF %%%
                   DESCRIPTION                                                                   DIFF %%%
                                                         MODIFIER    PAYMENT   PAYMENT   $$$                IMPLEMENTED from 2009   from 2009


                                                                        VASCULAR
ABDOMINAL AORTIC ANEURYSM (AAA) SCREENING
Ultrasound B-scan and/or real time with image             G0389       $111      $107     ($4)      -4%          $97        ($14)      -13%
documentation; for abdominal aortic aneurysm (AAA)         -26         $30      $30      ($0)      -1%          $28         ($2)       -6%
screening                                                  -TC         $81      $77      ($4)      -5%          $69        ($12)      -15%
ABDOMINAL DUPLEX – AORTA, IVC, ILIAC, BYPASS GRAFTS
                                                          93978       $239      $227     ($13)     -5%          $216       ($23)      -10%
Duplex scan of aorta, inferior vena cava, iliac
                                                           -26         $34      $33       ($1)     -2%           $33        ($1)       -3%
vasculature or bypass grafts; complete study
                                                           -TC        $205      $193     ($12)     -6%          $183       ($22)      -11%
                                                          93979       $165      $157      ($8)     -5%          $148       ($17)      -10%
Duplex scan of aorta, inferior vena cava, iliac
                                                           -26         $22      $22       $0       2%            $22         $0        0%
vasculature or bypass grafts; unilateral or limited study
                                                           -TC        $142      $134      ($8)     -6%          $126       ($16)      -11%
ABDOMINAL DUPLEX – ARTERIAL INFLOW/VENOUS OUTFLOW
Duplex scan of arterial inflow and venous outflow of      93975       $378      $360     ($18)     -5%          $334       ($44)      -12%
abdominal, pelvic, scrotal contents and/or                 -26         $93      $92       ($1)     -1%           $89        ($4)       -4%
retroperitoneal organs; complete study                     -TC        $285      $269     ($16)     -6%          $245       ($40)      -14%
Duplex scan of arterial inflow and venous outflow of      93976       $218      $206     ($12)     -5%          $190       ($28)      -13%
abdominal, pelvic, scrotal contents and/or                 -26         $61      $61       $0       1%            $59        ($2)       -3%
retroperitoneal organs; limited study                      -TC        $157      $145     ($12)     -8%          $131       ($26)      -16%
ASE 2010 Final MPFS Payments with CF $28.4061 and $36.0666                                                                       November 16, 2009

                                                            CPT CODE &     2009      2010    DIFF                  2013 FULLY DIFF $$$   DIFF %%%
                     DESCRIPTION                                                                      DIFF %%%
                                                             MODIFIER    PAYMENT   PAYMENT   $$$                 IMPLEMENTED from 2009   from 2009


ARTERIAL - UPPER AND LOWER EXTREMITIES
Noninvasive physiologic studies of upper or lower             93922       $120      $117      ($4)      -3%          $113       ($7)       -6%
extremity arteries, single level, bilateral (eg,
ankle/brachial indices, Doppler waveform analysis,             -26         $13       $12      ($1)      -6%          $12        ($1)       -6%
volume plethysmography, transcutaneous oxygen
tension measurement)                                           -TC        $108      $104      ($4)      -3%          $100       ($8)       -7%


                                                              93923       $186      $179      ($7)      -4%          $172       ($14)      -8%
Non-invasive physiologic studies of upper or lower
extremity arteries, multiple levels or with provocative
functional maneuvers, complete bilateral study (eg,            -26         $23       $23      ($0)      -1%          $22        ($1)       -3%
segmental blood pressure measurements, segmental
Doppler waveform analysis, segmental volume ple
                                                               -TC        $163      $157      ($6)      -4%          $149       ($14)      -8%

Non-invasive physiologic studies of lower extremity           93924       $229      $221       ($8)      -4%         $209       ($20)       -9%
arteries, at rest and following treadmill stress testing,      -26         $26      $26        ($0)      -2%          $25        ($1)       -4%
complete bilateral study                                       -TC        $203      $195       ($8)      -4%         $184       ($19)       -9%
                                                              93925       $308      $296      ($12)      -4%         $276       ($32)      -10%
Duplex scan of lower extremity arteries or arterial
                                                               -26         $30      $29        ($1)      -3%          $29        ($1)       -4%
bypass grafts; complete bilateral study
                                                               -TC        $279      $267      ($12)      -4%         $247       ($32)      -11%
                                                              93926       $197      $190       ($7)      -3%         $184       ($13)       -7%
Duplex scan of lower extremity arteries or arterial
                                                               -26         $20      $20        $0        1%           $20        ($0)       -1%
bypass grafts; unilateral or limited study
                                                               -TC        $177      $170       ($7)      -4%         $164       ($13)       -7%
                                                              93930       $244      $232      ($12)      -5%         $221       ($23)       -9%
Duplex scan of upper extremity arteries or arterial
                                                               -26         $24      $23        ($1)      -2%          $23        ($1)       -4%
bypass grafts; complete bilateral study
                                                               -TC        $220      $209      ($11)      -5%         $198       ($22)      -10%
                                                              93931       $163      $155       ($8)      -5%         $146       ($17)      -10%
Duplex scan of upper extremity arteries or arterial
                                                               -26         $16      $140     $124       772%          $16        ($0)       -3%
bypass grafts; unilateral or limited study
                                                               -TC        $148      $16      ($132)     -90%         $131       ($17)      -12%
ASE 2010 Final MPFS Payments with CF $28.4061 and $36.0666                                                                     November 16, 2009

                                                           CPT CODE &     2009      2010    DIFF                 2013 FULLY DIFF $$$   DIFF %%%
                     DESCRIPTION                                                                    DIFF %%%
                                                            MODIFIER    PAYMENT   PAYMENT   $$$                IMPLEMENTED from 2009   from 2009


CEREBROVASCULAR EXAM – EXTRACRANIAL

                                                             93875       $101       $98     ($3)      -3%          $94        ($7)       -7%
Noninvasive physiologic studies of extracranial
arteries, complete bilateral study (eg, periorbital flow
direction with arterial compression, ocular                   -26         $11       $11     $0        2%           $11        $0          2%
pneumoplethysmography, Doppler ultrasound spectral
analysis)
                                                              -TC         $90       $87     ($3)      -3%          $83        ($7)       -8%

                                                             93880       $248      $235     ($13)     -5%          $217       ($31)      -12%
Duplex scan of extracranial arteries; complete bilateral
                                                              -26         $31      $31       ($0)     -1%           $30        ($1)       -5%
study
                                                              -TC        $217      $205     ($13)     -6%          $188       ($29)      -13%
                                                             93882       $164      $159      ($5)     -3%          $159        ($5)       -3%
Duplex scan of extracranial arteries; unilateral or
                                                              -26         $21      $21       ($0)     -2%           $21        ($0)       -2%
limited study
                                                              -TC        $143      $139      ($5)     -3%          $139        ($4)       -3%
HEMODIALYSIS SHUNT
                                                             93990       $193      $190     ($3)      -1%          $196        $3         1%
Duplex scan of hemodialysis access (including arterial
                                                              -26         $13      $13      ($0)      -3%           $13       ($0)        0%
inflow, body of access and venous outflow)
                                                              -TC        $180      $178     ($2)      -1%          $183        $3         2%

Vessel mapping of vessels for hemodialysis access            G0365       $193      $190     ($3)      -2%          $195       $2          1%
(services for preoperative vessel mapping prior to
creation of hemodialysis access using an autogenous           -26         $12       $12     $0        2%           $13        $1          5%
hemodialysis conduit, including arterial inflow and
venous outflow) (Medicare only)                               -TC        $180      $178     ($2)      -1%          $183       $3          2%
TRANSCRANIAL DOPPLER
                                                             93886       $298      $296     ($2)      -1%          $319       $21         7%
Transcranial Doppler study of the intracranial arteries;
                                                              -26         $47      $47      ($0)      -1%           $47        $0         1%
complete study
                                                              -TC        $251      $250     ($1)      0%           $272       $21         8%
                                                             93888       $203      $197     ($6)      -3%          $199       ($4)        -2%
Transcranial Doppler study of the intracranial arteries;
                                                              -26         $32      $31      ($1)      -2%           $31       ($1)        -2%
limited study
                                                              -TC        $171      $166     ($5)      -3%           $68      ($103)      -60%
                                                             93890       $262      $260     ($2)      -1%          $281       $19         7%
Transcranial Doppler study of the intracranial arteries;
                                                              -26         $50      $50      ($0)      0%            $50        $0         1%
vasoreactivity study
                                                              -TC        $212      $210     ($2)      -1%          $230       $18         9%
Transcranial Doppler study of the intracranial arteries;     93892       $287      $298     $11       4%           $359       $72        25%
emboli detection without intravenous microbubble              -26         $57      $57      ($0)      -1%           $58        $1         2%
injection                                                     -TC        $230      $241     $11       5%           $300       $70        31%
                                                             93893       $286      $292      $6       2%           $334       $48        17%
Transcranial Doppler study of the intracranial arteries;
                                                              -26         $57      $57       $0       1%            $58        $1         3%
emboli detection with intravenous microbubble injection
ASE 2010 Final MPFS Payments with CF $28.4061 and $36.0666                                                                    November 16, 2009

                                                           CPT CODE &     2009      2010    DIFF                2013 FULLY DIFF $$$   DIFF %%%
                    DESCRIPTION                                                                    DIFF %%%
                                                            MODIFIER    PAYMENT   PAYMENT   $$$               IMPLEMENTED from 2009   from 2009
Transcranial Doppler study of the intracranial arteries;
emboli detection with intravenous microbubble injection
                                                              -TC        $229      $234     $5       2%           $276       $47        20%
ASE 2010 Final MPFS Payments with CF $28.4061 and $36.0666                                                                  November 16, 2009

                                                        CPT CODE &     2009      2010    DIFF                 2013 FULLY DIFF $$$   DIFF %%%
                    DESCRIPTION                                                                  DIFF %%%
                                                         MODIFIER    PAYMENT   PAYMENT   $$$                IMPLEMENTED from 2009   from 2009


VENOUS EXTREMITIES

Non-invasive physiologic studies of extremity veins,         93965    $123      $119     ($4)      -4%          $110       ($13)      -11%
complete bilateral study (eg, Doppler waveform
analysis with responses to compression and other              -26      $18       $18     ($0)      -2%          $17        ($1)       -4%
maneuvers, phleborheography, impedance
plethysmography)                                              -TC     $105      $101     ($4)      -4%          $93        ($12)      -12%
Duplex scan of extremity veins including responses to        93970    $254      $241     ($13)     -5%          $228       ($26)      -10%
compression and other maneuvers; complete bilateral           -26      $35      $35       ($0)     -1%           $34        ($1)       -3%
study                                                         -TC     $219      $206     ($13)     -6%          $194       ($25)      -11%
Duplex scan of extremity veins including responses to        93971    $168      $159      ($9)     -6%          $148       ($20)      -12%
compression and other maneuvers; unilateral or                -26      $23      $23       $0       2%            $23        ($0)       -1%
limited study                                                 -TC     $145      $135     ($10)     -7%          $126       ($19)      -13%

								
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