APC-Based_Fee_Schedule_04.01.11_Excel_Ver_

Document Sample
APC-Based_Fee_Schedule_04.01.11_Excel_Ver_ Powered By Docstoc
					Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                           Description          January 2011   January 2011   January 2011     January 2011 Description
  HCPCS                             (short)



00100       Anesth, salivary gland                          N              N
00102       Anesth, repair of cleft lip                     N              N
00103       Anesth, blepharoplasty                          N              N
00104       Anesth, electroshock                            N              N
00120       Anesth, ear surgery                             N              N
00124       Anesth, ear exam                                N              N
00126       Anesth, tympanotomy                             N              N
00140       Anesth, procedures on eye                       N              N
00142       Anesth, lens surgery                            N              N
00144       Anesth, corneal transplant                      N              N
00145       Anesth, vitreoretinal surg                      N              N
00147       Anesth, iridectomy                              N              N
00148       Anesth, eye exam                                N              N
00160       Anesth, nose/sinus surgery                      N              N
00162       Anesth, nose/sinus surgery                      N              N
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                           Description           January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                             (short)            Relative Weights



00100       Anesth, salivary gland                          0.0000               0.00
00102       Anesth, repair of cleft lip                     0.0000               0.00
00103       Anesth, blepharoplasty                          0.0000               0.00
00104       Anesth, electroshock                            0.0000               0.00
00120       Anesth, ear surgery                             0.0000               0.00
00124       Anesth, ear exam                                0.0000               0.00
00126       Anesth, tympanotomy                             0.0000               0.00
00140       Anesth, procedures on eye                       0.0000               0.00
00142       Anesth, lens surgery                            0.0000               0.00
00144       Anesth, corneal transplant                      0.0000               0.00
00145       Anesth, vitreoretinal surg                      0.0000               0.00
00147       Anesth, iridectomy                              0.0000               0.00
00148       Anesth, eye exam                                0.0000               0.00
00160       Anesth, nose/sinus surgery                      0.0000               0.00
00162       Anesth, nose/sinus surgery                      0.0000               0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                           Description           January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                             (short)



00100       Anesth, salivary gland                          0.00                0.00                0.00
00102       Anesth, repair of cleft lip                     0.00                0.00                0.00
00103       Anesth, blepharoplasty                          0.00                0.00                0.00
00104       Anesth, electroshock                            0.00                0.00                0.00
00120       Anesth, ear surgery                             0.00                0.00                0.00
00124       Anesth, ear exam                                0.00                0.00                0.00
00126       Anesth, tympanotomy                             0.00                0.00                0.00
00140       Anesth, procedures on eye                       0.00                0.00                0.00
00142       Anesth, lens surgery                            0.00                0.00                0.00
00144       Anesth, corneal transplant                      0.00                0.00                0.00
00145       Anesth, vitreoretinal surg                      0.00                0.00                0.00
00147       Anesth, iridectomy                              0.00                0.00                0.00
00148       Anesth, eye exam                                0.00                0.00                0.00
00160       Anesth, nose/sinus surgery                      0.00                0.00                0.00
00162       Anesth, nose/sinus surgery                      0.00                0.00                0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011     January 2011 Description
  HCPCS                            (short)



00164       Anesth, biopsy of nose                          N              N
00170       Anesth, procedure on mouth                      N              N
00172       Anesth, cleft palate repair                     N              N
00174       Anesth, pharyngeal surgery                      N              N
00176       Anesth, pharyngeal surgery                      C              C
00190       Anesth, face/skull bone surg                    N              N
00192       Anesth, facial bone surgery                     C              C
00210       Anesth, cranial surg nos                        N              N
00211       Anesth, cran surg, hemotoma                     C              C
00212       Anesth, skull drainage                          N              N
00214       Anesth, skull drainage                          C              C
00215       Anesth, skull repair/fract                      C              C
00216       Anesth, head vessel surgery                     N              N
00218       Anesth, special head surgery                    N              N
00220       Anesth, intrcrn nerve                           N              N
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



00164       Anesth, biopsy of nose                          0.0000               0.00
00170       Anesth, procedure on mouth                      0.0000               0.00
00172       Anesth, cleft palate repair                     0.0000               0.00
00174       Anesth, pharyngeal surgery                      0.0000               0.00
00176       Anesth, pharyngeal surgery                      0.0000               0.00
00190       Anesth, face/skull bone surg                    0.0000               0.00
00192       Anesth, facial bone surgery                     0.0000               0.00
00210       Anesth, cranial surg nos                        0.0000               0.00
00211       Anesth, cran surg, hemotoma                     0.0000               0.00
00212       Anesth, skull drainage                          0.0000               0.00
00214       Anesth, skull drainage                          0.0000               0.00
00215       Anesth, skull repair/fract                      0.0000               0.00
00216       Anesth, head vessel surgery                     0.0000               0.00
00218       Anesth, special head surgery                    0.0000               0.00
00220       Anesth, intrcrn nerve                           0.0000               0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



00164       Anesth, biopsy of nose                          0.00                0.00                0.00
00170       Anesth, procedure on mouth                      0.00                0.00                0.00
00172       Anesth, cleft palate repair                     0.00                0.00                0.00
00174       Anesth, pharyngeal surgery                      0.00                0.00                0.00
00176       Anesth, pharyngeal surgery                      0.00                0.00                0.00
00190       Anesth, face/skull bone surg                    0.00                0.00                0.00
00192       Anesth, facial bone surgery                     0.00                0.00                0.00
00210       Anesth, cranial surg nos                        0.00                0.00                0.00
00211       Anesth, cran surg, hemotoma                     0.00                0.00                0.00
00212       Anesth, skull drainage                          0.00                0.00                0.00
00214       Anesth, skull drainage                          0.00                0.00                0.00
00215       Anesth, skull repair/fract                      0.00                0.00                0.00
00216       Anesth, head vessel surgery                     0.00                0.00                0.00
00218       Anesth, special head surgery                    0.00                0.00                0.00
00220       Anesth, intrcrn nerve                           0.00                0.00                0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011     January 2011 Description
  HCPCS                            (short)



00222       Anesth, head nerve surgery                      N              N
00300       Anesth, head/neck/ptrunk                        N              N
00320       Anesth, neck organ, 1 & over                    N              N
00322       Anesth, biopsy of thyroid                       N              N
00326       Anesth, larynx/trach, < 1 yr                    N              N
00350       Anesth, neck vessel surgery                     N              N
00352       Anesth, neck vessel surgery                     N              N
00400       Anesth, skin, ext/per/atrunk                    N              N
00402       Anesth, surgery of breast                       N              N
00404       Anesth, surgery of breast                       N              N
00406       Anesth, surgery of breast                       N              N
00410       Anesth, correct heart rhythm                    N              N
00450       Anesth, surgery of shoulder                     N              N
00452       Anesth, surgery of shoulder                     C              C
00454       Anesth, collar bone biopsy                      N              N
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



00222       Anesth, head nerve surgery                      0.0000               0.00
00300       Anesth, head/neck/ptrunk                        0.0000               0.00
00320       Anesth, neck organ, 1 & over                    0.0000               0.00
00322       Anesth, biopsy of thyroid                       0.0000               0.00
00326       Anesth, larynx/trach, < 1 yr                    0.0000               0.00
00350       Anesth, neck vessel surgery                     0.0000               0.00
00352       Anesth, neck vessel surgery                     0.0000               0.00
00400       Anesth, skin, ext/per/atrunk                    0.0000               0.00
00402       Anesth, surgery of breast                       0.0000               0.00
00404       Anesth, surgery of breast                       0.0000               0.00
00406       Anesth, surgery of breast                       0.0000               0.00
00410       Anesth, correct heart rhythm                    0.0000               0.00
00450       Anesth, surgery of shoulder                     0.0000               0.00
00452       Anesth, surgery of shoulder                     0.0000               0.00
00454       Anesth, collar bone biopsy                      0.0000               0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



00222       Anesth, head nerve surgery                      0.00                0.00                0.00
00300       Anesth, head/neck/ptrunk                        0.00                0.00                0.00
00320       Anesth, neck organ, 1 & over                    0.00                0.00                0.00
00322       Anesth, biopsy of thyroid                       0.00                0.00                0.00
00326       Anesth, larynx/trach, < 1 yr                    0.00                0.00                0.00
00350       Anesth, neck vessel surgery                     0.00                0.00                0.00
00352       Anesth, neck vessel surgery                     0.00                0.00                0.00
00400       Anesth, skin, ext/per/atrunk                    0.00                0.00                0.00
00402       Anesth, surgery of breast                       0.00                0.00                0.00
00404       Anesth, surgery of breast                       0.00                0.00                0.00
00406       Anesth, surgery of breast                       0.00                0.00                0.00
00410       Anesth, correct heart rhythm                    0.00                0.00                0.00
00450       Anesth, surgery of shoulder                     0.00                0.00                0.00
00452       Anesth, surgery of shoulder                     0.00                0.00                0.00
00454       Anesth, collar bone biopsy                      0.00                0.00                0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011     January 2011 Description
  HCPCS                            (short)



00470       Anesth, removal of rib                          N              N
00472       Anesth, chest wall repair                       N              N
00474       Anesth, surgery of rib(s)                       C              C
00500       Anesth, esophageal surgery                      N              N
00520       Anesth, chest procedure                         N              N
00522       Anesth, chest lining biopsy                     N              N
00524       Anesth, chest drainage                          C              C
00528       Anesth, chest partition view                    N              N
00529       Anesth, chest partition view                    N              N
00530       Anesth, pacemaker insertion                     N              N
00532       Anesth, vascular access                         N              N
00534       Anesth, cardioverter/defib                      N              N
00537       Anesth, cardiac electrophys                     N              N
00539       Anesth, trach-bronch reconst                    N              N
00540       Anesth, chest surgery                           C              C
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



00470       Anesth, removal of rib                          0.0000               0.00
00472       Anesth, chest wall repair                       0.0000               0.00
00474       Anesth, surgery of rib(s)                       0.0000               0.00
00500       Anesth, esophageal surgery                      0.0000               0.00
00520       Anesth, chest procedure                         0.0000               0.00
00522       Anesth, chest lining biopsy                     0.0000               0.00
00524       Anesth, chest drainage                          0.0000               0.00
00528       Anesth, chest partition view                    0.0000               0.00
00529       Anesth, chest partition view                    0.0000               0.00
00530       Anesth, pacemaker insertion                     0.0000               0.00
00532       Anesth, vascular access                         0.0000               0.00
00534       Anesth, cardioverter/defib                      0.0000               0.00
00537       Anesth, cardiac electrophys                     0.0000               0.00
00539       Anesth, trach-bronch reconst                    0.0000               0.00
00540       Anesth, chest surgery                           0.0000               0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



00470       Anesth, removal of rib                          0.00                0.00                0.00
00472       Anesth, chest wall repair                       0.00                0.00                0.00
00474       Anesth, surgery of rib(s)                       0.00                0.00                0.00
00500       Anesth, esophageal surgery                      0.00                0.00                0.00
00520       Anesth, chest procedure                         0.00                0.00                0.00
00522       Anesth, chest lining biopsy                     0.00                0.00                0.00
00524       Anesth, chest drainage                          0.00                0.00                0.00
00528       Anesth, chest partition view                    0.00                0.00                0.00
00529       Anesth, chest partition view                    0.00                0.00                0.00
00530       Anesth, pacemaker insertion                     0.00                0.00                0.00
00532       Anesth, vascular access                         0.00                0.00                0.00
00534       Anesth, cardioverter/defib                      0.00                0.00                0.00
00537       Anesth, cardiac electrophys                     0.00                0.00                0.00
00539       Anesth, trach-bronch reconst                    0.00                0.00                0.00
00540       Anesth, chest surgery                           0.00                0.00                0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011     January 2011 Description
  HCPCS                            (short)



00541       Anesth, one lung ventilation                    N              N
00542       Anesth, release of lung                         C              C
00546       Anesth, lung,chest wall surg                    C              C
00548       Anesth, trachea,bronchi surg                    N              N
00550       Anesth, sternal debridement                     N              N
00560       Anesth, heart surg w/o pump                     C              C
00561       Anesth, heart surg < age 1                      C              C
00562       Anesth hrt surg w/pmp age 1+                    C              C
00563       Anesth, heart surg w/arrest                     N              N
00566       Anesth, cabg w/o pump                           N              N
00567       Anesth, cabg w/pump                             C              C
00580       Anesth, heart/lung transplnt                    C              C
00600       Anesth, spine, cord surgery                     N              N
00604       Anesth, sitting procedure                       C              C
00620       Anesth, spine, cord surgery                     N              N
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



00541       Anesth, one lung ventilation                    0.0000               0.00
00542       Anesth, release of lung                         0.0000               0.00
00546       Anesth, lung,chest wall surg                    0.0000               0.00
00548       Anesth, trachea,bronchi surg                    0.0000               0.00
00550       Anesth, sternal debridement                     0.0000               0.00
00560       Anesth, heart surg w/o pump                     0.0000               0.00
00561       Anesth, heart surg < age 1                      0.0000               0.00
00562       Anesth hrt surg w/pmp age 1+                    0.0000               0.00
00563       Anesth, heart surg w/arrest                     0.0000               0.00
00566       Anesth, cabg w/o pump                           0.0000               0.00
00567       Anesth, cabg w/pump                             0.0000               0.00
00580       Anesth, heart/lung transplnt                    0.0000               0.00
00600       Anesth, spine, cord surgery                     0.0000               0.00
00604       Anesth, sitting procedure                       0.0000               0.00
00620       Anesth, spine, cord surgery                     0.0000               0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



00541       Anesth, one lung ventilation                    0.00                0.00                0.00
00542       Anesth, release of lung                         0.00                0.00                0.00
00546       Anesth, lung,chest wall surg                    0.00                0.00                0.00
00548       Anesth, trachea,bronchi surg                    0.00                0.00                0.00
00550       Anesth, sternal debridement                     0.00                0.00                0.00
00560       Anesth, heart surg w/o pump                     0.00                0.00                0.00
00561       Anesth, heart surg < age 1                      0.00                0.00                0.00
00562       Anesth hrt surg w/pmp age 1+                    0.00                0.00                0.00
00563       Anesth, heart surg w/arrest                     0.00                0.00                0.00
00566       Anesth, cabg w/o pump                           0.00                0.00                0.00
00567       Anesth, cabg w/pump                             0.00                0.00                0.00
00580       Anesth, heart/lung transplnt                    0.00                0.00                0.00
00600       Anesth, spine, cord surgery                     0.00                0.00                0.00
00604       Anesth, sitting procedure                       0.00                0.00                0.00
00620       Anesth, spine, cord surgery                     0.00                0.00                0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011     January 2011 Description
  HCPCS                            (short)



00622       Anesth, removal of nerves                       C              C
00625       Anes spine tranthor w/o vent                    N              N
00626       Anes, spine transthor w/vent                    N              N
00630       Anesth, spine, cord surgery                     N              N
00632       Anesth, removal of nerves                       C              C
00634       Anesth for chemonucleolysis                     N              N
00635       Anesth, lumbar puncture                         N              N
00640       Anesth, spine manipulation                      N              N
00670       Anesth, spine, cord surgery                     C              C
00700       Anesth, abdominal wall surg                     N              N
00702       Anesth, for liver biopsy                        N              N
00730       Anesth, abdominal wall surg                     N              N
00740       Anesth, upper gi visualize                      N              N
00750       Anesth, repair of hernia                        N              N
00752       Anesth, repair of hernia                        N              N
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



00622       Anesth, removal of nerves                       0.0000               0.00
00625       Anes spine tranthor w/o vent                    0.0000               0.00
00626       Anes, spine transthor w/vent                    0.0000               0.00
00630       Anesth, spine, cord surgery                     0.0000               0.00
00632       Anesth, removal of nerves                       0.0000               0.00
00634       Anesth for chemonucleolysis                     0.0000               0.00
00635       Anesth, lumbar puncture                         0.0000               0.00
00640       Anesth, spine manipulation                      0.0000               0.00
00670       Anesth, spine, cord surgery                     0.0000               0.00
00700       Anesth, abdominal wall surg                     0.0000               0.00
00702       Anesth, for liver biopsy                        0.0000               0.00
00730       Anesth, abdominal wall surg                     0.0000               0.00
00740       Anesth, upper gi visualize                      0.0000               0.00
00750       Anesth, repair of hernia                        0.0000               0.00
00752       Anesth, repair of hernia                        0.0000               0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



00622       Anesth, removal of nerves                       0.00                0.00                0.00
00625       Anes spine tranthor w/o vent                    0.00                0.00                0.00
00626       Anes, spine transthor w/vent                    0.00                0.00                0.00
00630       Anesth, spine, cord surgery                     0.00                0.00                0.00
00632       Anesth, removal of nerves                       0.00                0.00                0.00
00634       Anesth for chemonucleolysis                     0.00                0.00                0.00
00635       Anesth, lumbar puncture                         0.00                0.00                0.00
00640       Anesth, spine manipulation                      0.00                0.00                0.00
00670       Anesth, spine, cord surgery                     0.00                0.00                0.00
00700       Anesth, abdominal wall surg                     0.00                0.00                0.00
00702       Anesth, for liver biopsy                        0.00                0.00                0.00
00730       Anesth, abdominal wall surg                     0.00                0.00                0.00
00740       Anesth, upper gi visualize                      0.00                0.00                0.00
00750       Anesth, repair of hernia                        0.00                0.00                0.00
00752       Anesth, repair of hernia                        0.00                0.00                0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011     January 2011 Description
  HCPCS                            (short)



00754       Anesth, repair of hernia                        N              N
00756       Anesth, repair of hernia                        N              N
00770       Anesth, blood vessel repair                     N              N
00790       Anesth, surg upper abdomen                      N              N
00792       Anesth, hemorr/excise liver                     C              C
00794       Anesth, pancreas removal                        C              C
00796       Anesth, for liver transplant                    C              C
00797       Anesth, surgery for obesity                     N              N
00800       Anesth, abdominal wall surg                     N              N
00802       Anesth, fat layer removal                       C              C
00810       Anesth, low intestine scope                     N              N
00820       Anesth, abdominal wall surg                     N              N
00830       Anesth, repair of hernia                        N              N
00832       Anesth, repair of hernia                        N              N
00834       Anesth, hernia repair< 1 yr                     N              N
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



00754       Anesth, repair of hernia                        0.0000               0.00
00756       Anesth, repair of hernia                        0.0000               0.00
00770       Anesth, blood vessel repair                     0.0000               0.00
00790       Anesth, surg upper abdomen                      0.0000               0.00
00792       Anesth, hemorr/excise liver                     0.0000               0.00
00794       Anesth, pancreas removal                        0.0000               0.00
00796       Anesth, for liver transplant                    0.0000               0.00
00797       Anesth, surgery for obesity                     0.0000               0.00
00800       Anesth, abdominal wall surg                     0.0000               0.00
00802       Anesth, fat layer removal                       0.0000               0.00
00810       Anesth, low intestine scope                     0.0000               0.00
00820       Anesth, abdominal wall surg                     0.0000               0.00
00830       Anesth, repair of hernia                        0.0000               0.00
00832       Anesth, repair of hernia                        0.0000               0.00
00834       Anesth, hernia repair< 1 yr                     0.0000               0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



00754       Anesth, repair of hernia                        0.00                0.00                0.00
00756       Anesth, repair of hernia                        0.00                0.00                0.00
00770       Anesth, blood vessel repair                     0.00                0.00                0.00
00790       Anesth, surg upper abdomen                      0.00                0.00                0.00
00792       Anesth, hemorr/excise liver                     0.00                0.00                0.00
00794       Anesth, pancreas removal                        0.00                0.00                0.00
00796       Anesth, for liver transplant                    0.00                0.00                0.00
00797       Anesth, surgery for obesity                     0.00                0.00                0.00
00800       Anesth, abdominal wall surg                     0.00                0.00                0.00
00802       Anesth, fat layer removal                       0.00                0.00                0.00
00810       Anesth, low intestine scope                     0.00                0.00                0.00
00820       Anesth, abdominal wall surg                     0.00                0.00                0.00
00830       Anesth, repair of hernia                        0.00                0.00                0.00
00832       Anesth, repair of hernia                        0.00                0.00                0.00
00834       Anesth, hernia repair< 1 yr                     0.00                0.00                0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011     January 2011 Description
  HCPCS                            (short)



00836       Anesth hernia repair preemie                    N              N
00840       Anesth, surg lower abdomen                      N              N
00842       Anesth, amniocentesis                           N              N
00844       Anesth, pelvis surgery                          C              C
00846       Anesth, hysterectomy                            C              C
00848       Anesth, pelvic organ surg                       C              C
00851       Anesth, tubal ligation                          N              N
00860       Anesth, surgery of abdomen                      N              N
00862       Anesth, kidney/ureter surg                      N              N
00864       Anesth, removal of bladder                      C              C
00865       Anesth, removal of prostate                     C              C
00866       Anesth, removal of adrenal                      C              C
00868       Anesth, kidney transplant                       C              C
00870       Anesth, bladder stone surg                      N              N
00872       Anesth kidney stone destruct                    N              N
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



00836       Anesth hernia repair preemie                    0.0000               0.00
00840       Anesth, surg lower abdomen                      0.0000               0.00
00842       Anesth, amniocentesis                           0.0000               0.00
00844       Anesth, pelvis surgery                          0.0000               0.00
00846       Anesth, hysterectomy                            0.0000               0.00
00848       Anesth, pelvic organ surg                       0.0000               0.00
00851       Anesth, tubal ligation                          0.0000               0.00
00860       Anesth, surgery of abdomen                      0.0000               0.00
00862       Anesth, kidney/ureter surg                      0.0000               0.00
00864       Anesth, removal of bladder                      0.0000               0.00
00865       Anesth, removal of prostate                     0.0000               0.00
00866       Anesth, removal of adrenal                      0.0000               0.00
00868       Anesth, kidney transplant                       0.0000               0.00
00870       Anesth, bladder stone surg                      0.0000               0.00
00872       Anesth kidney stone destruct                    0.0000               0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



00836       Anesth hernia repair preemie                    0.00                0.00                0.00
00840       Anesth, surg lower abdomen                      0.00                0.00                0.00
00842       Anesth, amniocentesis                           0.00                0.00                0.00
00844       Anesth, pelvis surgery                          0.00                0.00                0.00
00846       Anesth, hysterectomy                            0.00                0.00                0.00
00848       Anesth, pelvic organ surg                       0.00                0.00                0.00
00851       Anesth, tubal ligation                          0.00                0.00                0.00
00860       Anesth, surgery of abdomen                      0.00                0.00                0.00
00862       Anesth, kidney/ureter surg                      0.00                0.00                0.00
00864       Anesth, removal of bladder                      0.00                0.00                0.00
00865       Anesth, removal of prostate                     0.00                0.00                0.00
00866       Anesth, removal of adrenal                      0.00                0.00                0.00
00868       Anesth, kidney transplant                       0.00                0.00                0.00
00870       Anesth, bladder stone surg                      0.00                0.00                0.00
00872       Anesth kidney stone destruct                    0.00                0.00                0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011     January 2011 Description
  HCPCS                            (short)



00873       Anesth kidney stone destruct                    N              N
00880       Anesth, abdomen vessel surg                     N              N
00882       Anesth, major vein ligation                     C              C
00902       Anesth, anorectal surgery                       N              N
00904       Anesth, perineal surgery                        C              C
00906       Anesth, removal of vulva                        N              N
00908       Anesth, removal of prostate                     C              C
00910       Anesth, bladder surgery                         N              N
00912       Anesth, bladder tumor surg                      N              N
00914       Anesth, removal of prostate                     N              N
00916       Anesth, bleeding control                        N              N
00918       Anesth, stone removal                           N              N
00920       Anesth, genitalia surgery                       N              N
00921       Anesth, vasectomy                               N              N
00922       Anesth, sperm duct surgery                      N              N
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



00873       Anesth kidney stone destruct                    0.0000               0.00
00880       Anesth, abdomen vessel surg                     0.0000               0.00
00882       Anesth, major vein ligation                     0.0000               0.00
00902       Anesth, anorectal surgery                       0.0000               0.00
00904       Anesth, perineal surgery                        0.0000               0.00
00906       Anesth, removal of vulva                        0.0000               0.00
00908       Anesth, removal of prostate                     0.0000               0.00
00910       Anesth, bladder surgery                         0.0000               0.00
00912       Anesth, bladder tumor surg                      0.0000               0.00
00914       Anesth, removal of prostate                     0.0000               0.00
00916       Anesth, bleeding control                        0.0000               0.00
00918       Anesth, stone removal                           0.0000               0.00
00920       Anesth, genitalia surgery                       0.0000               0.00
00921       Anesth, vasectomy                               0.0000               0.00
00922       Anesth, sperm duct surgery                      0.0000               0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



00873       Anesth kidney stone destruct                    0.00                0.00                0.00
00880       Anesth, abdomen vessel surg                     0.00                0.00                0.00
00882       Anesth, major vein ligation                     0.00                0.00                0.00
00902       Anesth, anorectal surgery                       0.00                0.00                0.00
00904       Anesth, perineal surgery                        0.00                0.00                0.00
00906       Anesth, removal of vulva                        0.00                0.00                0.00
00908       Anesth, removal of prostate                     0.00                0.00                0.00
00910       Anesth, bladder surgery                         0.00                0.00                0.00
00912       Anesth, bladder tumor surg                      0.00                0.00                0.00
00914       Anesth, removal of prostate                     0.00                0.00                0.00
00916       Anesth, bleeding control                        0.00                0.00                0.00
00918       Anesth, stone removal                           0.00                0.00                0.00
00920       Anesth, genitalia surgery                       0.00                0.00                0.00
00921       Anesth, vasectomy                               0.00                0.00                0.00
00922       Anesth, sperm duct surgery                      0.00                0.00                0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011     January 2011 Description
  HCPCS                            (short)



00924       Anesth, testis exploration                      N              N
00926       Anesth, removal of testis                       N              N
00928       Anesth, removal of testis                       N              N
00930       Anesth, testis suspension                       N              N
00932       Anesth, amputation of penis                     C              C
00934       Anesth, penis, nodes removal                    C              C
00936       Anesth, penis, nodes removal                    C              C
00938       Anesth, insert penis device                     N              N
00940       Anesth, vaginal procedures                      N              N
00942       Anesth, surg on vag/urethral                    N              N
00944       Anesth, vaginal hysterectomy                    C              C
00948       Anesth, repair of cervix                        N              N
00950       Anesth, vaginal endoscopy                       N              N
00952       Anesth, hysteroscope/graph                      N              N
01112       Anesth, bone aspirate/bx                        N              N
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



00924       Anesth, testis exploration                      0.0000               0.00
00926       Anesth, removal of testis                       0.0000               0.00
00928       Anesth, removal of testis                       0.0000               0.00
00930       Anesth, testis suspension                       0.0000               0.00
00932       Anesth, amputation of penis                     0.0000               0.00
00934       Anesth, penis, nodes removal                    0.0000               0.00
00936       Anesth, penis, nodes removal                    0.0000               0.00
00938       Anesth, insert penis device                     0.0000               0.00
00940       Anesth, vaginal procedures                      0.0000               0.00
00942       Anesth, surg on vag/urethral                    0.0000               0.00
00944       Anesth, vaginal hysterectomy                    0.0000               0.00
00948       Anesth, repair of cervix                        0.0000               0.00
00950       Anesth, vaginal endoscopy                       0.0000               0.00
00952       Anesth, hysteroscope/graph                      0.0000               0.00
01112       Anesth, bone aspirate/bx                        0.0000               0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



00924       Anesth, testis exploration                      0.00                0.00                0.00
00926       Anesth, removal of testis                       0.00                0.00                0.00
00928       Anesth, removal of testis                       0.00                0.00                0.00
00930       Anesth, testis suspension                       0.00                0.00                0.00
00932       Anesth, amputation of penis                     0.00                0.00                0.00
00934       Anesth, penis, nodes removal                    0.00                0.00                0.00
00936       Anesth, penis, nodes removal                    0.00                0.00                0.00
00938       Anesth, insert penis device                     0.00                0.00                0.00
00940       Anesth, vaginal procedures                      0.00                0.00                0.00
00942       Anesth, surg on vag/urethral                    0.00                0.00                0.00
00944       Anesth, vaginal hysterectomy                    0.00                0.00                0.00
00948       Anesth, repair of cervix                        0.00                0.00                0.00
00950       Anesth, vaginal endoscopy                       0.00                0.00                0.00
00952       Anesth, hysteroscope/graph                      0.00                0.00                0.00
01112       Anesth, bone aspirate/bx                        0.00                0.00                0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011     January 2011 Description
  HCPCS                            (short)



01120       Anesth, pelvis surgery                          N              N
01130       Anesth, body cast procedure                     N              N
01140       Anesth, amputation at pelvis                    C              C
01150       Anesth, pelvic tumor surgery                    C              C
01160       Anesth, pelvis procedure                        N              N
01170       Anesth, pelvis surgery                          N              N
01173       Anesth, fx repair, pelvis                       N              N
01180       Anesth, pelvis nerve removal                    N              N
01190       Anesth, pelvis nerve removal                    N              N
01200       Anesth, hip joint procedure                     N              N
01202       Anesth, arthroscopy of hip                      N              N
01210       Anesth, hip joint surgery                       N              N
01212       Anesth, hip disarticulation                     C              C
01214       Anesth, hip arthroplasty                        C              C
01215       Anesth, revise hip repair                       N              N
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



01120       Anesth, pelvis surgery                          0.0000               0.00
01130       Anesth, body cast procedure                     0.0000               0.00
01140       Anesth, amputation at pelvis                    0.0000               0.00
01150       Anesth, pelvic tumor surgery                    0.0000               0.00
01160       Anesth, pelvis procedure                        0.0000               0.00
01170       Anesth, pelvis surgery                          0.0000               0.00
01173       Anesth, fx repair, pelvis                       0.0000               0.00
01180       Anesth, pelvis nerve removal                    0.0000               0.00
01190       Anesth, pelvis nerve removal                    0.0000               0.00
01200       Anesth, hip joint procedure                     0.0000               0.00
01202       Anesth, arthroscopy of hip                      0.0000               0.00
01210       Anesth, hip joint surgery                       0.0000               0.00
01212       Anesth, hip disarticulation                     0.0000               0.00
01214       Anesth, hip arthroplasty                        0.0000               0.00
01215       Anesth, revise hip repair                       0.0000               0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



01120       Anesth, pelvis surgery                          0.00                0.00                0.00
01130       Anesth, body cast procedure                     0.00                0.00                0.00
01140       Anesth, amputation at pelvis                    0.00                0.00                0.00
01150       Anesth, pelvic tumor surgery                    0.00                0.00                0.00
01160       Anesth, pelvis procedure                        0.00                0.00                0.00
01170       Anesth, pelvis surgery                          0.00                0.00                0.00
01173       Anesth, fx repair, pelvis                       0.00                0.00                0.00
01180       Anesth, pelvis nerve removal                    0.00                0.00                0.00
01190       Anesth, pelvis nerve removal                    0.00                0.00                0.00
01200       Anesth, hip joint procedure                     0.00                0.00                0.00
01202       Anesth, arthroscopy of hip                      0.00                0.00                0.00
01210       Anesth, hip joint surgery                       0.00                0.00                0.00
01212       Anesth, hip disarticulation                     0.00                0.00                0.00
01214       Anesth, hip arthroplasty                        0.00                0.00                0.00
01215       Anesth, revise hip repair                       0.00                0.00                0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011     January 2011 Description
  HCPCS                            (short)



01220       Anesth, procedure on femur                      N              N
01230       Anesth, surgery of femur                        N              N
01232       Anesth, amputation of femur                     C              C
01234       Anesth, radical femur surg                      C              C
01250       Anesth, upper leg surgery                       N              N
01260       Anesth, upper leg veins surg                    N              N
01270       Anesth, thigh arteries surg                     N              N
01272       Anesth, femoral artery surg                     C              C
01274       Anesth, femoral embolectomy                     C              C
01320       Anesth, knee area surgery                       N              N
01340       Anesth, knee area procedure                     N              N
01360       Anesth, knee area surgery                       N              N
01380       Anesth, knee joint procedure                    N              N
01382       Anesth, dx knee arthroscopy                     N              N
01390       Anesth, knee area procedure                     N              N
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



01220       Anesth, procedure on femur                      0.0000               0.00
01230       Anesth, surgery of femur                        0.0000               0.00
01232       Anesth, amputation of femur                     0.0000               0.00
01234       Anesth, radical femur surg                      0.0000               0.00
01250       Anesth, upper leg surgery                       0.0000               0.00
01260       Anesth, upper leg veins surg                    0.0000               0.00
01270       Anesth, thigh arteries surg                     0.0000               0.00
01272       Anesth, femoral artery surg                     0.0000               0.00
01274       Anesth, femoral embolectomy                     0.0000               0.00
01320       Anesth, knee area surgery                       0.0000               0.00
01340       Anesth, knee area procedure                     0.0000               0.00
01360       Anesth, knee area surgery                       0.0000               0.00
01380       Anesth, knee joint procedure                    0.0000               0.00
01382       Anesth, dx knee arthroscopy                     0.0000               0.00
01390       Anesth, knee area procedure                     0.0000               0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



01220       Anesth, procedure on femur                      0.00                0.00                0.00
01230       Anesth, surgery of femur                        0.00                0.00                0.00
01232       Anesth, amputation of femur                     0.00                0.00                0.00
01234       Anesth, radical femur surg                      0.00                0.00                0.00
01250       Anesth, upper leg surgery                       0.00                0.00                0.00
01260       Anesth, upper leg veins surg                    0.00                0.00                0.00
01270       Anesth, thigh arteries surg                     0.00                0.00                0.00
01272       Anesth, femoral artery surg                     0.00                0.00                0.00
01274       Anesth, femoral embolectomy                     0.00                0.00                0.00
01320       Anesth, knee area surgery                       0.00                0.00                0.00
01340       Anesth, knee area procedure                     0.00                0.00                0.00
01360       Anesth, knee area surgery                       0.00                0.00                0.00
01380       Anesth, knee joint procedure                    0.00                0.00                0.00
01382       Anesth, dx knee arthroscopy                     0.00                0.00                0.00
01390       Anesth, knee area procedure                     0.00                0.00                0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                           Description          January 2011   January 2011   January 2011     January 2011 Description
  HCPCS                             (short)



01392       Anesth, knee area surgery                       N              N
01400       Anesth, knee joint surgery                      N              N
01402       Anesth, knee arthroplasty                       C              C
01404       Anesth, amputation at knee                      C              C
01420       Anesth, knee joint casting                      N              N
01430       Anesth, knee veins surgery                      N              N
01432       Anesth, knee vessel surg                        N              N
01440       Anesth, knee arteries surg                      N              N
01442       Anesth, knee artery surg                        C              C
01444       Anesth, knee artery repair                      C              C
01462       Anesth, lower leg procedure                     N              N
01464       Anesth, ankle/ft arthroscopy                    N              N
01470       Anesth, lower leg surgery                       N              N
01472       Anesth, achilles tendon surg                    N              N
01474       Anesth, lower leg surgery                       N              N
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                           Description           January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                             (short)            Relative Weights



01392       Anesth, knee area surgery                       0.0000               0.00
01400       Anesth, knee joint surgery                      0.0000               0.00
01402       Anesth, knee arthroplasty                       0.0000               0.00
01404       Anesth, amputation at knee                      0.0000               0.00
01420       Anesth, knee joint casting                      0.0000               0.00
01430       Anesth, knee veins surgery                      0.0000               0.00
01432       Anesth, knee vessel surg                        0.0000               0.00
01440       Anesth, knee arteries surg                      0.0000               0.00
01442       Anesth, knee artery surg                        0.0000               0.00
01444       Anesth, knee artery repair                      0.0000               0.00
01462       Anesth, lower leg procedure                     0.0000               0.00
01464       Anesth, ankle/ft arthroscopy                    0.0000               0.00
01470       Anesth, lower leg surgery                       0.0000               0.00
01472       Anesth, achilles tendon surg                    0.0000               0.00
01474       Anesth, lower leg surgery                       0.0000               0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                           Description           January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                             (short)



01392       Anesth, knee area surgery                       0.00                0.00                0.00
01400       Anesth, knee joint surgery                      0.00                0.00                0.00
01402       Anesth, knee arthroplasty                       0.00                0.00                0.00
01404       Anesth, amputation at knee                      0.00                0.00                0.00
01420       Anesth, knee joint casting                      0.00                0.00                0.00
01430       Anesth, knee veins surgery                      0.00                0.00                0.00
01432       Anesth, knee vessel surg                        0.00                0.00                0.00
01440       Anesth, knee arteries surg                      0.00                0.00                0.00
01442       Anesth, knee artery surg                        0.00                0.00                0.00
01444       Anesth, knee artery repair                      0.00                0.00                0.00
01462       Anesth, lower leg procedure                     0.00                0.00                0.00
01464       Anesth, ankle/ft arthroscopy                    0.00                0.00                0.00
01470       Anesth, lower leg surgery                       0.00                0.00                0.00
01472       Anesth, achilles tendon surg                    0.00                0.00                0.00
01474       Anesth, lower leg surgery                       0.00                0.00                0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011     January 2011 Description
  HCPCS                            (short)



01480       Anesth, lower leg bone surg                     N              N
01482       Anesth, radical leg surgery                     N              N
01484       Anesth, lower leg revision                      N              N
01486       Anesth, ankle replacement                       C              C
01490       Anesth, lower leg casting                       N              N
01500       Anesth, leg arteries surg                       N              N
01502       Anesth, lwr leg embolectomy                     C              C
01520       Anesth, lower leg vein surg                     N              N
01522       Anesth, lower leg vein surg                     N              N
01610       Anesth, surgery of shoulder                     N              N
01620       Anesth, shoulder procedure                      N              N
01622       Anes dx shoulder arthroscopy                    N              N
01630       Anesth, surgery of shoulder                     N              N
01634       Anesth, shoulder joint amput                    C              C
01636       Anesth, forequarter amput                       C              C
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



01480       Anesth, lower leg bone surg                     0.0000               0.00
01482       Anesth, radical leg surgery                     0.0000               0.00
01484       Anesth, lower leg revision                      0.0000               0.00
01486       Anesth, ankle replacement                       0.0000               0.00
01490       Anesth, lower leg casting                       0.0000               0.00
01500       Anesth, leg arteries surg                       0.0000               0.00
01502       Anesth, lwr leg embolectomy                     0.0000               0.00
01520       Anesth, lower leg vein surg                     0.0000               0.00
01522       Anesth, lower leg vein surg                     0.0000               0.00
01610       Anesth, surgery of shoulder                     0.0000               0.00
01620       Anesth, shoulder procedure                      0.0000               0.00
01622       Anes dx shoulder arthroscopy                    0.0000               0.00
01630       Anesth, surgery of shoulder                     0.0000               0.00
01634       Anesth, shoulder joint amput                    0.0000               0.00
01636       Anesth, forequarter amput                       0.0000               0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



01480       Anesth, lower leg bone surg                     0.00                0.00                0.00
01482       Anesth, radical leg surgery                     0.00                0.00                0.00
01484       Anesth, lower leg revision                      0.00                0.00                0.00
01486       Anesth, ankle replacement                       0.00                0.00                0.00
01490       Anesth, lower leg casting                       0.00                0.00                0.00
01500       Anesth, leg arteries surg                       0.00                0.00                0.00
01502       Anesth, lwr leg embolectomy                     0.00                0.00                0.00
01520       Anesth, lower leg vein surg                     0.00                0.00                0.00
01522       Anesth, lower leg vein surg                     0.00                0.00                0.00
01610       Anesth, surgery of shoulder                     0.00                0.00                0.00
01620       Anesth, shoulder procedure                      0.00                0.00                0.00
01622       Anes dx shoulder arthroscopy                    0.00                0.00                0.00
01630       Anesth, surgery of shoulder                     0.00                0.00                0.00
01634       Anesth, shoulder joint amput                    0.00                0.00                0.00
01636       Anesth, forequarter amput                       0.00                0.00                0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011     January 2011 Description
  HCPCS                            (short)



01638       Anesth, shoulder replacement                    C              C
01650       Anesth, shoulder artery surg                    N              N
01652       Anesth, shoulder vessel surg                    C              C
01654       Anesth, shoulder vessel surg                    C              C
01656       Anesth, arm-leg vessel surg                     C              C
01670       Anesth, shoulder vein surg                      N              N
01680       Anesth, shoulder casting                        N              N
01682       Anesth, airplane cast                           N              N
01710       Anesth, elbow area surgery                      N              N
01712       Anesth, uppr arm tendon surg                    N              N
01714       Anesth, uppr arm tendon surg                    N              N
01716       Anesth, biceps tendon repair                    N              N
01730       Anesth, uppr arm procedure                      N              N
01732       Anesth, dx elbow arthroscopy                    N              N
01740       Anesth, upper arm surgery                       N              N
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



01638       Anesth, shoulder replacement                    0.0000               0.00
01650       Anesth, shoulder artery surg                    0.0000               0.00
01652       Anesth, shoulder vessel surg                    0.0000               0.00
01654       Anesth, shoulder vessel surg                    0.0000               0.00
01656       Anesth, arm-leg vessel surg                     0.0000               0.00
01670       Anesth, shoulder vein surg                      0.0000               0.00
01680       Anesth, shoulder casting                        0.0000               0.00
01682       Anesth, airplane cast                           0.0000               0.00
01710       Anesth, elbow area surgery                      0.0000               0.00
01712       Anesth, uppr arm tendon surg                    0.0000               0.00
01714       Anesth, uppr arm tendon surg                    0.0000               0.00
01716       Anesth, biceps tendon repair                    0.0000               0.00
01730       Anesth, uppr arm procedure                      0.0000               0.00
01732       Anesth, dx elbow arthroscopy                    0.0000               0.00
01740       Anesth, upper arm surgery                       0.0000               0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



01638       Anesth, shoulder replacement                    0.00                0.00                0.00
01650       Anesth, shoulder artery surg                    0.00                0.00                0.00
01652       Anesth, shoulder vessel surg                    0.00                0.00                0.00
01654       Anesth, shoulder vessel surg                    0.00                0.00                0.00
01656       Anesth, arm-leg vessel surg                     0.00                0.00                0.00
01670       Anesth, shoulder vein surg                      0.00                0.00                0.00
01680       Anesth, shoulder casting                        0.00                0.00                0.00
01682       Anesth, airplane cast                           0.00                0.00                0.00
01710       Anesth, elbow area surgery                      0.00                0.00                0.00
01712       Anesth, uppr arm tendon surg                    0.00                0.00                0.00
01714       Anesth, uppr arm tendon surg                    0.00                0.00                0.00
01716       Anesth, biceps tendon repair                    0.00                0.00                0.00
01730       Anesth, uppr arm procedure                      0.00                0.00                0.00
01732       Anesth, dx elbow arthroscopy                    0.00                0.00                0.00
01740       Anesth, upper arm surgery                       0.00                0.00                0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011     January 2011 Description
  HCPCS                            (short)



01742       Anesth, humerus surgery                         N              N
01744       Anesth, humerus repair                          N              N
01756       Anesth, radical humerus surg                    C              C
01758       Anesth, humeral lesion surg                     N              N
01760       Anesth, elbow replacement                       N              N
01770       Anesth, uppr arm artery surg                    N              N
01772       Anesth, uppr arm embolectomy                    N              N
01780       Anesth, upper arm vein surg                     N              N
01782       Anesth, uppr arm vein repair                    N              N
01810       Anesth, lower arm surgery                       N              N
01820       Anesth, lower arm procedure                     N              N
01829       Anesth, dx wrist arthroscopy                    N              N
01830       Anesth, lower arm surgery                       N              N
01832       Anesth, wrist replacement                       N              N
01840       Anesth, lwr arm artery surg                     N              N
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



01742       Anesth, humerus surgery                         0.0000               0.00
01744       Anesth, humerus repair                          0.0000               0.00
01756       Anesth, radical humerus surg                    0.0000               0.00
01758       Anesth, humeral lesion surg                     0.0000               0.00
01760       Anesth, elbow replacement                       0.0000               0.00
01770       Anesth, uppr arm artery surg                    0.0000               0.00
01772       Anesth, uppr arm embolectomy                    0.0000               0.00
01780       Anesth, upper arm vein surg                     0.0000               0.00
01782       Anesth, uppr arm vein repair                    0.0000               0.00
01810       Anesth, lower arm surgery                       0.0000               0.00
01820       Anesth, lower arm procedure                     0.0000               0.00
01829       Anesth, dx wrist arthroscopy                    0.0000               0.00
01830       Anesth, lower arm surgery                       0.0000               0.00
01832       Anesth, wrist replacement                       0.0000               0.00
01840       Anesth, lwr arm artery surg                     0.0000               0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



01742       Anesth, humerus surgery                         0.00                0.00                0.00
01744       Anesth, humerus repair                          0.00                0.00                0.00
01756       Anesth, radical humerus surg                    0.00                0.00                0.00
01758       Anesth, humeral lesion surg                     0.00                0.00                0.00
01760       Anesth, elbow replacement                       0.00                0.00                0.00
01770       Anesth, uppr arm artery surg                    0.00                0.00                0.00
01772       Anesth, uppr arm embolectomy                    0.00                0.00                0.00
01780       Anesth, upper arm vein surg                     0.00                0.00                0.00
01782       Anesth, uppr arm vein repair                    0.00                0.00                0.00
01810       Anesth, lower arm surgery                       0.00                0.00                0.00
01820       Anesth, lower arm procedure                     0.00                0.00                0.00
01829       Anesth, dx wrist arthroscopy                    0.00                0.00                0.00
01830       Anesth, lower arm surgery                       0.00                0.00                0.00
01832       Anesth, wrist replacement                       0.00                0.00                0.00
01840       Anesth, lwr arm artery surg                     0.00                0.00                0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011     January 2011 Description
  HCPCS                            (short)



01842       Anesth, lwr arm embolectomy                     N              N
01844       Anesth, vascular shunt surg                     N              N
01850       Anesth, lower arm vein surg                     N              N
01852       Anesth, lwr arm vein repair                     N              N
01860       Anesth, lower arm casting                       N              N
01916       Anesth, dx arteriography                        N              N
01920       Anesth, catheterize heart                       N              N
01922       Anesth, cat or MRI scan                         N              N
01924       Anes, ther interven rad, art                    N              N
01925       Anes, ther interven rad, car                    N              N
01926       Anes, tx interv rad hrt/cran                    N              N
01930       Anes, ther interven rad, vei                    N              N
01931       Anes, ther interven rad, tip                    N              N
01932       Anes, tx interv rad, th vein                    N              N
01933       Anes, tx interv rad, cran v                     N              N
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



01842       Anesth, lwr arm embolectomy                     0.0000               0.00
01844       Anesth, vascular shunt surg                     0.0000               0.00
01850       Anesth, lower arm vein surg                     0.0000               0.00
01852       Anesth, lwr arm vein repair                     0.0000               0.00
01860       Anesth, lower arm casting                       0.0000               0.00
01916       Anesth, dx arteriography                        0.0000               0.00
01920       Anesth, catheterize heart                       0.0000               0.00
01922       Anesth, cat or MRI scan                         0.0000               0.00
01924       Anes, ther interven rad, art                    0.0000               0.00
01925       Anes, ther interven rad, car                    0.0000               0.00
01926       Anes, tx interv rad hrt/cran                    0.0000               0.00
01930       Anes, ther interven rad, vei                    0.0000               0.00
01931       Anes, ther interven rad, tip                    0.0000               0.00
01932       Anes, tx interv rad, th vein                    0.0000               0.00
01933       Anes, tx interv rad, cran v                     0.0000               0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



01842       Anesth, lwr arm embolectomy                     0.00                0.00                0.00
01844       Anesth, vascular shunt surg                     0.00                0.00                0.00
01850       Anesth, lower arm vein surg                     0.00                0.00                0.00
01852       Anesth, lwr arm vein repair                     0.00                0.00                0.00
01860       Anesth, lower arm casting                       0.00                0.00                0.00
01916       Anesth, dx arteriography                        0.00                0.00                0.00
01920       Anesth, catheterize heart                       0.00                0.00                0.00
01922       Anesth, cat or MRI scan                         0.00                0.00                0.00
01924       Anes, ther interven rad, art                    0.00                0.00                0.00
01925       Anes, ther interven rad, car                    0.00                0.00                0.00
01926       Anes, tx interv rad hrt/cran                    0.00                0.00                0.00
01930       Anes, ther interven rad, vei                    0.00                0.00                0.00
01931       Anes, ther interven rad, tip                    0.00                0.00                0.00
01932       Anes, tx interv rad, th vein                    0.00                0.00                0.00
01933       Anes, tx interv rad, cran v                     0.00                0.00                0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011     January 2011 Description
  HCPCS                            (short)



01935       Anesth, perc img dx sp proc                     N              N
01936       Anesth, perc img tx sp proc                     N              N
01951       Anesth, burn, less 4 percent                    N              N
01952       Anesth, burn, 4-9 percent                       N              N
01953       Anesth, burn, each 9 percent                    N              N
01958       Anesth, antepartum manipul                      N              N
01960       Anesth, vaginal delivery                        N              N
01961       Anesth, cs delivery                             N              N
01962       Anesth, emer hysterectomy                       N              N
01963       Anesth, cs hysterectomy                         N              N
01965       Anesth, inc/missed ab proc                      N              N
01966       Anesth, induced ab procedure                    N              N
01967       Anesth/analg, vag delivery                      N              N
01968       Anes/analg cs deliver add-on                    N              N
01969       Anesth/analg cs hyst add-on                     N              N
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



01935       Anesth, perc img dx sp proc                     0.0000               0.00
01936       Anesth, perc img tx sp proc                     0.0000               0.00
01951       Anesth, burn, less 4 percent                    0.0000               0.00
01952       Anesth, burn, 4-9 percent                       0.0000               0.00
01953       Anesth, burn, each 9 percent                    0.0000               0.00
01958       Anesth, antepartum manipul                      0.0000               0.00
01960       Anesth, vaginal delivery                        0.0000               0.00
01961       Anesth, cs delivery                             0.0000               0.00
01962       Anesth, emer hysterectomy                       0.0000               0.00
01963       Anesth, cs hysterectomy                         0.0000               0.00
01965       Anesth, inc/missed ab proc                      0.0000               0.00
01966       Anesth, induced ab procedure                    0.0000               0.00
01967       Anesth/analg, vag delivery                      0.0000               0.00
01968       Anes/analg cs deliver add-on                    0.0000               0.00
01969       Anesth/analg cs hyst add-on                     0.0000               0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



01935       Anesth, perc img dx sp proc                     0.00                0.00                0.00
01936       Anesth, perc img tx sp proc                     0.00                0.00                0.00
01951       Anesth, burn, less 4 percent                    0.00                0.00                0.00
01952       Anesth, burn, 4-9 percent                       0.00                0.00                0.00
01953       Anesth, burn, each 9 percent                    0.00                0.00                0.00
01958       Anesth, antepartum manipul                      0.00                0.00                0.00
01960       Anesth, vaginal delivery                        0.00                0.00                0.00
01961       Anesth, cs delivery                             0.00                0.00                0.00
01962       Anesth, emer hysterectomy                       0.00                0.00                0.00
01963       Anesth, cs hysterectomy                         0.00                0.00                0.00
01965       Anesth, inc/missed ab proc                      0.00                0.00                0.00
01966       Anesth, induced ab procedure                    0.00                0.00                0.00
01967       Anesth/analg, vag delivery                      0.00                0.00                0.00
01968       Anes/analg cs deliver add-on                    0.00                0.00                0.00
01969       Anesth/analg cs hyst add-on                     0.00                0.00                0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                            Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011               January 2011 Description
  HCPCS                            (short)



01990       Support for organ donor                         C              C
01991       Anesth, nerve block/inj                         N              N
01992       Anesth, n block/inj, prone                      N              N
01996       Hosp manage cont drug admin                     N              N
01999       Unlisted anesth procedure                       N              1
10021       Fna w/o image                                   T              T            0002                    Fine Needle Biopsy/Aspiration
10022       Fna w/image                                     T              T            0004        Level I Needle Biopsy/ Aspiration Except Bone Marrow
10040       Acne surgery                                    T              T            0013                  Level II Debridement & Destruction
10060       Drainage of skin abscess                        T              T            0006                      Level I Incision & Drainage
10061       Drainage of skin abscess                        T              T            0006                      Level I Incision & Drainage
10080       Drainage of pilonidal cyst                      T              T            0006                      Level I Incision & Drainage
10081       Drainage of pilonidal cyst                      T              T            0007                     Level II Incision & Drainage
10120       Remove foreign body                             T              T            0016                 Level IV Debridement & Destruction
10121       Remove foreign body                             T              T            0021                       Level III Excision/ Biopsy
10140       Drainage of hematoma/fluid                      T              T            0007                     Level II Incision & Drainage
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



01990       Support for organ donor                         0.0000                0.00
01991       Anesth, nerve block/inj                         0.0000                0.00
01992       Anesth, n block/inj, prone                      0.0000                0.00
01996       Hosp manage cont drug admin                     0.0000                0.00
01999       Unlisted anesth procedure                       0.0000                0.00
10021       Fna w/o image                                   1.5703              108.16
10022       Fna w/image                                     4.5843              315.75
10040       Acne surgery                                    0.9103               62.70
10060       Drainage of skin abscess                        1.4906              102.67
10061       Drainage of skin abscess                        1.4906              102.67
10080       Drainage of pilonidal cyst                      1.4906              102.67
10081       Drainage of pilonidal cyst                     13.0129              896.28
10120       Remove foreign body                             2.7318              188.16
10121       Remove foreign body                            18.0784             1245.17
10140       Drainage of hematoma/fluid                     13.0129              896.28
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



01990       Support for organ donor                          0.00                0.00               0.00
01991       Anesth, nerve block/inj                          0.00                0.00               0.00
01992       Anesth, n block/inj, prone                       0.00                0.00               0.00
01996       Hosp manage cont drug admin                      0.00                0.00               0.00
01999       Unlisted anesth procedure                        0.00                0.00               0.00
10021       Fna w/o image                                   76.40              165.86              202.91                                     X
10022       Fna w/image                                    223.03              484.19              592.38                                     X
10040       Acne surgery                                    44.29               96.15              117.63                                     X
10060       Drainage of skin abscess                        72.52              157.44              192.62                                     X
10061       Drainage of skin abscess                        72.52              157.44              192.62                                     X
10080       Drainage of pilonidal cyst                      72.52              157.44              192.62                                     X
10081       Drainage of pilonidal cyst                     633.08             1,374.42            1,681.53                                    X
10120       Remove foreign body                            132.90              288.53              353.00                                     X
10121       Remove foreign body                            879.51             1,909.44            2,336.09                                    X
10140       Drainage of hematoma/fluid                     633.08             1,374.42            1,681.53                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011       January 2011 Description
  HCPCS                            (short)



10160       Puncture drainage of lesion                     T              T            0006            Level I Incision & Drainage
10180       Complex drainage, wound                         T              T            0008          Level III Incision and Drainage
11000       Debride infected skin                           T              T            0016        Level IV Debridement & Destruction
11001       Debride infected skin add-on                    T              T            0013        Level II Debridement & Destruction
11004       Debride genitalia & perineum                    C              C
11005       Debride abdom wall                              C              C
11006       Debride genit/per/abdom wall                    C              C
11008       Remove mesh from abd wall                       C              C
11010       Debride skin, fx                                T              T            0019             Level I Excision/ Biopsy
11011       Debride skin/muscle, fx                         T              T            0019             Level I Excision/ Biopsy
11012       Debride skin/muscle/bone, fx                    T              T            0019             Level I Excision/ Biopsy
11040       Debride skin, partial                           D              D
11041       Debride skin, full                              D              D
11042       Debride skin/tissue                             T              T            0016        Level IV Debridement & Destruction
11043       Debride tissue/muscle                           T              T            0016        Level IV Debridement & Destruction
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



10160       Puncture drainage of lesion                     1.4906              102.67
10180       Complex drainage, wound                        20.1996             1391.27
11000       Debride infected skin                           2.7318              188.16
11001       Debride infected skin add-on                    0.9103               62.70
11004       Debride genitalia & perineum                    0.0000                0.00
11005       Debride abdom wall                              0.0000                0.00
11006       Debride genit/per/abdom wall                    0.0000                0.00
11008       Remove mesh from abd wall                       0.0000                0.00
11010       Debride skin, fx                                5.0887              350.49
11011       Debride skin/muscle, fx                         5.0887              350.49
11012       Debride skin/muscle/bone, fx                    5.0887              350.49
11040       Debride skin, partial                           0.0000                0.00
11041       Debride skin, full                              0.0000                0.00
11042       Debride skin/tissue                             2.7318              188.16
11043       Debride tissue/muscle                           2.7318              188.16
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



10160       Puncture drainage of lesion                     72.52              157.44              192.62                                     X
10180       Complex drainage, wound                        982.71             2,133.48            2,610.19                                    X
11000       Debride infected skin                          132.90              288.53              353.00                                     X
11001       Debride infected skin add-on                    44.29               96.15              117.63                                     X
11004       Debride genitalia & perineum                     0.00                0.00               0.00
11005       Debride abdom wall                               0.00                0.00               0.00
11006       Debride genit/per/abdom wall                     0.00                0.00               0.00
11008       Remove mesh from abd wall                        0.00                0.00               0.00
11010       Debride skin, fx                               247.57              537.47              657.56                                     X
11011       Debride skin/muscle, fx                        247.57              537.47              657.56                                     X
11012       Debride skin/muscle/bone, fx                   247.57              537.47              657.56                                     X
11040       Debride skin, partial                            0.00                0.00               0.00                X                     X
11041       Debride skin, full                               0.00                0.00               0.00                X                     X
11042       Debride skin/tissue                            132.90              288.53              353.00                                     X
11043       Debride tissue/muscle                          132.90              288.53              353.00                                     X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                    Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011       January 2011 Description
  HCPCS                            (short)



11044       Debride tissue/muscle/bone                      T              T            0020              Level II Excision/ Biopsy
11045       Deb subq tissue add-on                          T              T            0016        Level IV Debridement & Destruction
11046       Deb musc/fascia add-on                          T              T            0016        Level IV Debridement & Destruction
11047       Deb bone add-on                                 T              T            0020              Level II Excision/ Biopsy
11055       Trim skin lesion                                T              T            0013        Level II Debridement & Destruction
11056       Trim skin lesions, 2 to 4                       T              T            0013        Level II Debridement & Destruction
11057       Trim skin lesions, over 4                       T              T            0013        Level II Debridement & Destruction
11100       Biopsy, skin lesion                             T              T            0015        Level III Debridement & Destruction
11101       Biopsy, skin add-on                             T              T            0013        Level II Debridement & Destruction
11200       Removal of skin tags                            T              T            0013        Level II Debridement & Destruction
11201       Remove skin tags add-on                         T              T            0013        Level II Debridement & Destruction
11300       Shave skin lesion                               T              T            0013        Level II Debridement & Destruction
11301       Shave skin lesion                               T              T            0013        Level II Debridement & Destruction
11302       Shave skin lesion                               T              T            0013        Level II Debridement & Destruction
11303       Shave skin lesion                               T              T            0015        Level III Debridement & Destruction
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



11044       Debride tissue/muscle/bone                      8.4929              584.96
11045       Deb subq tissue add-on                          2.7318              188.16
11046       Deb musc/fascia add-on                          2.7318              188.16
11047       Deb bone add-on                                 8.4929              584.96
11055       Trim skin lesion                                0.9103               62.70
11056       Trim skin lesions, 2 to 4                       0.9103               62.70
11057       Trim skin lesions, over 4                       0.9103               62.70
11100       Biopsy, skin lesion                             1.4975              103.14
11101       Biopsy, skin add-on                             0.9103               62.70
11200       Removal of skin tags                            0.9103               62.70
11201       Remove skin tags add-on                         0.9103               62.70
11300       Shave skin lesion                               0.9103               62.70
11301       Shave skin lesion                               0.9103               62.70
11302       Shave skin lesion                               0.9103               62.70
11303       Shave skin lesion                               1.4975              103.14
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



11044       Debride tissue/muscle/bone                     413.18              897.02             1,097.45                                    X
11045       Deb subq tissue add-on                         132.90              288.53              353.00               X                     X
11046       Deb musc/fascia add-on                         132.90              288.53              353.00               X                     X
11047       Deb bone add-on                                413.18              897.02             1,097.45              X                     X
11055       Trim skin lesion                                44.29               96.15              117.63                                     X
11056       Trim skin lesions, 2 to 4                       44.29               96.15              117.63                                     X
11057       Trim skin lesions, over 4                       44.29               96.15              117.63                                     X
11100       Biopsy, skin lesion                             72.85              158.17              193.51                                     X
11101       Biopsy, skin add-on                             44.29               96.15              117.63                                     X
11200       Removal of skin tags                            44.29               96.15              117.63                                     X
11201       Remove skin tags add-on                         44.29               96.15              117.63                                     X
11300       Shave skin lesion                               44.29               96.15              117.63                                     X
11301       Shave skin lesion                               44.29               96.15              117.63                                     X
11302       Shave skin lesion                               44.29               96.15              117.63                                     X
11303       Shave skin lesion                               72.85              158.17              193.51                                     X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011      January 2011 Description
  HCPCS                            (short)



11305       Shave skin lesion                               T              T            0013        Level II Debridement & Destruction
11306       Shave skin lesion                               T              T            0013        Level II Debridement & Destruction
11307       Shave skin lesion                               T              T            0013        Level II Debridement & Destruction
11308       Shave skin lesion                               T              T            0013        Level II Debridement & Destruction
11310       Shave skin lesion                               T              T            0013        Level II Debridement & Destruction
11311       Shave skin lesion                               T              T            0013        Level II Debridement & Destruction
11312       Shave skin lesion                               T              T            0013        Level II Debridement & Destruction
11313       Shave skin lesion                               T              T            0013        Level II Debridement & Destruction
11400       Exc tr-ext b9+marg 0.5 < cm                     T              T            0019              Level I Excision/ Biopsy
11401       Exc tr-ext b9+marg 0.6-1 cm                     T              T            0019              Level I Excision/ Biopsy
11402       Exc tr-ext b9+marg 1.1-2 cm                     T              T            0019              Level I Excision/ Biopsy
11403       Exc tr-ext b9+marg 2.1-3 cm                     T              T            0020             Level II Excision/ Biopsy
11404       Exc tr-ext b9+marg 3.1-4 cm                     T              T            0021            Level III Excision/ Biopsy
11406       Exc tr-ext b9+marg > 4.0 cm                     T              T            0021            Level III Excision/ Biopsy
11420       Exc h-f-nk-sp b9+marg 0.5 <                     T              T            0020             Level II Excision/ Biopsy
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



11305       Shave skin lesion                               0.9103               62.70
11306       Shave skin lesion                               0.9103               62.70
11307       Shave skin lesion                               0.9103               62.70
11308       Shave skin lesion                               0.9103               62.70
11310       Shave skin lesion                               0.9103               62.70
11311       Shave skin lesion                               0.9103               62.70
11312       Shave skin lesion                               0.9103               62.70
11313       Shave skin lesion                               0.9103               62.70
11400       Exc tr-ext b9+marg 0.5 < cm                     5.0887              350.49
11401       Exc tr-ext b9+marg 0.6-1 cm                     5.0887              350.49
11402       Exc tr-ext b9+marg 1.1-2 cm                     5.0887              350.49
11403       Exc tr-ext b9+marg 2.1-3 cm                     8.4929              584.96
11404       Exc tr-ext b9+marg 3.1-4 cm                    18.0784             1245.17
11406       Exc tr-ext b9+marg > 4.0 cm                    18.0784             1245.17
11420       Exc h-f-nk-sp b9+marg 0.5 <                     8.4929              584.96
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



11305       Shave skin lesion                               44.29               96.15              117.63                                     X
11306       Shave skin lesion                               44.29               96.15              117.63                                     X
11307       Shave skin lesion                               44.29               96.15              117.63                                     X
11308       Shave skin lesion                               44.29               96.15              117.63                                     X
11310       Shave skin lesion                               44.29               96.15              117.63                                     X
11311       Shave skin lesion                               44.29               96.15              117.63                                     X
11312       Shave skin lesion                               44.29               96.15              117.63                                     X
11313       Shave skin lesion                               44.29               96.15              117.63                                     X
11400       Exc tr-ext b9+marg 0.5 < cm                    247.57              537.47              657.56                                     X
11401       Exc tr-ext b9+marg 0.6-1 cm                    247.57              537.47              657.56                                     X
11402       Exc tr-ext b9+marg 1.1-2 cm                    247.57              537.47              657.56                                     X
11403       Exc tr-ext b9+marg 2.1-3 cm                    413.18              897.02             1,097.45                                    X
11404       Exc tr-ext b9+marg 3.1-4 cm                    879.51             1,909.44            2,336.09                                    X
11406       Exc tr-ext b9+marg > 4.0 cm                    879.51             1,909.44            2,336.09                                    X
11420       Exc h-f-nk-sp b9+marg 0.5 <                    413.18              897.02             1,097.45                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011     January 2011 Description
  HCPCS                            (short)



11421       Exc h-f-nk-sp b9+marg 0.6-1                     T              T            0020           Level II Excision/ Biopsy
11422       Exc h-f-nk-sp b9+marg 1.1-2                     T              T            0020           Level II Excision/ Biopsy
11423       Exc h-f-nk-sp b9+marg 2.1-3                     T              T            0021           Level III Excision/ Biopsy
11424       Exc h-f-nk-sp b9+marg 3.1-4                     T              T            0021           Level III Excision/ Biopsy
11426       Exc h-f-nk-sp b9+marg > 4 cm                    T              T            0022           Level IV Excision/ Biopsy
11440       Exc face-mm b9+marg 0.5 < cm                    T              T            0019            Level I Excision/ Biopsy
11441       Exc face-mm b9+marg 0.6-1 cm                    T              T            0019            Level I Excision/ Biopsy
11442       Exc face-mm b9+marg 1.1-2 cm                    T              T            0020           Level II Excision/ Biopsy
11443       Exc face-mm b9+marg 2.1-3 cm                    T              T            0020           Level II Excision/ Biopsy
11444       Exc face-mm b9+marg 3.1-4 cm                    T              T            0020           Level II Excision/ Biopsy
11446       Exc face-mm b9+marg > 4 cm                      T              T            0022           Level IV Excision/ Biopsy
11450       Removal, sweat gland lesion                     T              T            0022           Level IV Excision/ Biopsy
11451       Removal, sweat gland lesion                     T              T            0022           Level IV Excision/ Biopsy
11462       Removal, sweat gland lesion                     T              T            0022           Level IV Excision/ Biopsy
11463       Removal, sweat gland lesion                     T              T            0022           Level IV Excision/ Biopsy
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



11421       Exc h-f-nk-sp b9+marg 0.6-1                     8.4929              584.96
11422       Exc h-f-nk-sp b9+marg 1.1-2                     8.4929              584.96
11423       Exc h-f-nk-sp b9+marg 2.1-3                    18.0784             1245.17
11424       Exc h-f-nk-sp b9+marg 3.1-4                    18.0784             1245.17
11426       Exc h-f-nk-sp b9+marg > 4 cm                   23.8986             1646.04
11440       Exc face-mm b9+marg 0.5 < cm                    5.0887              350.49
11441       Exc face-mm b9+marg 0.6-1 cm                    5.0887              350.49
11442       Exc face-mm b9+marg 1.1-2 cm                    8.4929              584.96
11443       Exc face-mm b9+marg 2.1-3 cm                    8.4929              584.96
11444       Exc face-mm b9+marg 3.1-4 cm                    8.4929              584.96
11446       Exc face-mm b9+marg > 4 cm                     23.8986             1646.04
11450       Removal, sweat gland lesion                    23.8986             1646.04
11451       Removal, sweat gland lesion                    23.8986             1646.04
11462       Removal, sweat gland lesion                    23.8986             1646.04
11463       Removal, sweat gland lesion                    23.8986             1646.04
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



11421       Exc h-f-nk-sp b9+marg 0.6-1                     413.18             897.02             1,097.45                                    X
11422       Exc h-f-nk-sp b9+marg 1.1-2                     413.18             897.02             1,097.45                                    X
11423       Exc h-f-nk-sp b9+marg 2.1-3                     879.51            1,909.44            2,336.09                                    X
11424       Exc h-f-nk-sp b9+marg 3.1-4                     879.51            1,909.44            2,336.09                                    X
11426       Exc h-f-nk-sp b9+marg > 4 cm                   1,162.67           2,524.17            3,088.18                                    X
11440       Exc face-mm b9+marg 0.5 < cm                    247.57             537.47              657.56                                     X
11441       Exc face-mm b9+marg 0.6-1 cm                    247.57             537.47              657.56                                     X
11442       Exc face-mm b9+marg 1.1-2 cm                    413.18             897.02             1,097.45                                    X
11443       Exc face-mm b9+marg 2.1-3 cm                    413.18             897.02             1,097.45                                    X
11444       Exc face-mm b9+marg 3.1-4 cm                    413.18             897.02             1,097.45                                    X
11446       Exc face-mm b9+marg > 4 cm                     1,162.67           2,524.17            3,088.18                                    X
11450       Removal, sweat gland lesion                    1,162.67           2,524.17            3,088.18                                    X
11451       Removal, sweat gland lesion                    1,162.67           2,524.17            3,088.18                                    X
11462       Removal, sweat gland lesion                    1,162.67           2,524.17            3,088.18                                    X
11463       Removal, sweat gland lesion                    1,162.67           2,524.17            3,088.18                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011     January 2011 Description
  HCPCS                            (short)



11470       Removal, sweat gland lesion                     T              T            0022           Level IV Excision/ Biopsy
11471       Removal, sweat gland lesion                     T              T            0022           Level IV Excision/ Biopsy
11600       Exc tr-ext mlg+marg 0.5 < cm                    T              T            0020           Level II Excision/ Biopsy
11601       Exc tr-ext mlg+marg 0.6-1 cm                    T              T            0019            Level I Excision/ Biopsy
11602       Exc tr-ext mlg+marg 1.1-2 cm                    T              T            0019            Level I Excision/ Biopsy
11603       Exc tr-ext mlg+marg 2.1-3 cm                    T              T            0020           Level II Excision/ Biopsy
11604       Exc tr-ext mlg+marg 3.1-4 cm                    T              T            0020           Level II Excision/ Biopsy
11606       Exc tr-ext mlg+marg > 4 cm                      T              T            0021           Level III Excision/ Biopsy
11620       Exc h-f-nk-sp mlg+marg 0.5 <                    T              T            0020           Level II Excision/ Biopsy
11621       Exc h-f-nk-sp mlg+marg 0.6-1                    T              T            0019            Level I Excision/ Biopsy
11622       Exc h-f-nk-sp mlg+marg 1.1-2                    T              T            0020           Level II Excision/ Biopsy
11623       Exc h-f-nk-sp mlg+marg 2.1-3                    T              T            0021           Level III Excision/ Biopsy
11624       Exc h-f-nk-sp mlg+marg 3.1-4                    T              T            0021           Level III Excision/ Biopsy
11626       Exc h-f-nk-sp mlg+mar > 4 cm                    T              T            0022           Level IV Excision/ Biopsy
11640       Exc face-mm malig+marg 0.5 <                    T              T            0019            Level I Excision/ Biopsy
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



11470       Removal, sweat gland lesion                    23.8986             1646.04
11471       Removal, sweat gland lesion                    23.8986             1646.04
11600       Exc tr-ext mlg+marg 0.5 < cm                    8.4929              584.96
11601       Exc tr-ext mlg+marg 0.6-1 cm                    5.0887              350.49
11602       Exc tr-ext mlg+marg 1.1-2 cm                    5.0887              350.49
11603       Exc tr-ext mlg+marg 2.1-3 cm                    8.4929              584.96
11604       Exc tr-ext mlg+marg 3.1-4 cm                    8.4929              584.96
11606       Exc tr-ext mlg+marg > 4 cm                     18.0784             1245.17
11620       Exc h-f-nk-sp mlg+marg 0.5 <                    8.4929              584.96
11621       Exc h-f-nk-sp mlg+marg 0.6-1                    5.0887              350.49
11622       Exc h-f-nk-sp mlg+marg 1.1-2                    8.4929              584.96
11623       Exc h-f-nk-sp mlg+marg 2.1-3                   18.0784             1245.17
11624       Exc h-f-nk-sp mlg+marg 3.1-4                   18.0784             1245.17
11626       Exc h-f-nk-sp mlg+mar > 4 cm                   23.8986             1646.04
11640       Exc face-mm malig+marg 0.5 <                    5.0887              350.49
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



11470       Removal, sweat gland lesion                    1,162.67           2,524.17            3,088.18                                    X
11471       Removal, sweat gland lesion                    1,162.67           2,524.17            3,088.18                                    X
11600       Exc tr-ext mlg+marg 0.5 < cm                    413.18             897.02             1,097.45                                    X
11601       Exc tr-ext mlg+marg 0.6-1 cm                    247.57             537.47              657.56                                     X
11602       Exc tr-ext mlg+marg 1.1-2 cm                    247.57             537.47              657.56                                     X
11603       Exc tr-ext mlg+marg 2.1-3 cm                    413.18             897.02             1,097.45                                    X
11604       Exc tr-ext mlg+marg 3.1-4 cm                    413.18             897.02             1,097.45                                    X
11606       Exc tr-ext mlg+marg > 4 cm                      879.51            1,909.44            2,336.09                                    X
11620       Exc h-f-nk-sp mlg+marg 0.5 <                    413.18             897.02             1,097.45                                    X
11621       Exc h-f-nk-sp mlg+marg 0.6-1                    247.57             537.47              657.56                                     X
11622       Exc h-f-nk-sp mlg+marg 1.1-2                    413.18             897.02             1,097.45                                    X
11623       Exc h-f-nk-sp mlg+marg 2.1-3                    879.51            1,909.44            2,336.09                                    X
11624       Exc h-f-nk-sp mlg+marg 3.1-4                    879.51            1,909.44            2,336.09                                    X
11626       Exc h-f-nk-sp mlg+mar > 4 cm                   1,162.67           2,524.17            3,088.18                                    X
11640       Exc face-mm malig+marg 0.5 <                    247.57             537.47              657.56                                     X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011      January 2011 Description
  HCPCS                            (short)



11641       Exc face-mm malig+marg 0.6-1                    T              T            0019              Level I Excision/ Biopsy
11642       Exc face-mm malig+marg 1.1-2                    T              T            0019              Level I Excision/ Biopsy
11643       Exc face-mm malig+marg 2.1-3                    T              T            0020             Level II Excision/ Biopsy
11644       Exc face-mm malig+marg 3.1-4                    T              T            0021            Level III Excision/ Biopsy
11646       Exc face-mm mlg+marg > 4 cm                     T              T            0022            Level IV Excision/ Biopsy
11719       Trim nail(s)                                    T              T            0012        Level I Debridement & Destruction
11720       Debride nail, 1-5                               T              T            0013        Level II Debridement & Destruction
11721       Debride nail, 6 or more                         T              T            0013        Level II Debridement & Destruction
11730       Removal of nail plate                           T              T            0013        Level II Debridement & Destruction
11732       Remove nail plate, add-on                       T              T            0013        Level II Debridement & Destruction
11740       Drain blood from under nail                     T              T            0012        Level I Debridement & Destruction
11750       Removal of nail bed                             T              T            0019              Level I Excision/ Biopsy
11752       Remove nail bed/finger tip                      T              T            0022            Level IV Excision/ Biopsy
11755       Biopsy, nail unit                               T              T            0019              Level I Excision/ Biopsy
11760       Repair of nail bed                              T              T            0133                 Level I Skin Repair
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



11641       Exc face-mm malig+marg 0.6-1                    5.0887              350.49
11642       Exc face-mm malig+marg 1.1-2                    5.0887              350.49
11643       Exc face-mm malig+marg 2.1-3                    8.4929              584.96
11644       Exc face-mm malig+marg 3.1-4                   18.0784             1245.17
11646       Exc face-mm mlg+marg > 4 cm                    23.8986             1646.04
11719       Trim nail(s)                                    0.4326               29.80
11720       Debride nail, 1-5                               0.9103               62.70
11721       Debride nail, 6 or more                         0.9103               62.70
11730       Removal of nail plate                           0.9103               62.70
11732       Remove nail plate, add-on                       0.9103               62.70
11740       Drain blood from under nail                     0.4326               29.80
11750       Removal of nail bed                             5.0887              350.49
11752       Remove nail bed/finger tip                     23.8986             1646.04
11755       Biopsy, nail unit                               5.0887              350.49
11760       Repair of nail bed                              1.3330               91.81
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



11641       Exc face-mm malig+marg 0.6-1                    247.57             537.47              657.56                                     X
11642       Exc face-mm malig+marg 1.1-2                    247.57             537.47              657.56                                     X
11643       Exc face-mm malig+marg 2.1-3                    413.18             897.02             1,097.45                                    X
11644       Exc face-mm malig+marg 3.1-4                    879.51            1,909.44            2,336.09                                    X
11646       Exc face-mm mlg+marg > 4 cm                    1,162.67           2,524.17            3,088.18                                    X
11719       Trim nail(s)                                     21.05              45.69               55.90                                     X
11720       Debride nail, 1-5                                44.29              96.15              117.63                                     X
11721       Debride nail, 6 or more                          44.29              96.15              117.63                                     X
11730       Removal of nail plate                            44.29              96.15              117.63                                     X
11732       Remove nail plate, add-on                        44.29              96.15              117.63                                     X
11740       Drain blood from under nail                      21.05              45.69               55.90                                     X
11750       Removal of nail bed                             247.57             537.47              657.56                                     X
11752       Remove nail bed/finger tip                     1,162.67           2,524.17            3,088.18                                    X
11755       Biopsy, nail unit                               247.57             537.47              657.56                                     X
11760       Repair of nail bed                               64.85             140.79              172.25                                     X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                           Description          January 2011   January 2011   January 2011      January 2011 Description
  HCPCS                             (short)



11762       Reconstruction of nail bed                      T              T            0136                Level IV Skin Repair
11765       Excision of nail fold, toe                      T              T            0013        Level II Debridement & Destruction
11770       Removal of pilonidal lesion                     T              T            0022            Level IV Excision/ Biopsy
11771       Removal of pilonidal lesion                     T              T            0022            Level IV Excision/ Biopsy
11772       Removal of pilonidal lesion                     T              T            0022            Level IV Excision/ Biopsy
11900       Injection into skin lesions                     T              T            0013        Level II Debridement & Destruction
11901       Added skin lesions injection                    T              T            0013        Level II Debridement & Destruction
11920       Correct skin color defects                      T              1            0134                 Level II Skin Repair
11921       Correct skin color defects                      T              1            0134                 Level II Skin Repair
11922       Correct skin color defects                      T              1            0134                 Level II Skin Repair
11950       Therapy for contour defects                     T              1            0133                 Level I Skin Repair
11951       Therapy for contour defects                     T              1            0133                 Level I Skin Repair
11952       Therapy for contour defects                     T              1            0133                 Level I Skin Repair
11954       Therapy for contour defects                     T              1            0133                 Level I Skin Repair
11960       Insert tissue expander(s)                       T              T            0137                 Level V Skin Repair
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                           Description           January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                             (short)            Relative Weights



11762       Reconstruction of nail bed                     17.2117             1185.47
11765       Excision of nail fold, toe                      0.9103               62.70
11770       Removal of pilonidal lesion                    23.8986             1646.04
11771       Removal of pilonidal lesion                    23.8986             1646.04
11772       Removal of pilonidal lesion                    23.8986             1646.04
11900       Injection into skin lesions                     0.9103               62.70
11901       Added skin lesions injection                    0.9103               62.70
11920       Correct skin color defects                      3.1618              217.77
11921       Correct skin color defects                      3.1618              217.77
11922       Correct skin color defects                      3.1618              217.77
11950       Therapy for contour defects                     1.3330               91.81
11951       Therapy for contour defects                     1.3330               91.81
11952       Therapy for contour defects                     1.3330               91.81
11954       Therapy for contour defects                     1.3330               91.81
11960       Insert tissue expander(s)                      22.2821             1534.70
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                           Description           January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                             (short)



11762       Reconstruction of nail bed                      837.35            1,817.90            2,224.10                                    X
11765       Excision of nail fold, toe                       44.29              96.15              117.63                                     X
11770       Removal of pilonidal lesion                    1,162.67           2,524.17            3,088.18                                    X
11771       Removal of pilonidal lesion                    1,162.67           2,524.17            3,088.18                                    X
11772       Removal of pilonidal lesion                    1,162.67           2,524.17            3,088.18                                    X
11900       Injection into skin lesions                      44.29              96.15              117.63                                     X
11901       Added skin lesions injection                     44.29              96.15              117.63                                     X
11920       Correct skin color defects                        0.00               0.00               0.00                                      X
11921       Correct skin color defects                        0.00               0.00               0.00                                      X
11922       Correct skin color defects                        0.00               0.00               0.00                                      X
11950       Therapy for contour defects                       0.00               0.00               0.00                                      X
11951       Therapy for contour defects                       0.00               0.00               0.00                                      X
11952       Therapy for contour defects                       0.00               0.00               0.00                                      X
11954       Therapy for contour defects                       0.00               0.00               0.00                                      X
11960       Insert tissue expander(s)                      1,084.02           2,353.44            2,879.29                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                            (short)




11970       Replace tissue expander                         T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot
11971       Remove tissue expander(s)                       T              T            0022                         Level IV Excision/ Biopsy
11975       Insert contraceptive cap                        E              3
11976       Removal of contraceptive cap                    T              T            0019                         Level I Excision/ Biopsy
11977       Removal/reinsert contra cap                     E              3
11980       Implant hormone pellet(s)                       X              X            0340                       Minor Ancillary Procedures
11981       Insert drug implant device                      X              X            0340                       Minor Ancillary Procedures
11982       Remove drug implant device                      X              X            0340                       Minor Ancillary Procedures
11983       Remove/insert drug implant                      X              X            0340                       Minor Ancillary Procedures
12001       Repair superficial wound(s)                     T              T            0133                          Level I Skin Repair
12002       Repair superficial wound(s)                     T              T            0133                          Level I Skin Repair
12004       Repair superficial wound(s)                     T              T            0133                          Level I Skin Repair
12005       Repair superficial wound(s)                     T              T            0133                          Level I Skin Repair
12006       Repair superficial wound(s)                     T              T            0133                          Level I Skin Repair
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights




11970       Replace tissue expander                        47.3213             3259.30
11971       Remove tissue expander(s)                      23.8986             1646.04
11975       Insert contraceptive cap                        0.0000                0.00
11976       Removal of contraceptive cap                    5.0887              350.49
11977       Removal/reinsert contra cap                     0.0000                0.00
11980       Implant hormone pellet(s)                       0.6712               46.23
11981       Insert drug implant device                      0.6712               46.23
11982       Remove drug implant device                      0.6712               46.23
11983       Remove/insert drug implant                      0.6712               46.23
12001       Repair superficial wound(s)                     1.3330               91.81
12002       Repair superficial wound(s)                     1.3330               91.81
12004       Repair superficial wound(s)                     1.3330               91.81
12005       Repair superficial wound(s)                     1.3330               91.81
12006       Repair superficial wound(s)                     1.3330               91.81
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)




11970       Replace tissue expander                        2,302.18           4,998.08            6,114.86                                    X
11971       Remove tissue expander(s)                      1,162.67           2,524.17            3,088.18                                    X
11975       Insert contraceptive cap                          M01                M01                 M01
11976       Removal of contraceptive cap                    247.57             537.47              657.56                                     X
11977       Removal/reinsert contra cap                       M01                M01                 M01
11980       Implant hormone pellet(s)                        32.65              70.89               86.73                                     X
11981       Insert drug implant device                       32.65              70.89               86.73                                     X
11982       Remove drug implant device                       32.65              70.89               86.73                                     X
11983       Remove/insert drug implant                       32.65              70.89               86.73                                     X
12001       Repair superficial wound(s)                      64.85             140.79              172.25                                     X
12002       Repair superficial wound(s)                      64.85             140.79              172.25                                     X
12004       Repair superficial wound(s)                      64.85             140.79              172.25                                     X
12005       Repair superficial wound(s)                      64.85             140.79              172.25                                     X
12006       Repair superficial wound(s)                      64.85             140.79              172.25                                     X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                           Description          January 2011   January 2011   January 2011     January 2011 Description
  HCPCS                             (short)



12007       Repair superficial wound(s)                     T              T            0133             Level I Skin Repair
12011       Repair superficial wound(s)                     T              T            0133             Level I Skin Repair
12013       Repair superficial wound(s)                     T              T            0133             Level I Skin Repair
12014       Repair superficial wound(s)                     T              T            0133             Level I Skin Repair
12015       Repair superficial wound(s)                     T              T            0133             Level I Skin Repair
12016       Repair superficial wound(s)                     T              T            0133             Level I Skin Repair
12017       Repair superficial wound(s)                     T              T            0133             Level I Skin Repair
12018       Repair superficial wound(s)                     T              T            0133             Level I Skin Repair
12020       Closure of split wound                          T              T            0135             Level III Skin Repair
12021       Closure of split wound                          T              T            0134             Level II Skin Repair
12031       Intmd wnd repair s/tr/ext                       T              T            0133             Level I Skin Repair
12032       Intmd wnd repair s/tr/ext                       T              T            0134             Level II Skin Repair
12034       Intmd wnd repair s/tr/ext                       T              T            0133             Level I Skin Repair
12035       Intmd wnd repair s/tr/ext                       T              T            0133             Level I Skin Repair
12036       Intmd wnd repair s/tr/ext                       T              T            0134             Level II Skin Repair
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                           Description           January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                             (short)            Relative Weights



12007       Repair superficial wound(s)                     1.3330               91.81
12011       Repair superficial wound(s)                     1.3330               91.81
12013       Repair superficial wound(s)                     1.3330               91.81
12014       Repair superficial wound(s)                     1.3330               91.81
12015       Repair superficial wound(s)                     1.3330               91.81
12016       Repair superficial wound(s)                     1.3330               91.81
12017       Repair superficial wound(s)                     1.3330               91.81
12018       Repair superficial wound(s)                     1.3330               91.81
12020       Closure of split wound                          4.6422              319.74
12021       Closure of split wound                          3.1618              217.77
12031       Intmd wnd repair s/tr/ext                       1.3330               91.81
12032       Intmd wnd repair s/tr/ext                       3.1618              217.77
12034       Intmd wnd repair s/tr/ext                       1.3330               91.81
12035       Intmd wnd repair s/tr/ext                       1.3330               91.81
12036       Intmd wnd repair s/tr/ext                       3.1618              217.77
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                           Description           January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                             (short)



12007       Repair superficial wound(s)                     64.85              140.79              172.25                                     X
12011       Repair superficial wound(s)                     64.85              140.79              172.25                                     X
12013       Repair superficial wound(s)                     64.85              140.79              172.25                                     X
12014       Repair superficial wound(s)                     64.85              140.79              172.25                                     X
12015       Repair superficial wound(s)                     64.85              140.79              172.25                                     X
12016       Repair superficial wound(s)                     64.85              140.79              172.25                                     X
12017       Repair superficial wound(s)                     64.85              140.79              172.25                                     X
12018       Repair superficial wound(s)                     64.85              140.79              172.25                                     X
12020       Closure of split wound                         225.84              490.31              599.87                                     X
12021       Closure of split wound                         153.82              333.95              408.57                                     X
12031       Intmd wnd repair s/tr/ext                       64.85              140.79              172.25                                     X
12032       Intmd wnd repair s/tr/ext                      153.82              333.95              408.57                                     X
12034       Intmd wnd repair s/tr/ext                       64.85              140.79              172.25                                     X
12035       Intmd wnd repair s/tr/ext                       64.85              140.79              172.25                                     X
12036       Intmd wnd repair s/tr/ext                      153.82              333.95              408.57                                     X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                           Description          January 2011   January 2011   January 2011     January 2011 Description
  HCPCS                             (short)



12037       Intmd wnd repair s/tr/ext                       T              T            0134             Level II Skin Repair
12041       Intmd wnd repair n-hf/genit                     T              T            0133             Level I Skin Repair
12042       Intmd wnd repair n-hg/genit                     T              T            0133             Level I Skin Repair
12044       Intmd wnd repair n-hg/genit                     T              T            0133             Level I Skin Repair
12045       Intmd wnd repair n-hg/genit                     T              T            0134             Level II Skin Repair
12046       Intmd wnd repair n-hg/genit                     T              T            0134             Level II Skin Repair
12047       Intmd wnd repair n-hg/genit                     T              T            0134             Level II Skin Repair
12051       Intmd wnd repair face/mm                        T              T            0134             Level II Skin Repair
12052       Intmd wnd repair face/mm                        T              T            0133             Level I Skin Repair
12053       Intmd wnd repair face/mm                        T              T            0133             Level I Skin Repair
12054       Intmd wnd repair, face/mm                       T              T            0133             Level I Skin Repair
12055       Intmd wnd repair face/mm                        T              T            0134             Level II Skin Repair
12056       Intmd wnd repair face/mm                        T              T            0134             Level II Skin Repair
12057       Intmd wnd repair face/mm                        T              T            0134             Level II Skin Repair
13100       Repair of wound or lesion                       T              T            0135             Level III Skin Repair
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                           Description           January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                             (short)            Relative Weights



12037       Intmd wnd repair s/tr/ext                       3.1618              217.77
12041       Intmd wnd repair n-hf/genit                     1.3330               91.81
12042       Intmd wnd repair n-hg/genit                     1.3330               91.81
12044       Intmd wnd repair n-hg/genit                     1.3330               91.81
12045       Intmd wnd repair n-hg/genit                     3.1618              217.77
12046       Intmd wnd repair n-hg/genit                     3.1618              217.77
12047       Intmd wnd repair n-hg/genit                     3.1618              217.77
12051       Intmd wnd repair face/mm                        3.1618              217.77
12052       Intmd wnd repair face/mm                        1.3330               91.81
12053       Intmd wnd repair face/mm                        1.3330               91.81
12054       Intmd wnd repair, face/mm                       1.3330               91.81
12055       Intmd wnd repair face/mm                        3.1618              217.77
12056       Intmd wnd repair face/mm                        3.1618              217.77
12057       Intmd wnd repair face/mm                        3.1618              217.77
13100       Repair of wound or lesion                       4.6422              319.74
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                           Description           January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                             (short)



12037       Intmd wnd repair s/tr/ext                      153.82              333.95              408.57                                     X
12041       Intmd wnd repair n-hf/genit                     64.85              140.79              172.25                                     X
12042       Intmd wnd repair n-hg/genit                     64.85              140.79              172.25                                     X
12044       Intmd wnd repair n-hg/genit                     64.85              140.79              172.25                                     X
12045       Intmd wnd repair n-hg/genit                    153.82              333.95              408.57                                     X
12046       Intmd wnd repair n-hg/genit                    153.82              333.95              408.57                                     X
12047       Intmd wnd repair n-hg/genit                    153.82              333.95              408.57                                     X
12051       Intmd wnd repair face/mm                       153.82              333.95              408.57                                     X
12052       Intmd wnd repair face/mm                        64.85              140.79              172.25                                     X
12053       Intmd wnd repair face/mm                        64.85              140.79              172.25                                     X
12054       Intmd wnd repair, face/mm                       64.85              140.79              172.25                                     X
12055       Intmd wnd repair face/mm                       153.82              333.95              408.57                                     X
12056       Intmd wnd repair face/mm                       153.82              333.95              408.57                                     X
12057       Intmd wnd repair face/mm                       153.82              333.95              408.57                                     X
13100       Repair of wound or lesion                      225.84              490.31              599.87                                     X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011     January 2011 Description
  HCPCS                            (short)



13101       Repair of wound or lesion                       T              T            0135             Level III Skin Repair
13102       Repair wound/lesion add-on                      T              T            0135             Level III Skin Repair
13120       Repair of wound or lesion                       T              T            0134             Level II Skin Repair
13121       Repair of wound or lesion                       T              T            0134             Level II Skin Repair
13122       Repair wound/lesion add-on                      T              T            0133              Level I Skin Repair
13131       Repair of wound or lesion                       T              T            0134             Level II Skin Repair
13132       Repair of wound or lesion                       T              T            0135             Level III Skin Repair
13133       Repair wound/lesion add-on                      T              T            0134             Level II Skin Repair
13150       Repair of wound or lesion                       T              T            0135             Level III Skin Repair
13151       Repair of wound or lesion                       T              T            0135             Level III Skin Repair
13152       Repair of wound or lesion                       T              T            0135             Level III Skin Repair
13153       Repair wound/lesion add-on                      T              T            0134             Level II Skin Repair
13160       Late closure of wound                           T              T            0137             Level V Skin Repair
14000       Skin tissue rearrangement                       T              T            0136             Level IV Skin Repair
14001       Skin tissue rearrangement                       T              T            0136             Level IV Skin Repair
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



13101       Repair of wound or lesion                       4.6422              319.74
13102       Repair wound/lesion add-on                      4.6422              319.74
13120       Repair of wound or lesion                       3.1618              217.77
13121       Repair of wound or lesion                       3.1618              217.77
13122       Repair wound/lesion add-on                      1.3330               91.81
13131       Repair of wound or lesion                       3.1618              217.77
13132       Repair of wound or lesion                       4.6422              319.74
13133       Repair wound/lesion add-on                      3.1618              217.77
13150       Repair of wound or lesion                       4.6422              319.74
13151       Repair of wound or lesion                       4.6422              319.74
13152       Repair of wound or lesion                       4.6422              319.74
13153       Repair wound/lesion add-on                      3.1618              217.77
13160       Late closure of wound                          22.2821             1534.70
14000       Skin tissue rearrangement                      17.2117             1185.47
14001       Skin tissue rearrangement                      17.2117             1185.47
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



13101       Repair of wound or lesion                       225.84             490.31              599.87                                     X
13102       Repair wound/lesion add-on                      225.84             490.31              599.87                                     X
13120       Repair of wound or lesion                       153.82             333.95              408.57                                     X
13121       Repair of wound or lesion                       153.82             333.95              408.57                                     X
13122       Repair wound/lesion add-on                       64.85             140.79              172.25                                     X
13131       Repair of wound or lesion                       153.82             333.95              408.57                                     X
13132       Repair of wound or lesion                       225.84             490.31              599.87                                     X
13133       Repair wound/lesion add-on                      153.82             333.95              408.57                                     X
13150       Repair of wound or lesion                       225.84             490.31              599.87                                     X
13151       Repair of wound or lesion                       225.84             490.31              599.87                                     X
13152       Repair of wound or lesion                       225.84             490.31              599.87                                     X
13153       Repair wound/lesion add-on                      153.82             333.95              408.57                                     X
13160       Late closure of wound                          1,084.02           2,353.44            2,879.29                                    X
14000       Skin tissue rearrangement                       837.35            1,817.90            2,224.10                                    X
14001       Skin tissue rearrangement                       837.35            1,817.90            2,224.10                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011     January 2011 Description
  HCPCS                            (short)



14020       Skin tissue rearrangement                       T              T            0136             Level IV Skin Repair
14021       Skin tissue rearrangement                       T              T            0136             Level IV Skin Repair
14040       Skin tissue rearrangement                       T              T            0136             Level IV Skin Repair
14041       Skin tissue rearrangement                       T              T            0136             Level IV Skin Repair
14060       Skin tissue rearrangement                       T              T            0136             Level IV Skin Repair
14061       Skin tissue rearrangement                       T              T            0136             Level IV Skin Repair
14301       Skin tissue rearrangement                       T              T            0137             Level V Skin Repair
14302       Skin tissue rearrange add-on                    T              T            0137             Level V Skin Repair
14350       Skin tissue rearrangement                       T              T            0137             Level V Skin Repair
15002       Wound prep, trk/arm/leg                         T              T            0135             Level III Skin Repair
15003       Wound prep, addl 100 cm                         T              T            0135             Level III Skin Repair
15004       Wound prep, f/n/hf/g                            T              T            0135             Level III Skin Repair
15005       Wnd prep, f/n/hf/g, addl cm                     T              T            0135             Level III Skin Repair
15040       Harvest cultured skin graft                     T              T            0134             Level II Skin Repair
15050       Skin pinch graft                                T              T            0135             Level III Skin Repair
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



14020       Skin tissue rearrangement                      17.2117             1185.47
14021       Skin tissue rearrangement                      17.2117             1185.47
14040       Skin tissue rearrangement                      17.2117             1185.47
14041       Skin tissue rearrangement                      17.2117             1185.47
14060       Skin tissue rearrangement                      17.2117             1185.47
14061       Skin tissue rearrangement                      17.2117             1185.47
14301       Skin tissue rearrangement                      22.2821             1534.70
14302       Skin tissue rearrange add-on                   22.2821             1534.70
14350       Skin tissue rearrangement                      22.2821             1534.70
15002       Wound prep, trk/arm/leg                         4.6422              319.74
15003       Wound prep, addl 100 cm                         4.6422              319.74
15004       Wound prep, f/n/hf/g                            4.6422              319.74
15005       Wnd prep, f/n/hf/g, addl cm                     4.6422              319.74
15040       Harvest cultured skin graft                     3.1618              217.77
15050       Skin pinch graft                                4.6422              319.74
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



14020       Skin tissue rearrangement                       837.35            1,817.90            2,224.10                                    X
14021       Skin tissue rearrangement                       837.35            1,817.90            2,224.10                                    X
14040       Skin tissue rearrangement                       837.35            1,817.90            2,224.10                                    X
14041       Skin tissue rearrangement                       837.35            1,817.90            2,224.10                                    X
14060       Skin tissue rearrangement                       837.35            1,817.90            2,224.10                                    X
14061       Skin tissue rearrangement                       837.35            1,817.90            2,224.10                                    X
14301       Skin tissue rearrangement                      1,084.02           2,353.44            2,879.29                                    X
14302       Skin tissue rearrange add-on                   1,084.02           2,353.44            2,879.29                                    X
14350       Skin tissue rearrangement                      1,084.02           2,353.44            2,879.29                                    X
15002       Wound prep, trk/arm/leg                         225.84             490.31              599.87                                     X
15003       Wound prep, addl 100 cm                         225.84             490.31              599.87                                     X
15004       Wound prep, f/n/hf/g                            225.84             490.31              599.87                                     X
15005       Wnd prep, f/n/hf/g, addl cm                     225.84             490.31              599.87                                     X
15040       Harvest cultured skin graft                     153.82             333.95              408.57                                     X
15050       Skin pinch graft                                225.84             490.31              599.87                                     X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                           Description          January 2011   January 2011   January 2011     January 2011 Description
  HCPCS                             (short)



15100       Skin splt grft, trnk/arm/leg                    T              T            0137             Level V Skin Repair
15101       Skin splt grft t/a/l, add-on                    T              T            0137             Level V Skin Repair
15110       Epidrm autogrft trnk/arm/leg                    T              T            0135             Level III Skin Repair
15111       Epidrm autogrft t/a/l add-on                    T              T            0135             Level III Skin Repair
15115       Epidrm a-grft face/nck/hf/g                     T              T            0135             Level III Skin Repair
15116       Epidrm a-grft f/n/hf/g addl                     T              T            0135             Level III Skin Repair
15120       Skn splt a-grft fac/nck/hf/g                    T              T            0137             Level V Skin Repair
15121       Skn splt a-grft f/n/hf/g add                    T              T            0137             Level V Skin Repair
15130       Derm autograft, trnk/arm/leg                    T              T            0136             Level IV Skin Repair
15131       Derm autograft t/a/l add-on                     T              T            0136             Level IV Skin Repair
15135       Derm autograft face/nck/hf/g                    T              T            0136             Level IV Skin Repair
15136       Derm autograft, f/n/hf/g add                    T              T            0136             Level IV Skin Repair
15150       Cult epiderm grft t/arm/leg                     T              T            0135             Level III Skin Repair
15151       Cult epiderm grft t/a/l addl                    T              T            0135             Level III Skin Repair
15152       Cult epiderm graft t/a/l +%                     T              T            0135             Level III Skin Repair
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                           Description           January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                             (short)            Relative Weights



15100       Skin splt grft, trnk/arm/leg                   22.2821             1534.70
15101       Skin splt grft t/a/l, add-on                   22.2821             1534.70
15110       Epidrm autogrft trnk/arm/leg                    4.6422              319.74
15111       Epidrm autogrft t/a/l add-on                    4.6422              319.74
15115       Epidrm a-grft face/nck/hf/g                     4.6422              319.74
15116       Epidrm a-grft f/n/hf/g addl                     4.6422              319.74
15120       Skn splt a-grft fac/nck/hf/g                   22.2821             1534.70
15121       Skn splt a-grft f/n/hf/g add                   22.2821             1534.70
15130       Derm autograft, trnk/arm/leg                   17.2117             1185.47
15131       Derm autograft t/a/l add-on                    17.2117             1185.47
15135       Derm autograft face/nck/hf/g                   17.2117             1185.47
15136       Derm autograft, f/n/hf/g add                   17.2117             1185.47
15150       Cult epiderm grft t/arm/leg                     4.6422              319.74
15151       Cult epiderm grft t/a/l addl                    4.6422              319.74
15152       Cult epiderm graft t/a/l +%                     4.6422              319.74
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                           Description           January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                             (short)



15100       Skin splt grft, trnk/arm/leg                   1,084.02           2,353.44            2,879.29                                    X
15101       Skin splt grft t/a/l, add-on                   1,084.02           2,353.44            2,879.29                                    X
15110       Epidrm autogrft trnk/arm/leg                    225.84             490.31              599.87                                     X
15111       Epidrm autogrft t/a/l add-on                    225.84             490.31              599.87                                     X
15115       Epidrm a-grft face/nck/hf/g                     225.84             490.31              599.87                                     X
15116       Epidrm a-grft f/n/hf/g addl                     225.84             490.31              599.87                                     X
15120       Skn splt a-grft fac/nck/hf/g                   1,084.02           2,353.44            2,879.29                                    X
15121       Skn splt a-grft f/n/hf/g add                   1,084.02           2,353.44            2,879.29                                    X
15130       Derm autograft, trnk/arm/leg                    837.35            1,817.90            2,224.10                                    X
15131       Derm autograft t/a/l add-on                     837.35            1,817.90            2,224.10                                    X
15135       Derm autograft face/nck/hf/g                    837.35            1,817.90            2,224.10                                    X
15136       Derm autograft, f/n/hf/g add                    837.35            1,817.90            2,224.10                                    X
15150       Cult epiderm grft t/arm/leg                     225.84             490.31              599.87                                     X
15151       Cult epiderm grft t/a/l addl                    225.84             490.31              599.87                                     X
15152       Cult epiderm graft t/a/l +%                     225.84             490.31              599.87                                     X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                           Description          January 2011   January 2011   January 2011     January 2011 Description
  HCPCS                             (short)



15155       Cult epiderm graft, f/n/hf/g                    T              T            0135             Level III Skin Repair
15156       Cult epidrm grft f/n/hfg add                    T              T            0135             Level III Skin Repair
15157       Cult epiderm grft f/n/hfg +%                    T              T            0135             Level III Skin Repair
15170       Acell graft trunk/arms/legs                     T              T            0135             Level III Skin Repair
15171       Acell graft t/arm/leg add-on                    T              T            0134             Level II Skin Repair
15175       Acellular graft, f/n/hf/g                       T              T            0135             Level III Skin Repair
15176       Acell graft, f/n/hf/g add-on                    T              T            0135             Level III Skin Repair
15200       Skin full graft, trunk                          T              T            0136             Level IV Skin Repair
15201       Skin full graft trunk add-on                    T              T            0136             Level IV Skin Repair
15220       Skin full graft sclp/arm/leg                    T              T            0136             Level IV Skin Repair
15221       Skin full graft add-on                          T              T            0135             Level III Skin Repair
15240       Skin full grft face/genit/hf                    T              T            0136             Level IV Skin Repair
15241       Skin full graft add-on                          T              T            0135             Level III Skin Repair
15260       Skin full graft een & lips                      T              T            0136             Level IV Skin Repair
15261       Skin full graft add-on                          T              T            0136             Level IV Skin Repair
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                           Description           January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                             (short)            Relative Weights



15155       Cult epiderm graft, f/n/hf/g                    4.6422              319.74
15156       Cult epidrm grft f/n/hfg add                    4.6422              319.74
15157       Cult epiderm grft f/n/hfg +%                    4.6422              319.74
15170       Acell graft trunk/arms/legs                     4.6422              319.74
15171       Acell graft t/arm/leg add-on                    3.1618              217.77
15175       Acellular graft, f/n/hf/g                       4.6422              319.74
15176       Acell graft, f/n/hf/g add-on                    4.6422              319.74
15200       Skin full graft, trunk                         17.2117             1185.47
15201       Skin full graft trunk add-on                   17.2117             1185.47
15220       Skin full graft sclp/arm/leg                   17.2117             1185.47
15221       Skin full graft add-on                          4.6422              319.74
15240       Skin full grft face/genit/hf                   17.2117             1185.47
15241       Skin full graft add-on                          4.6422              319.74
15260       Skin full graft een & lips                     17.2117             1185.47
15261       Skin full graft add-on                         17.2117             1185.47
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                           Description           January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                             (short)



15155       Cult epiderm graft, f/n/hf/g                   225.84              490.31              599.87                                     X
15156       Cult epidrm grft f/n/hfg add                   225.84              490.31              599.87                                     X
15157       Cult epiderm grft f/n/hfg +%                   225.84              490.31              599.87                                     X
15170       Acell graft trunk/arms/legs                    225.84              490.31              599.87                                     X
15171       Acell graft t/arm/leg add-on                   153.82              333.95              408.57                                     X
15175       Acellular graft, f/n/hf/g                      225.84              490.31              599.87                                     X
15176       Acell graft, f/n/hf/g add-on                   225.84              490.31              599.87                                     X
15200       Skin full graft, trunk                         837.35             1,817.90            2,224.10                                    X
15201       Skin full graft trunk add-on                   837.35             1,817.90            2,224.10                                    X
15220       Skin full graft sclp/arm/leg                   837.35             1,817.90            2,224.10                                    X
15221       Skin full graft add-on                         225.84              490.31              599.87                                     X
15240       Skin full grft face/genit/hf                   837.35             1,817.90            2,224.10                                    X
15241       Skin full graft add-on                         225.84              490.31              599.87                                     X
15260       Skin full graft een & lips                     837.35             1,817.90            2,224.10                                    X
15261       Skin full graft add-on                         837.35             1,817.90            2,224.10                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                            Description         January 2011   January 2011   January 2011     January 2011 Description
  HCPCS                              (short)



15300       Apply skinallogrft, t/arm/lg                    T              T            0135             Level III Skin Repair
15301       Apply sknallogrft t/a/l addl                    T              T            0135             Level III Skin Repair
15320       Apply skin allogrft f/n/hf/g                    T              T            0135             Level III Skin Repair
15321       Aply sknallogrft f/n/hfg add                    T              T            0135             Level III Skin Repair
15330       Aply acell alogrft t/arm/leg                    T              T            0135             Level III Skin Repair
15331       Aply acell grft t/a/l add-on                    T              T            0135             Level III Skin Repair
15335       Apply acell graft, f/n/hf/g                     T              T            0135             Level III Skin Repair
15336       Aply acell grft f/n/hf/g add                    T              T            0135             Level III Skin Repair
15340       Apply cult skin substitute                      T              T            0134             Level II Skin Repair
15341       Apply cult skin sub add-on                      T              T            0134             Level II Skin Repair
15360       Apply cult derm sub, t/a/l                      T              T            0134             Level II Skin Repair
15361       Aply cult derm sub t/a/l add                    T              T            0134             Level II Skin Repair
15365       Apply cult derm sub f/n/hf/g                    T              T            0134             Level II Skin Repair
15366       Apply cult derm f/hf/g add                      T              T            0134             Level II Skin Repair
15400       Apply skin xenograft, t/a/l                     T              T            0135             Level III Skin Repair
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                            Description          January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                              (short)           Relative Weights



15300       Apply skinallogrft, t/arm/lg                    4.6422              319.74
15301       Apply sknallogrft t/a/l addl                    4.6422              319.74
15320       Apply skin allogrft f/n/hf/g                    4.6422              319.74
15321       Aply sknallogrft f/n/hfg add                    4.6422              319.74
15330       Aply acell alogrft t/arm/leg                    4.6422              319.74
15331       Aply acell grft t/a/l add-on                    4.6422              319.74
15335       Apply acell graft, f/n/hf/g                     4.6422              319.74
15336       Aply acell grft f/n/hf/g add                    4.6422              319.74
15340       Apply cult skin substitute                      3.1618              217.77
15341       Apply cult skin sub add-on                      3.1618              217.77
15360       Apply cult derm sub, t/a/l                      3.1618              217.77
15361       Aply cult derm sub t/a/l add                    3.1618              217.77
15365       Apply cult derm sub f/n/hf/g                    3.1618              217.77
15366       Apply cult derm f/hf/g add                      3.1618              217.77
15400       Apply skin xenograft, t/a/l                     4.6422              319.74
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                            Description          January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                              (short)



15300       Apply skinallogrft, t/arm/lg                   225.84              490.31              599.87                                     X
15301       Apply sknallogrft t/a/l addl                   225.84              490.31              599.87                                     X
15320       Apply skin allogrft f/n/hf/g                   225.84              490.31              599.87                                     X
15321       Aply sknallogrft f/n/hfg add                   225.84              490.31              599.87                                     X
15330       Aply acell alogrft t/arm/leg                   225.84              490.31              599.87                                     X
15331       Aply acell grft t/a/l add-on                   225.84              490.31              599.87                                     X
15335       Apply acell graft, f/n/hf/g                    225.84              490.31              599.87                                     X
15336       Aply acell grft f/n/hf/g add                   225.84              490.31              599.87                                     X
15340       Apply cult skin substitute                     153.82              333.95              408.57                                     X
15341       Apply cult skin sub add-on                     153.82              333.95              408.57                                     X
15360       Apply cult derm sub, t/a/l                     153.82              333.95              408.57                                     X
15361       Aply cult derm sub t/a/l add                   153.82              333.95              408.57                                     X
15365       Apply cult derm sub f/n/hf/g                   153.82              333.95              408.57                                     X
15366       Apply cult derm f/hf/g add                     153.82              333.95              408.57                                     X
15400       Apply skin xenograft, t/a/l                    225.84              490.31              599.87                                     X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011     January 2011 Description
  HCPCS                            (short)



15401       Apply skn xenogrft t/a/l add                    T              T            0135             Level III Skin Repair
15420       Apply skin xgraft, f/n/hf/g                     T              T            0135             Level III Skin Repair
15421       Apply skn xgrft f/n/hf/g add                    T              T            0135             Level III Skin Repair
15430       Apply acellular xenograft                       T              T            0135             Level III Skin Repair
15431       Apply acellular xgraft add                      T              T            0135             Level III Skin Repair
15570       Form skin pedicle flap                          T              T            0137             Level V Skin Repair
15572       Form skin pedicle flap                          T              T            0137             Level V Skin Repair
15574       Form skin pedicle flap                          T              T            0137             Level V Skin Repair
15576       Form skin pedicle flap                          T              T            0137             Level V Skin Repair
15600       Skin graft                                      T              T            0137             Level V Skin Repair
15610       Skin graft                                      T              T            0137             Level V Skin Repair
15620       Skin graft                                      T              T            0137             Level V Skin Repair
15630       Skin graft                                      T              T            0137             Level V Skin Repair
15650       Transfer skin pedicle flap                      T              T            0137             Level V Skin Repair
15731       Forehead flap w/vasc pedicle                    T              1            0137             Level V Skin Repair
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



15401       Apply skn xenogrft t/a/l add                    4.6422              319.74
15420       Apply skin xgraft, f/n/hf/g                     4.6422              319.74
15421       Apply skn xgrft f/n/hf/g add                    4.6422              319.74
15430       Apply acellular xenograft                       4.6422              319.74
15431       Apply acellular xgraft add                      4.6422              319.74
15570       Form skin pedicle flap                         22.2821             1534.70
15572       Form skin pedicle flap                         22.2821             1534.70
15574       Form skin pedicle flap                         22.2821             1534.70
15576       Form skin pedicle flap                         22.2821             1534.70
15600       Skin graft                                     22.2821             1534.70
15610       Skin graft                                     22.2821             1534.70
15620       Skin graft                                     22.2821             1534.70
15630       Skin graft                                     22.2821             1534.70
15650       Transfer skin pedicle flap                     22.2821             1534.70
15731       Forehead flap w/vasc pedicle                   22.2821             1534.70
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



15401       Apply skn xenogrft t/a/l add                    225.84             490.31              599.87                                     X
15420       Apply skin xgraft, f/n/hf/g                     225.84             490.31              599.87                                     X
15421       Apply skn xgrft f/n/hf/g add                    225.84             490.31              599.87                                     X
15430       Apply acellular xenograft                       225.84             490.31              599.87                                     X
15431       Apply acellular xgraft add                      225.84             490.31              599.87                                     X
15570       Form skin pedicle flap                         1,084.02           2,353.44            2,879.29                                    X
15572       Form skin pedicle flap                         1,084.02           2,353.44            2,879.29                                    X
15574       Form skin pedicle flap                         1,084.02           2,353.44            2,879.29                                    X
15576       Form skin pedicle flap                         1,084.02           2,353.44            2,879.29                                    X
15600       Skin graft                                     1,084.02           2,353.44            2,879.29                                    X
15610       Skin graft                                     1,084.02           2,353.44            2,879.29                                    X
15620       Skin graft                                     1,084.02           2,353.44            2,879.29                                    X
15630       Skin graft                                     1,084.02           2,353.44            2,879.29                                    X
15650       Transfer skin pedicle flap                     1,084.02           2,353.44            2,879.29                                    X
15731       Forehead flap w/vasc pedicle                     0.00               0.00                0.00                                      X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011     January 2011 Description
  HCPCS                            (short)



15732       Muscle-skin graft, head/neck                    T              T            0137             Level V Skin Repair
15734       Muscle-skin graft, trunk                        T              T            0137             Level V Skin Repair
15736       Muscle-skin graft, arm                          T              T            0137             Level V Skin Repair
15738       Muscle-skin graft, leg                          T              T            0137             Level V Skin Repair
15740       Island pedicle flap graft                       T              T            0136             Level IV Skin Repair
15750       Neurovascular pedicle graft                     T              T            0137             Level V Skin Repair
15756       Free myo/skin flap microvasc                    C              C
15757       Free skin flap, microvasc                       C              C
15758       Free fascial flap, microvasc                    C              C
15760       Composite skin graft                            T              T            0137              Level V Skin Repair
15770       Derma-fat-fascia graft                          T              T            0137              Level V Skin Repair
15775       Hair transplant punch grafts                    T              1            0133              Level I Skin Repair
15776       Hair transplant punch grafts                    T              1            0133              Level I Skin Repair
15780       Abrasion treatment of skin                      T              T            0022           Level IV Excision/ Biopsy
15781       Abrasion treatment of skin                      T              1            0019            Level I Excision/ Biopsy
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



15732       Muscle-skin graft, head/neck                   22.2821             1534.70
15734       Muscle-skin graft, trunk                       22.2821             1534.70
15736       Muscle-skin graft, arm                         22.2821             1534.70
15738       Muscle-skin graft, leg                         22.2821             1534.70
15740       Island pedicle flap graft                      17.2117             1185.47
15750       Neurovascular pedicle graft                    22.2821             1534.70
15756       Free myo/skin flap microvasc                    0.0000                0.00
15757       Free skin flap, microvasc                       0.0000                0.00
15758       Free fascial flap, microvasc                    0.0000                0.00
15760       Composite skin graft                           22.2821             1534.70
15770       Derma-fat-fascia graft                         22.2821             1534.70
15775       Hair transplant punch grafts                    1.3330               91.81
15776       Hair transplant punch grafts                    1.3330               91.81
15780       Abrasion treatment of skin                     23.8986             1646.04
15781       Abrasion treatment of skin                      5.0887              350.49
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



15732       Muscle-skin graft, head/neck                   1,084.02           2,353.44            2,879.29                                    X
15734       Muscle-skin graft, trunk                       1,084.02           2,353.44            2,879.29                                    X
15736       Muscle-skin graft, arm                         1,084.02           2,353.44            2,879.29                                    X
15738       Muscle-skin graft, leg                         1,084.02           2,353.44            2,879.29                                    X
15740       Island pedicle flap graft                       837.35            1,817.90            2,224.10                                    X
15750       Neurovascular pedicle graft                    1,084.02           2,353.44            2,879.29                                    X
15756       Free myo/skin flap microvasc                     0.00               0.00                0.00
15757       Free skin flap, microvasc                        0.00               0.00                0.00
15758       Free fascial flap, microvasc                     0.00               0.00                0.00
15760       Composite skin graft                           1,084.02           2,353.44            2,879.29                                    X
15770       Derma-fat-fascia graft                         1,084.02           2,353.44            2,879.29                                    X
15775       Hair transplant punch grafts                     0.00               0.00                0.00                                      X
15776       Hair transplant punch grafts                     0.00               0.00                0.00                                      X
15780       Abrasion treatment of skin                     1,162.67           2,524.17            3,088.18                                    X
15781       Abrasion treatment of skin                       0.00               0.00                0.00                                      X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                    Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011       January 2011 Description
  HCPCS                            (short)



15782       Abrasion treatment of skin                      T              1            0019              Level I Excision/ Biopsy
15783       Abrasion treatment of skin                      T              1            0016        Level IV Debridement & Destruction
15786       Abrasion, lesion, single                        T              1            0013        Level II Debridement & Destruction
15787       Abrasion, lesions, add-on                       T              1            0013        Level II Debridement & Destruction
15788       Chemical peel, face, epiderm                    T              1            0013        Level II Debridement & Destruction
15789       Chemical peel, face, dermal                     T              1            0015        Level III Debridement & Destruction
15792       Chemical peel, nonfacial                        T              1            0015        Level III Debridement & Destruction
15793       Chemical peel, nonfacial                        T              1            0013        Level II Debridement & Destruction
15819       Plastic surgery, neck                           T              1            0134                 Level II Skin Repair
15820       Revision of lower eyelid                        T              T            0137                 Level V Skin Repair
15821       Revision of lower eyelid                        T              T            0137                 Level V Skin Repair
15822       Revision of upper eyelid                        T              T            0137                 Level V Skin Repair
15823       Revision of upper eyelid                        T              T            0137                 Level V Skin Repair
15824       Removal of forehead wrinkles                    T              1            0137                 Level V Skin Repair
15825       Removal of neck wrinkles                        T              1            0137                 Level V Skin Repair
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



15782       Abrasion treatment of skin                      5.0887              350.49
15783       Abrasion treatment of skin                      2.7318              188.16
15786       Abrasion, lesion, single                        0.9103               62.70
15787       Abrasion, lesions, add-on                       0.9103               62.70
15788       Chemical peel, face, epiderm                    0.9103               62.70
15789       Chemical peel, face, dermal                     1.4975              103.14
15792       Chemical peel, nonfacial                        1.4975              103.14
15793       Chemical peel, nonfacial                        0.9103               62.70
15819       Plastic surgery, neck                           3.1618              217.77
15820       Revision of lower eyelid                       22.2821             1534.70
15821       Revision of lower eyelid                       22.2821             1534.70
15822       Revision of upper eyelid                       22.2821             1534.70
15823       Revision of upper eyelid                       22.2821             1534.70
15824       Removal of forehead wrinkles                   22.2821             1534.70
15825       Removal of neck wrinkles                       22.2821             1534.70
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



15782       Abrasion treatment of skin                       0.00               0.00                0.00                                      X
15783       Abrasion treatment of skin                       0.00               0.00                0.00                                      X
15786       Abrasion, lesion, single                         0.00               0.00                0.00                                      X
15787       Abrasion, lesions, add-on                        0.00               0.00                0.00                                      X
15788       Chemical peel, face, epiderm                     0.00               0.00                0.00                                      X
15789       Chemical peel, face, dermal                      0.00               0.00                0.00                                      X
15792       Chemical peel, nonfacial                         0.00               0.00                0.00                                      X
15793       Chemical peel, nonfacial                         0.00               0.00                0.00                                      X
15819       Plastic surgery, neck                            0.00               0.00                0.00                                      X
15820       Revision of lower eyelid                       1,084.02           2,353.44            2,879.29                                    X
15821       Revision of lower eyelid                       1,084.02           2,353.44            2,879.29                                    X
15822       Revision of upper eyelid                       1,084.02           2,353.44            2,879.29                                    X
15823       Revision of upper eyelid                       1,084.02           2,353.44            2,879.29                                    X
15824       Removal of forehead wrinkles                     0.00               0.00                0.00                                      X
15825       Removal of neck wrinkles                         0.00               0.00                0.00                                      X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                           Description          January 2011   January 2011   January 2011     January 2011 Description
  HCPCS                             (short)



15826       Removal of brow wrinkles                        T              1            0137             Level V Skin Repair
15828       Removal of face wrinkles                        T              1            0137             Level V Skin Repair
15829       Removal of skin wrinkles                        T              1            0137             Level V Skin Repair
15830       Exc skin abd                                    T              T            0022           Level IV Excision/ Biopsy
15832       Excise excessive skin tissue                    T              1            0022           Level IV Excision/ Biopsy
15833       Excise excessive skin tissue                    T              1            0022           Level IV Excision/ Biopsy
15834       Excise excessive skin tissue                    T              1            0022           Level IV Excision/ Biopsy
15835       Excise excessive skin tissue                    T              1            0022           Level IV Excision/ Biopsy
15836       Excise excessive skin tissue                    T              1            0021           Level III Excision/ Biopsy
15837       Excise excessive skin tissue                    T              1            0021           Level III Excision/ Biopsy
15838       Excise excessive skin tissue                    T              1            0021           Level III Excision/ Biopsy
15839       Excise excessive skin tissue                    T              1            0021           Level III Excision/ Biopsy
15840       Graft for face nerve palsy                      T              T            0137             Level V Skin Repair
15841       Graft for face nerve palsy                      T              T            0137             Level V Skin Repair
15842       Flap for face nerve palsy                       T              T            0137             Level V Skin Repair
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                           Description           January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                             (short)            Relative Weights



15826       Removal of brow wrinkles                       22.2821             1534.70
15828       Removal of face wrinkles                       22.2821             1534.70
15829       Removal of skin wrinkles                       22.2821             1534.70
15830       Exc skin abd                                   23.8986             1646.04
15832       Excise excessive skin tissue                   23.8986             1646.04
15833       Excise excessive skin tissue                   23.8986             1646.04
15834       Excise excessive skin tissue                   23.8986             1646.04
15835       Excise excessive skin tissue                   23.8986             1646.04
15836       Excise excessive skin tissue                   18.0784             1245.17
15837       Excise excessive skin tissue                   18.0784             1245.17
15838       Excise excessive skin tissue                   18.0784             1245.17
15839       Excise excessive skin tissue                   18.0784             1245.17
15840       Graft for face nerve palsy                     22.2821             1534.70
15841       Graft for face nerve palsy                     22.2821             1534.70
15842       Flap for face nerve palsy                      22.2821             1534.70
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                           Description           January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                             (short)



15826       Removal of brow wrinkles                         0.00               0.00                0.00                                      X
15828       Removal of face wrinkles                         0.00               0.00                0.00                                      X
15829       Removal of skin wrinkles                         0.00               0.00                0.00                                      X
15830       Exc skin abd                                   1,162.67           2,524.17            3,088.18                                    X
15832       Excise excessive skin tissue                     0.00               0.00                0.00                                      X
15833       Excise excessive skin tissue                     0.00               0.00                0.00                                      X
15834       Excise excessive skin tissue                     0.00               0.00                0.00                                      X
15835       Excise excessive skin tissue                     0.00               0.00                0.00                                      X
15836       Excise excessive skin tissue                     0.00               0.00                0.00                                      X
15837       Excise excessive skin tissue                     0.00               0.00                0.00                                      X
15838       Excise excessive skin tissue                     0.00               0.00                0.00                                      X
15839       Excise excessive skin tissue                     0.00               0.00                0.00                                      X
15840       Graft for face nerve palsy                     1,084.02           2,353.44            2,879.29                                    X
15841       Graft for face nerve palsy                     1,084.02           2,353.44            2,879.29                                    X
15842       Flap for face nerve palsy                      1,084.02           2,353.44            2,879.29                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011       January 2011 Description
  HCPCS                            (short)



15845       Skin and muscle repair, face                    T              T            0137                Level V Skin Repair
15847       Exc skin abd add-on                             T              T            0022             Level IV Excision/ Biopsy
15850       Removal of sutures                              T              T            0016        Level IV Debridement & Destruction
15851       Removal of sutures                              T              T            0016        Level IV Debridement & Destruction
15852       Dressing change not for burn                    X              X            0340            Minor Ancillary Procedures
15860       Test for blood flow in graft                    X              X            0340            Minor Ancillary Procedures
15876       Suction assisted lipectomy                      T              1            0137                Level V Skin Repair
15877       Suction assisted lipectomy                      T              1            0137                Level V Skin Repair
15878       Suction assisted lipectomy                      T              1            0137                Level V Skin Repair
15879       Suction assisted lipectomy                      T              1            0137                Level V Skin Repair
15920       Removal of tail bone ulcer                      T              T            0019              Level I Excision/ Biopsy
15922       Removal of tail bone ulcer                      T              T            0137                Level V Skin Repair
15931       Remove sacrum pressure sore                     T              T            0022             Level IV Excision/ Biopsy
15933       Remove sacrum pressure sore                     T              T            0022             Level IV Excision/ Biopsy
15934       Remove sacrum pressure sore                     T              T            0137                Level V Skin Repair
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



15845       Skin and muscle repair, face                   22.2821             1534.70
15847       Exc skin abd add-on                            23.8986             1646.04
15850       Removal of sutures                              2.7318              188.16
15851       Removal of sutures                              2.7318              188.16
15852       Dressing change not for burn                    0.6712               46.23
15860       Test for blood flow in graft                    0.6712               46.23
15876       Suction assisted lipectomy                     22.2821             1534.70
15877       Suction assisted lipectomy                     22.2821             1534.70
15878       Suction assisted lipectomy                     22.2821             1534.70
15879       Suction assisted lipectomy                     22.2821             1534.70
15920       Removal of tail bone ulcer                      5.0887              350.49
15922       Removal of tail bone ulcer                     22.2821             1534.70
15931       Remove sacrum pressure sore                    23.8986             1646.04
15933       Remove sacrum pressure sore                    23.8986             1646.04
15934       Remove sacrum pressure sore                    22.2821             1534.70
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



15845       Skin and muscle repair, face                   1,084.02           2,353.44            2,879.29                                    X
15847       Exc skin abd add-on                            1,162.67           2,524.17            3,088.18                                    X
15850       Removal of sutures                              132.90             288.53              353.00                                     X
15851       Removal of sutures                              132.90             288.53              353.00                                     X
15852       Dressing change not for burn                     32.65              70.89               86.73                                     X
15860       Test for blood flow in graft                     32.65              70.89               86.73                                     X
15876       Suction assisted lipectomy                        0.00               0.00                0.00                                     X
15877       Suction assisted lipectomy                        0.00               0.00                0.00                                     X
15878       Suction assisted lipectomy                        0.00               0.00                0.00                                     X
15879       Suction assisted lipectomy                        0.00               0.00                0.00                                     X
15920       Removal of tail bone ulcer                      247.57             537.47              657.56                                     X
15922       Removal of tail bone ulcer                     1,084.02           2,353.44            2,879.29                                    X
15931       Remove sacrum pressure sore                    1,162.67           2,524.17            3,088.18                                    X
15933       Remove sacrum pressure sore                    1,162.67           2,524.17            3,088.18                                    X
15934       Remove sacrum pressure sore                    1,084.02           2,353.44            2,879.29                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011     January 2011 Description
  HCPCS                            (short)



15935       Remove sacrum pressure sore                     T              T            0137              Level V Skin Repair
15936       Remove sacrum pressure sore                     T              T            0136             Level IV Skin Repair
15937       Remove sacrum pressure sore                     T              T            0137              Level V Skin Repair
15940       Remove hip pressure sore                        T              T            0022           Level IV Excision/ Biopsy
15941       Remove hip pressure sore                        T              T            0022           Level IV Excision/ Biopsy
15944       Remove hip pressure sore                        T              T            0137              Level V Skin Repair
15945       Remove hip pressure sore                        T              T            0137              Level V Skin Repair
15946       Remove hip pressure sore                        T              T            0137              Level V Skin Repair
15950       Remove thigh pressure sore                      T              T            0022           Level IV Excision/ Biopsy
15951       Remove thigh pressure sore                      T              T            0022           Level IV Excision/ Biopsy
15952       Remove thigh pressure sore                      T              T            0136             Level IV Skin Repair
15953       Remove thigh pressure sore                      T              T            0136             Level IV Skin Repair
15956       Remove thigh pressure sore                      T              T            0136             Level IV Skin Repair
15958       Remove thigh pressure sore                      T              T            0136             Level IV Skin Repair
15999       Removal of pressure sore                        T              T            0019            Level I Excision/ Biopsy
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



15935       Remove sacrum pressure sore                    22.2821             1534.70
15936       Remove sacrum pressure sore                    17.2117             1185.47
15937       Remove sacrum pressure sore                    22.2821             1534.70
15940       Remove hip pressure sore                       23.8986             1646.04
15941       Remove hip pressure sore                       23.8986             1646.04
15944       Remove hip pressure sore                       22.2821             1534.70
15945       Remove hip pressure sore                       22.2821             1534.70
15946       Remove hip pressure sore                       22.2821             1534.70
15950       Remove thigh pressure sore                     23.8986             1646.04
15951       Remove thigh pressure sore                     23.8986             1646.04
15952       Remove thigh pressure sore                     17.2117             1185.47
15953       Remove thigh pressure sore                     17.2117             1185.47
15956       Remove thigh pressure sore                     17.2117             1185.47
15958       Remove thigh pressure sore                     17.2117             1185.47
15999       Removal of pressure sore                        5.0887              350.49
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



15935       Remove sacrum pressure sore                    1,084.02           2,353.44            2,879.29                                    X
15936       Remove sacrum pressure sore                     837.35            1,817.90            2,224.10                                    X
15937       Remove sacrum pressure sore                    1,084.02           2,353.44            2,879.29                                    X
15940       Remove hip pressure sore                       1,162.67           2,524.17            3,088.18                                    X
15941       Remove hip pressure sore                       1,162.67           2,524.17            3,088.18                                    X
15944       Remove hip pressure sore                       1,084.02           2,353.44            2,879.29                                    X
15945       Remove hip pressure sore                       1,084.02           2,353.44            2,879.29                                    X
15946       Remove hip pressure sore                       1,084.02           2,353.44            2,879.29                                    X
15950       Remove thigh pressure sore                     1,162.67           2,524.17            3,088.18                                    X
15951       Remove thigh pressure sore                     1,162.67           2,524.17            3,088.18                                    X
15952       Remove thigh pressure sore                      837.35            1,817.90            2,224.10                                    X
15953       Remove thigh pressure sore                      837.35            1,817.90            2,224.10                                    X
15956       Remove thigh pressure sore                      837.35            1,817.90            2,224.10                                    X
15958       Remove thigh pressure sore                      837.35            1,817.90            2,224.10                                    X
15999       Removal of pressure sore                        247.57             537.47              657.56                                     X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                    Medicare APC




   CPT/                           Description          January 2011   January 2011   January 2011       January 2011 Description
  HCPCS                             (short)



16000       Initial treatment of burn(s)                    T              T            0013        Level II Debridement & Destruction
16020       Dress/debrid p-thick burn, s                    T              T            0015        Level III Debridement & Destruction
16025       Dress/debrid p-thick burn, m                    T              T            0015        Level III Debridement & Destruction
16030       Dress/debrid p-thick burn, l                    T              T            0015        Level III Debridement & Destruction
16035       Incision of burn scab, initi                    T              T            0015        Level III Debridement & Destruction
16036       Escharotomy; addl incision                      C              C
17000       Destruct premalg lesion                         T              T            0013        Level II Debridement & Destruction
17003       Destruct premalg les, 2-14                      T              T            0012         Level I Debridement & Destruction
17004       Destroy premlg lesions 15+                      T              T            0016        Level IV Debridement & Destruction
17106       Destruction of skin lesions                     T              T            0016        Level IV Debridement & Destruction
17107       Destruction of skin lesions                     T              T            0016        Level IV Debridement & Destruction
17108       Destruction of skin lesions                     T              T            0016        Level IV Debridement & Destruction
17110       Destruct b9 lesion, 1-14                        T              T            0013        Level II Debridement & Destruction
17111       Destruct lesion, 15 or more                     T              T            0015        Level III Debridement & Destruction
17250       Chemical cautery, tissue                        T              T            0015        Level III Debridement & Destruction
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                           Description           January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                             (short)            Relative Weights



16000       Initial treatment of burn(s)                    0.9103               62.70
16020       Dress/debrid p-thick burn, s                    1.4975              103.14
16025       Dress/debrid p-thick burn, m                    1.4975              103.14
16030       Dress/debrid p-thick burn, l                    1.4975              103.14
16035       Incision of burn scab, initi                    1.4975              103.14
16036       Escharotomy; addl incision                      0.0000                0.00
17000       Destruct premalg lesion                         0.9103               62.70
17003       Destruct premalg les, 2-14                      0.4326               29.80
17004       Destroy premlg lesions 15+                      2.7318              188.16
17106       Destruction of skin lesions                     2.7318              188.16
17107       Destruction of skin lesions                     2.7318              188.16
17108       Destruction of skin lesions                     2.7318              188.16
17110       Destruct b9 lesion, 1-14                        0.9103               62.70
17111       Destruct lesion, 15 or more                     1.4975              103.14
17250       Chemical cautery, tissue                        1.4975              103.14
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                           Description           January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                             (short)



16000       Initial treatment of burn(s)                    44.29               96.15              117.63                                     X
16020       Dress/debrid p-thick burn, s                    72.85              158.17              193.51                                     X
16025       Dress/debrid p-thick burn, m                    72.85              158.17              193.51                                     X
16030       Dress/debrid p-thick burn, l                    72.85              158.17              193.51                                     X
16035       Incision of burn scab, initi                    72.85              158.17              193.51                                     X
16036       Escharotomy; addl incision                       0.00                0.00                0.00
17000       Destruct premalg lesion                         44.29               96.15              117.63                                     X
17003       Destruct premalg les, 2-14                      21.05               45.69               55.90                                     X
17004       Destroy premlg lesions 15+                     132.90              288.53              353.00                                     X
17106       Destruction of skin lesions                    132.90              288.53              353.00                                     X
17107       Destruction of skin lesions                    132.90              288.53              353.00                                     X
17108       Destruction of skin lesions                    132.90              288.53              353.00                                     X
17110       Destruct b9 lesion, 1-14                        44.29               96.15              117.63                                     X
17111       Destruct lesion, 15 or more                     72.85              158.17              193.51                                     X
17250       Chemical cautery, tissue                        72.85              158.17              193.51                                     X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                    Medicare APC




   CPT/                            Description         January 2011   January 2011   January 2011       January 2011 Description
  HCPCS                              (short)



17260       Destruction of skin lesions                     T              T            0015        Level III Debridement & Destruction
17261       Destruction of skin lesions                     T              T            0015        Level III Debridement & Destruction
17262       Destruction of skin lesions                     T              T            0015        Level III Debridement & Destruction
17263       Destruction of skin lesions                     T              T            0015        Level III Debridement & Destruction
17264       Destruction of skin lesions                     T              T            0015        Level III Debridement & Destruction
17266       Destruction of skin lesions                     T              T            0016        Level IV Debridement & Destruction
17270       Destruction of skin lesions                     T              T            0015        Level III Debridement & Destruction
17271       Destruction of skin lesions                     T              T            0015        Level III Debridement & Destruction
17272       Destruction of skin lesions                     T              T            0015        Level III Debridement & Destruction
17273       Destruction of skin lesions                     T              T            0016        Level IV Debridement & Destruction
17274       Destruction of skin lesions                     T              T            0016        Level IV Debridement & Destruction
17276       Destruction of skin lesions                     T              T            0016        Level IV Debridement & Destruction
17280       Destruction of skin lesions                     T              T            0015        Level III Debridement & Destruction
17281       Destruction of skin lesions                     T              T            0016        Level IV Debridement & Destruction
17282       Destruction of skin lesions                     T              T            0016        Level IV Debridement & Destruction
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                            Description          January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                              (short)           Relative Weights



17260       Destruction of skin lesions                     1.4975              103.14
17261       Destruction of skin lesions                     1.4975              103.14
17262       Destruction of skin lesions                     1.4975              103.14
17263       Destruction of skin lesions                     1.4975              103.14
17264       Destruction of skin lesions                     1.4975              103.14
17266       Destruction of skin lesions                     2.7318              188.16
17270       Destruction of skin lesions                     1.4975              103.14
17271       Destruction of skin lesions                     1.4975              103.14
17272       Destruction of skin lesions                     1.4975              103.14
17273       Destruction of skin lesions                     2.7318              188.16
17274       Destruction of skin lesions                     2.7318              188.16
17276       Destruction of skin lesions                     2.7318              188.16
17280       Destruction of skin lesions                     1.4975              103.14
17281       Destruction of skin lesions                     2.7318              188.16
17282       Destruction of skin lesions                     2.7318              188.16
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                            Description          January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                              (short)



17260       Destruction of skin lesions                     72.85              158.17              193.51                                     X
17261       Destruction of skin lesions                     72.85              158.17              193.51                                     X
17262       Destruction of skin lesions                     72.85              158.17              193.51                                     X
17263       Destruction of skin lesions                     72.85              158.17              193.51                                     X
17264       Destruction of skin lesions                     72.85              158.17              193.51                                     X
17266       Destruction of skin lesions                    132.90              288.53              353.00                                     X
17270       Destruction of skin lesions                     72.85              158.17              193.51                                     X
17271       Destruction of skin lesions                     72.85              158.17              193.51                                     X
17272       Destruction of skin lesions                     72.85              158.17              193.51                                     X
17273       Destruction of skin lesions                    132.90              288.53              353.00                                     X
17274       Destruction of skin lesions                    132.90              288.53              353.00                                     X
17276       Destruction of skin lesions                    132.90              288.53              353.00                                     X
17280       Destruction of skin lesions                     72.85              158.17              193.51                                     X
17281       Destruction of skin lesions                    132.90              288.53              353.00                                     X
17282       Destruction of skin lesions                    132.90              288.53              353.00                                     X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                            Medicare APC




   CPT/                           Description          January 2011   January 2011   January 2011               January 2011 Description
  HCPCS                             (short)



17283       Destruction of skin lesions                     T              T            0016                 Level IV Debridement & Destruction
17284       Destruction of skin lesions                     T              T            0016                 Level IV Debridement & Destruction
17286       Destruction of skin lesions                     T              T            0016                 Level IV Debridement & Destruction
17311       Mohs, 1 stage, h/n/hf/g                         T              T            0694                             Mohs Surgery
17312       Mohs addl stage                                 T              T            0694                             Mohs Surgery
17313       Mohs, 1 stage, t/a/l                            T              T            0694                             Mohs Surgery
17314       Mohs, addl stage, t/a/l                         T              T            0694                             Mohs Surgery
17315       Mohs surg, addl block                           T              T            0694                             Mohs Surgery
17340       Cryotherapy of skin                             T              T            0013                  Level II Debridement & Destruction
17360       Skin peel therapy                               T              1            0013                  Level II Debridement & Destruction
17380       Hair removal by electrolysis                    T              1            0013                  Level II Debridement & Destruction
17999       Skin tissue procedure                           T              T            0012                  Level I Debridement & Destruction
19000       Drainage of breast lesion                       T              T            0004        Level I Needle Biopsy/ Aspiration Except Bone Marrow
19001       Drain breast lesion add-on                      T              T            0002                    Fine Needle Biopsy/Aspiration
19020       Incision of breast lesion                       T              T            0008                    Level III Incision and Drainage
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                           Description           January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                             (short)            Relative Weights



17283       Destruction of skin lesions                     2.7318              188.16
17284       Destruction of skin lesions                     2.7318              188.16
17286       Destruction of skin lesions                     2.7318              188.16
17311       Mohs, 1 stage, h/n/hf/g                         5.3665              369.62
17312       Mohs addl stage                                 5.3665              369.62
17313       Mohs, 1 stage, t/a/l                            5.3665              369.62
17314       Mohs, addl stage, t/a/l                         5.3665              369.62
17315       Mohs surg, addl block                           5.3665              369.62
17340       Cryotherapy of skin                             0.9103               62.70
17360       Skin peel therapy                               0.9103               62.70
17380       Hair removal by electrolysis                    0.9103               62.70
17999       Skin tissue procedure                           0.4326               29.80
19000       Drainage of breast lesion                       4.5843              315.75
19001       Drain breast lesion add-on                      1.5703              108.16
19020       Incision of breast lesion                      20.1996             1391.27
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                           Description           January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                             (short)



17283       Destruction of skin lesions                    132.90              288.53              353.00                                     X
17284       Destruction of skin lesions                    132.90              288.53              353.00                                     X
17286       Destruction of skin lesions                    132.90              288.53              353.00                                     X
17311       Mohs, 1 stage, h/n/hf/g                        261.08              566.81              693.46                                     X
17312       Mohs addl stage                                261.08              566.81              693.46                                     X
17313       Mohs, 1 stage, t/a/l                           261.08              566.81              693.46                                     X
17314       Mohs, addl stage, t/a/l                        261.08              566.81              693.46                                     X
17315       Mohs surg, addl block                          261.08              566.81              693.46                                     X
17340       Cryotherapy of skin                             44.29               96.15              117.63                                     X
17360       Skin peel therapy                                0.00                0.00                0.00                                     X
17380       Hair removal by electrolysis                     0.00                0.00                0.00                                     X
17999       Skin tissue procedure                           21.05               45.69               55.90                                     X
19000       Drainage of breast lesion                      223.03              484.19              592.38                                     X
19001       Drain breast lesion add-on                      76.40              165.86              202.91                                     X
19020       Incision of breast lesion                      982.71             2,133.48            2,610.19                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                             Medicare APC




   CPT/                           Description          January 2011   January 2011   January 2011                January 2011 Description
  HCPCS                             (short)



19030       Injection for breast x-ray                      N              N
19100       Bx breast percut w/o image                      T              T            0004        Level I Needle Biopsy/ Aspiration Except Bone Marrow
19101       Biopsy of breast, open                          T              T            0028                        Level I Breast Surgery
19102       Bx breast percut w/image                        T              T            0005        Level II Needle Biopsy/Aspiration Except Bone Marrow
19103       Bx breast percut w/device                       T              T            0037        Level IV Needle Biopsy/Aspiration Except Bone Marrow
19105       Cryosurg ablate fa, each                        T              T            0029                        Level II Breast Surgery
19110       Nipple exploration                              T              T            0028                        Level I Breast Surgery
19112       Excise breast duct fistula                      T              T            0028                        Level I Breast Surgery
19120       Removal of breast lesion                        T              T            0028                        Level I Breast Surgery
19125       Excision, breast lesion                         T              T            0028                        Level I Breast Surgery
19126       Excision, addl breast lesion                    T              T            0028                        Level I Breast Surgery
19260       Removal of chest wall lesion                    T              T            0021                       Level III Excision/ Biopsy
19271       Revision of chest wall                          C              C
19272       Extensive chest wall surgery                    C              C
19290       Place needle wire, breast                       N              N
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                           Description           January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                             (short)            Relative Weights



19030       Injection for breast x-ray                      0.0000               0.00
19100       Bx breast percut w/o image                      4.5843              315.75
19101       Biopsy of breast, open                         25.5910             1762.61
19102       Bx breast percut w/image                        8.1362              560.39
19103       Bx breast percut w/device                      15.7009             1081.42
19105       Cryosurg ablate fa, each                       33.9253             2336.64
19110       Nipple exploration                             25.5910             1762.61
19112       Excise breast duct fistula                     25.5910             1762.61
19120       Removal of breast lesion                       25.5910             1762.61
19125       Excision, breast lesion                        25.5910             1762.61
19126       Excision, addl breast lesion                   25.5910             1762.61
19260       Removal of chest wall lesion                   18.0784             1245.17
19271       Revision of chest wall                          0.0000               0.00
19272       Extensive chest wall surgery                    0.0000               0.00
19290       Place needle wire, breast                       0.0000               0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                           Description           January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                             (short)



19030       Injection for breast x-ray                       0.00               0.00                0.00
19100       Bx breast percut w/o image                      223.03             484.19              592.38                                     X
19101       Biopsy of breast, open                         1,245.00           2,702.92            3,306.87                                    X
19102       Bx breast percut w/image                        395.83             859.35             1,051.36                                    X
19103       Bx breast percut w/device                       763.85            1,658.33            2,028.87                                    X
19105       Cryosurg ablate fa, each                       1,650.47           3,583.19            4,383.83                                    X
19110       Nipple exploration                             1,245.00           2,702.92            3,306.87                                    X
19112       Excise breast duct fistula                     1,245.00           2,702.92            3,306.87                                    X
19120       Removal of breast lesion                       1,245.00           2,702.92            3,306.87                                    X
19125       Excision, breast lesion                        1,245.00           2,702.92            3,306.87                                    X
19126       Excision, addl breast lesion                   1,245.00           2,702.92            3,306.87                                    X
19260       Removal of chest wall lesion                    879.51            1,909.44            2,336.09                                    X
19271       Revision of chest wall                           0.00               0.00                0.00
19272       Extensive chest wall surgery                     0.00               0.00                0.00
19290       Place needle wire, breast                        0.00               0.00                0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                           Description          January 2011   January 2011   January 2011     January 2011 Description
  HCPCS                             (short)



19291       Place needle wire, breast                      N              N
19295       Place breast clip, percut                      Q1             Q1            0340          Minor Ancillary Procedures
19296       Place po breast cath for rad                   T              T             0648           Level IV Breast Surgery
19297       Place breast cath for rad                      T              T             0648           Level IV Breast Surgery
19298       Place breast rad tube/caths                    T              T             0648           Level IV Breast Surgery
19300       Removal of breast tissue                       T              T             0028            Level I Breast Surgery
19301       Partical mastectomy                            T              T             0028            Level I Breast Surgery
19302       P-mastectomy w/ln removal                      T              T             0030           Level III Breast Surgery
19303       Mast, simple, complete                         T              T             0029           Level II Breast Surgery
19304       Mast, subq                                     T              T             0029           Level II Breast Surgery
19305       Mast, radical                                  C              C
19306       Mast, rad, urban type                          C              C
19307       Mast, mod rad                                  T              T             0030            Level III Breast Surgery
19316       Suspension of breast                           T              T             0029            Level II Breast Surgery
19318       Reduction of large breast                      T              T             0030            Level III Breast Surgery
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                           Description           January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                             (short)            Relative Weights



19291       Place needle wire, breast                       0.0000               0.00
19295       Place breast clip, percut                       0.6712              46.23
19296       Place po breast cath for rad                   63.9911             4407.45                                46                  23
19297       Place breast cath for rad                      63.9911             4407.45                                46                  23
19298       Place breast rad tube/caths                    63.9911             4407.45                                46                  23
19300       Removal of breast tissue                       25.5910             1762.61
19301       Partical mastectomy                            25.5910             1762.61
19302       P-mastectomy w/ln removal                      45.0028             3099.61
19303       Mast, simple, complete                         33.9253             2336.64
19304       Mast, subq                                     33.9253             2336.64
19305       Mast, radical                                   0.0000               0.00
19306       Mast, rad, urban type                           0.0000               0.00
19307       Mast, mod rad                                  45.0028             3099.61
19316       Suspension of breast                           33.9253             2336.64
19318       Reduction of large breast                      45.0028             3099.61
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                           Description           January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                             (short)



19291       Place needle wire, breast                         0.00               0.00                0.00
19295       Place breast clip, percut                        32.65              70.89               86.73               X                     X
19296       Place po breast cath for rad                   3,113.17           6,758.74            8,268.93                                    X
19297       Place breast cath for rad                      3,113.17           6,758.74            8,268.93                                    X
19298       Place breast rad tube/caths                    3,113.17           6,758.74            8,268.93                                    X
19300       Removal of breast tissue                       1,245.00           2,702.92            3,306.87                                    X
19301       Partical mastectomy                            1,245.00           2,702.92            3,306.87                                    X
19302       P-mastectomy w/ln removal                      2,189.39           4,753.20            5,815.26                                    X
19303       Mast, simple, complete                         1,650.47           3,583.19            4,383.83                                    X
19304       Mast, subq                                     1,650.47           3,583.19            4,383.83                                    X
19305       Mast, radical                                     0.00               0.00                0.00
19306       Mast, rad, urban type                             0.00               0.00                0.00
19307       Mast, mod rad                                  2,189.39           4,753.20            5,815.26                                    X
19316       Suspension of breast                           1,650.47           3,583.19            4,383.83                                    X
19318       Reduction of large breast                      2,189.39           4,753.20            5,815.26                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011     January 2011 Description
  HCPCS                            (short)



19324       Enlarge breast                                  T              1            0030           Level III Breast Surgery
19325       Enlarge breast with implant                     T              T            0648           Level IV Breast Surgery
19328       Removal of breast implant                       T              T            0029           Level II Breast Surgery
19330       Removal of implant material                     T              T            0029           Level II Breast Surgery
19340       Immediate breast prosthesis                     T              T            0030           Level III Breast Surgery
19342       Delayed breast prosthesis                       T              T            0648           Level IV Breast Surgery
19350       Breast reconstruction                           T              T            0028            Level I Breast Surgery
19355       Correct inverted nipple(s)                      T              1            0029           Level II Breast Surgery
19357       Breast reconstruction                           T              T            0648           Level IV Breast Surgery
19361       Breast reconstr w/lat flap                      C              C
19364       Breast reconstruction                           C              C
19366       Breast reconstruction                           T              T            0029            Level II Breast Surgery
19367       Breast reconstruction                           C              C
19368       Breast reconstruction                           C              C
19369       Breast reconstruction                           C              C
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



19324       Enlarge breast                                 45.0028             3099.61
19325       Enlarge breast with implant                    63.9911             4407.45                                46                  23
19328       Removal of breast implant                      33.9253             2336.64
19330       Removal of implant material                    33.9253             2336.64
19340       Immediate breast prosthesis                    45.0028             3099.61
19342       Delayed breast prosthesis                      63.9911             4407.45                                46                  23
19350       Breast reconstruction                          25.5910             1762.61
19355       Correct inverted nipple(s)                     33.9253             2336.64
19357       Breast reconstruction                          63.9911             4407.45                                46                  23
19361       Breast reconstr w/lat flap                      0.0000               0.00
19364       Breast reconstruction                           0.0000               0.00
19366       Breast reconstruction                          33.9253             2336.64
19367       Breast reconstruction                           0.0000               0.00
19368       Breast reconstruction                           0.0000               0.00
19369       Breast reconstruction                           0.0000               0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



19324       Enlarge breast                                   0.00               0.00                0.00                                      X
19325       Enlarge breast with implant                    3,113.17           6,758.74            8,268.93                                    X
19328       Removal of breast implant                      1,650.47           3,583.19            4,383.83                                    X
19330       Removal of implant material                    1,650.47           3,583.19            4,383.83                                    X
19340       Immediate breast prosthesis                    2,189.39           4,753.20            5,815.26                                    X
19342       Delayed breast prosthesis                      3,113.17           6,758.74            8,268.93                                    X
19350       Breast reconstruction                          1,245.00           2,702.92            3,306.87                                    X
19355       Correct inverted nipple(s)                       0.00               0.00                0.00                                      X
19357       Breast reconstruction                          3,113.17           6,758.74            8,268.93                                    X
19361       Breast reconstr w/lat flap                       0.00               0.00                0.00
19364       Breast reconstruction                            0.00               0.00                0.00
19366       Breast reconstruction                          1,650.47           3,583.19            4,383.83                                    X
19367       Breast reconstruction                            0.00               0.00                0.00
19368       Breast reconstruction                            0.00               0.00                0.00
19369       Breast reconstruction                            0.00               0.00                0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                             Description        January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                               (short)



19370       Surgery of breast capsule                       T              T            0029                         Level II Breast Surgery
19371       Removal of breast capsule                       T              T            0029                         Level II Breast Surgery
19380       Revise breast reconstruction                    T              T            0030                         Level III Breast Surgery
19396       Design custom breast implant                    T              T            0029                         Level II Breast Surgery
19499       Breast surgery procedure                        T              T            0028                         Level I Breast Surgery
20000       Incision of abscess                             D              D
20005       Incision of deep abscess                        T              T            0020                        Level II Excision/ Biopsy
20100       Explore wound, neck                             T              T            0252                        Level III ENT Procedures
20101       Explore wound, chest                            T              T            0137                          Level V Skin Repair
20102       Explore wound, abdomen                          T              T            0137                          Level V Skin Repair
20103       Explore wound, extremity                        T              T            0007                       Level II Incision & Drainage

20150       Excise epiphyseal bar                           T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot
20200       Muscle biopsy                                   T              T            0021                          Level III Excision/ Biopsy
20205       Deep muscle biopsy                              T              T            0021                          Level III Excision/ Biopsy
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                             Description         January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                               (short)          Relative Weights



19370       Surgery of breast capsule                      33.9253             2336.64
19371       Removal of breast capsule                      33.9253             2336.64
19380       Revise breast reconstruction                   45.0028             3099.61
19396       Design custom breast implant                   33.9253             2336.64
19499       Breast surgery procedure                       25.5910             1762.61
20000       Incision of abscess                             0.0000               0.00
20005       Incision of deep abscess                        8.4929              584.96
20100       Explore wound, neck                             7.9194              545.46
20101       Explore wound, chest                           22.2821             1534.70
20102       Explore wound, abdomen                         22.2821             1534.70
20103       Explore wound, extremity                       13.0129              896.28

20150       Excise epiphyseal bar                          47.3213             3259.30
20200       Muscle biopsy                                  18.0784             1245.17
20205       Deep muscle biopsy                             18.0784             1245.17
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                             Description         January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                               (short)



19370       Surgery of breast capsule                      1,650.47           3,583.19            4,383.83                                    X
19371       Removal of breast capsule                      1,650.47           3,583.19            4,383.83                                    X
19380       Revise breast reconstruction                   2,189.39           4,753.20            5,815.26                                    X
19396       Design custom breast implant                   1,650.47           3,583.19            4,383.83                                    X
19499       Breast surgery procedure                       1,245.00           2,702.92            3,306.87                                    X
20000       Incision of abscess                              0.00               0.00                0.00                X                     X
20005       Incision of deep abscess                        413.18             897.02             1,097.45                                    X
20100       Explore wound, neck                             385.28             836.45             1,023.34                                    X
20101       Explore wound, chest                           1,084.02           2,353.44            2,879.29                                    X
20102       Explore wound, abdomen                         1,084.02           2,353.44            2,879.29                                    X
20103       Explore wound, extremity                        633.08            1,374.42            1,681.53                                    X

20150       Excise epiphyseal bar                          2,302.18           4,998.08            6,114.86                                    X
20200       Muscle biopsy                                   879.51            1,909.44            2,336.09                                    X
20205       Deep muscle biopsy                              879.51            1,909.44            2,336.09                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                              Medicare APC




   CPT/                             Description        January 2011   January 2011   January 2011                 January 2011 Description
  HCPCS                               (short)



20206       Needle biopsy, muscle                           T              T            0005         Level II Needle Biopsy/Aspiration Except Bone Marrow
20220       Bone biopsy, trocar/needle                      T              T            0020                        Level II Excision/ Biopsy
20225       Bone biopsy, trocar/needle                      T              T            0021                        Level III Excision/ Biopsy
20240       Bone biopsy, excisional                         T              T            0022                        Level IV Excision/ Biopsy
20245       Bone biopsy, excisional                         T              T            0022                        Level IV Excision/ Biopsy

20250       Open bone biopsy                                T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot

20251       Open bone biopsy                                T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot
20500       Injection of sinus tract                        T              T            0252                        Level III ENT Procedures
20501       Inject sinus tract for x-ray                    N              N
20520       Removal of foreign body                         T              T            0019                        Level I Excision/ Biopsy
20525       Removal of foreign body                         T              T            0022                       Level IV Excision/ Biopsy
20526       Ther injection, carp tunnel                     T              T            0204                        Level I Nerve Injections
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                             Description         January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                               (short)          Relative Weights



20206       Needle biopsy, muscle                           8.1362              560.39
20220       Bone biopsy, trocar/needle                      8.4929              584.96
20225       Bone biopsy, trocar/needle                     18.0784             1245.17
20240       Bone biopsy, excisional                        23.8986             1646.04
20245       Bone biopsy, excisional                        23.8986             1646.04

20250       Open bone biopsy                               22.9744             1582.38

20251       Open bone biopsy                               22.9744             1582.38
20500       Injection of sinus tract                        7.9194              545.46
20501       Inject sinus tract for x-ray                    0.0000               0.00
20520       Removal of foreign body                         5.0887              350.49
20525       Removal of foreign body                        23.8986             1646.04
20526       Ther injection, carp tunnel                     2.6683              183.78
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                             Description         January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                               (short)



20206       Needle biopsy, muscle                           395.83             859.35             1,051.36                                    X
20220       Bone biopsy, trocar/needle                      413.18             897.02             1,097.45                                    X
20225       Bone biopsy, trocar/needle                      879.51            1,909.44            2,336.09                                    X
20240       Bone biopsy, excisional                        1,162.67           2,524.17            3,088.18                                    X
20245       Bone biopsy, excisional                        1,162.67           2,524.17            3,088.18                                    X

20250       Open bone biopsy                               1,117.70           2,426.56            2,968.75                                    X

20251       Open bone biopsy                               1,117.70           2,426.56            2,968.75                                    X
20500       Injection of sinus tract                        385.28             836.45             1,023.34                                    X
20501       Inject sinus tract for x-ray                     0.00               0.00                0.00
20520       Removal of foreign body                         247.57             537.47              657.56                                     X
20525       Removal of foreign body                        1,162.67           2,524.17            3,088.18                                    X
20526       Ther injection, carp tunnel                     129.81             281.83              344.80                                     X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                            Description         January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                              (short)



20550       Inj tendon sheath/ligament                      T              T            0204                        Level I Nerve Injections
20551       Inj tendon origin/insertion                     T              T            0204                        Level I Nerve Injections
20552       Inj trigger point, 1/2 muscl                    T              T            0204                        Level I Nerve Injections
20553       Inject trigger points, =/> 3                    T              T            0204                        Level I Nerve Injections

20555       Place ndl musc/tis for rt                       T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot
20600       Drain/inject, joint/bursa                       T              T            0204                         Level I Nerve Injections
20605       Drain/inject, joint/bursa                       T              T            0204                         Level I Nerve Injections
20610       Drain/inject, joint/bursa                       T              T            0204                         Level I Nerve Injections
20612       Aspirate/inj ganglion cyst                      T              T            0204                         Level I Nerve Injections
20615       Treatment of bone cyst                          T              T            0004          Level I Needle Biopsy/ Aspiration Except Bone Marrow

20650       Insert and remove bone pin                      T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot
20660       Apply, rem fixation device                      T              T            0138          Level II Closed Treatment Fracture Finger/Toe/Trunk
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                            Description          January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                              (short)           Relative Weights



20550       Inj tendon sheath/ligament                      2.6683              183.78
20551       Inj tendon origin/insertion                     2.6683              183.78
20552       Inj trigger point, 1/2 muscl                    2.6683              183.78
20553       Inject trigger points, =/> 3                    2.6683              183.78

20555       Place ndl musc/tis for rt                      32.2439             2220.83
20600       Drain/inject, joint/bursa                       2.6683              183.78
20605       Drain/inject, joint/bursa                       2.6683              183.78
20610       Drain/inject, joint/bursa                       2.6683              183.78
20612       Aspirate/inj ganglion cyst                      2.6683              183.78
20615       Treatment of bone cyst                          4.5843              315.75

20650       Insert and remove bone pin                     22.9744             1582.38
20660       Apply, rem fixation device                      5.5050              379.16
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                            Description          January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                              (short)



20550       Inj tendon sheath/ligament                     129.81              281.83              344.80                                     X
20551       Inj tendon origin/insertion                    129.81              281.83              344.80                                     X
20552       Inj trigger point, 1/2 muscl                   129.81              281.83              344.80                                     X
20553       Inject trigger points, =/> 3                   129.81              281.83              344.80                                     X

20555       Place ndl musc/tis for rt                      1,568.67           3,405.60            4,166.56                                    X
20600       Drain/inject, joint/bursa                       129.81             281.83              344.80                                     X
20605       Drain/inject, joint/bursa                       129.81             281.83              344.80                                     X
20610       Drain/inject, joint/bursa                       129.81             281.83              344.80                                     X
20612       Aspirate/inj ganglion cyst                      129.81             281.83              344.80                                     X
20615       Treatment of bone cyst                          223.03             484.19              592.38                                     X

20650       Insert and remove bone pin                     1,117.70           2,426.56            2,968.75                                    X
20660       Apply, rem fixation device                      267.82             581.44              711.36                                     X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                            Description         January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                              (short)



20661       Application of head brace                       C              C

20662       Application of pelvis brace                     T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot

20663       Application of thigh brace                      T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot
20664       Halo brace application                          C              C
20665       Removal of fixation device                      X              X            0340                       Minor Ancillary Procedures
20670       Removal of support implant                      T              T            0021                        Level III Excision/ Biopsy
20680       Removal of support implant                      T              T            0022                       Level IV Excision/ Biopsy

20690       Apply bone fixation device                      T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

20692       Apply bone fixation device                      T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                            Description          January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                              (short)           Relative Weights



20661       Application of head brace                       0.0000               0.00

20662       Application of pelvis brace                    22.9744             1582.38

20663       Application of thigh brace                     22.9744             1582.38
20664       Halo brace application                          0.0000               0.00
20665       Removal of fixation device                      0.6712              46.23
20670       Removal of support implant                     18.0784             1245.17
20680       Removal of support implant                     23.8986             1646.04

20690       Apply bone fixation device                     32.2439             2220.83

20692       Apply bone fixation device                     32.2439             2220.83
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                            Description          January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                              (short)



20661       Application of head brace                        0.00               0.00                0.00

20662       Application of pelvis brace                    1,117.70           2,426.56            2,968.75                                    X

20663       Application of thigh brace                     1,117.70           2,426.56            2,968.75                                    X
20664       Halo brace application                            0.00               0.00                0.00
20665       Removal of fixation device                       32.65              70.89               86.73                                     X
20670       Removal of support implant                      879.51            1,909.44            2,336.09                                    X
20680       Removal of support implant                     1,162.67           2,524.17            3,088.18                                    X

20690       Apply bone fixation device                     1,568.67           3,405.60            4,166.56                                    X

20692       Apply bone fixation device                     1,568.67           3,405.60            4,166.56                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                           Description          January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                             (short)




20693       Adjust bone fixation device                     T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot

20694       Remove bone fixation device                     T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot

20696       Comp multiplane ext fixation                    T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot
20697       Comp ext fixate strut change                    T              T            0139          Level III Closed Treatment Fracture Finger/Toe/Trunk
20802       Replantation, arm, complete                     C              C
20805       Replant forearm, complete                       C              C
20808       Replantation hand, complete                     C              C
20816       Replantation digit, complete                    C              C
20822       Replantation digit, complete                    T              T            0054                Level II Hand Musculoskeletal Procedures
20824       Replantation thumb, complete                    C              C
20827       Replantation thumb, complete                    C              C
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                           Description           January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                             (short)            Relative Weights




20693       Adjust bone fixation device                    22.9744             1582.38

20694       Remove bone fixation device                    22.9744             1582.38

20696       Comp multiplane ext fixation                   32.2439             2220.83
20697       Comp ext fixate strut change                   20.8356             1435.07
20802       Replantation, arm, complete                     0.0000               0.00
20805       Replant forearm, complete                       0.0000               0.00
20808       Replantation hand, complete                     0.0000               0.00
20816       Replantation digit, complete                    0.0000               0.00
20822       Replantation digit, complete                   29.7686             2050.34
20824       Replantation thumb, complete                    0.0000               0.00
20827       Replantation thumb, complete                    0.0000               0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                           Description           January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                             (short)




20693       Adjust bone fixation device                    1,117.70           2,426.56            2,968.75                                    X

20694       Remove bone fixation device                    1,117.70           2,426.56            2,968.75                                    X

20696       Comp multiplane ext fixation                   1,568.67           3,405.60            4,166.56                                    X
20697       Comp ext fixate strut change                   1,013.65           2,200.66            2,692.38                                    X
20802       Replantation, arm, complete                      0.00               0.00                0.00
20805       Replant forearm, complete                        0.00               0.00                0.00
20808       Replantation hand, complete                      0.00               0.00                0.00
20816       Replantation digit, complete                     0.00               0.00                0.00
20822       Replantation digit, complete                   1,448.24           3,144.16            3,846.70                                    X
20824       Replantation thumb, complete                     0.00               0.00                0.00
20827       Replantation thumb, complete                     0.00               0.00                0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                           Description          January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                             (short)



20838       Replantation foot, complete                     C              C

20900       Removal of bone for graft                       T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

20902       Removal of bone for graft                       T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot
20910       Remove cartilage for graft                      T              T            0137                           Level V Skin Repair
20912       Remove cartilage for graft                      T              T            0137                           Level V Skin Repair
20920       Removal of fascia for graft                     T              T            0136                           Level IV Skin Repair
20922       Removal of fascia for graft                     T              T            0136                           Level IV Skin Repair

20924       Removal of tendon for graft                     T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot
20926       Removal of tissue for graft                     T              T            0135                           Level III Skin Repair
20930       Sp bone algrft morsel add-on                    C              C
20931       Sp bone algrft struct add-on                    C              C
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                           Description           January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                             (short)            Relative Weights



20838       Replantation foot, complete                     0.0000               0.00

20900       Removal of bone for graft                      32.2439             2220.83

20902       Removal of bone for graft                      32.2439             2220.83
20910       Remove cartilage for graft                     22.2821             1534.70
20912       Remove cartilage for graft                     22.2821             1534.70
20920       Removal of fascia for graft                    17.2117             1185.47
20922       Removal of fascia for graft                    17.2117             1185.47

20924       Removal of tendon for graft                    32.2439             2220.83
20926       Removal of tissue for graft                     4.6422              319.74
20930       Sp bone algrft morsel add-on                    0.0000               0.00
20931       Sp bone algrft struct add-on                    0.0000               0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                           Description           January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                             (short)



20838       Replantation foot, complete                      0.00               0.00                0.00

20900       Removal of bone for graft                      1,568.67           3,405.60            4,166.56                                    X

20902       Removal of bone for graft                      1,568.67           3,405.60            4,166.56                                    X
20910       Remove cartilage for graft                     1,084.02           2,353.44            2,879.29                                    X
20912       Remove cartilage for graft                     1,084.02           2,353.44            2,879.29                                    X
20920       Removal of fascia for graft                     837.35            1,817.90            2,224.10                                    X
20922       Removal of fascia for graft                     837.35            1,817.90            2,224.10                                    X

20924       Removal of tendon for graft                    1,568.67           3,405.60            4,166.56                                    X
20926       Removal of tissue for graft                     225.84             490.31              599.87                                     X
20930       Sp bone algrft morsel add-on                     0.00               0.00                0.00
20931       Sp bone algrft struct add-on                     0.00               0.00                0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                      Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011         January 2011 Description
  HCPCS                            (short)



20936       Sp bone agrft local add-on                      C              C
20937       Sp bone agrft morsel add-on                     C              C
20938       Sp bone agrft struct add-on                     C              C
20950       Fluid pressure, muscle                          T              T            0006               Level I Incision & Drainage
20955       Fibula bone graft, microvasc                    C              C
20956       Iliac bone graft, microvasc                     C              C
20957       Mt bone graft, microvasc                        C              C
20962       Other bone graft, microvasc                     C              C
20969       Bone/skin graft, microvasc                      C              C
20970       Bone/skin graft, iliac crest                    C              C
20972       Bone/skin graft, metatarsal                     T              T            0056        Level II Foot Musculoskeletal Procedures
20973       Bone/skin graft, great toe                      T              T            0056        Level II Foot Musculoskeletal Procedures
20974       Electrical bone stimulation                     A              3
20975       Electrical bone stimulation                     N              N
20979       Us bone stimulation                             X              X            0340              Minor Ancillary Procedures
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



20936       Sp bone agrft local add-on                      0.0000                0.00
20937       Sp bone agrft morsel add-on                     0.0000                0.00
20938       Sp bone agrft struct add-on                     0.0000                0.00
20950       Fluid pressure, muscle                          1.4906              102.67
20955       Fibula bone graft, microvasc                    0.0000                0.00
20956       Iliac bone graft, microvasc                     0.0000                0.00
20957       Mt bone graft, microvasc                        0.0000                0.00
20962       Other bone graft, microvasc                     0.0000                0.00
20969       Bone/skin graft, microvasc                      0.0000                0.00
20970       Bone/skin graft, iliac crest                    0.0000                0.00
20972       Bone/skin graft, metatarsal                    55.2578             3805.94
20973       Bone/skin graft, great toe                     55.2578             3805.94
20974       Electrical bone stimulation                     0.0000                0.00
20975       Electrical bone stimulation                     0.0000                0.00
20979       Us bone stimulation                             0.6712               46.23
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



20936       Sp bone agrft local add-on                        0.00               0.00                0.00
20937       Sp bone agrft morsel add-on                       0.00               0.00                0.00
20938       Sp bone agrft struct add-on                       0.00               0.00                0.00
20950       Fluid pressure, muscle                           72.52             157.44              192.62                                     X
20955       Fibula bone graft, microvasc                      0.00               0.00                0.00
20956       Iliac bone graft, microvasc                       0.00               0.00                0.00
20957       Mt bone graft, microvasc                          0.00               0.00                0.00
20962       Other bone graft, microvasc                       0.00               0.00                0.00
20969       Bone/skin graft, microvasc                        0.00               0.00                0.00
20970       Bone/skin graft, iliac crest                      0.00               0.00                0.00
20972       Bone/skin graft, metatarsal                    2,688.29           5,836.33            7,140.41                                    X
20973       Bone/skin graft, great toe                     2,688.29           5,836.33            7,140.41                                    X
20974       Electrical bone stimulation                       M01                M01                 M01
20975       Electrical bone stimulation                       0.00               0.00                0.00
20979       Us bone stimulation                              32.65              70.89               86.73                                     X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                           Description          January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                             (short)




20982       Ablate, bone tumor(s) perq                      T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot
20985       Cptr-asst dir ms px                             N              N

20999       Musculoskeletal surgery                         T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot
21010       Incision of jaw joint                           T              T            0254                        Level V ENT Procedures
21011       Exc face les sc < 2 cm                          T              T            0020                        Level II Excision/ Biopsy
21012       Exc face les sc = 2 cm                          T              T            0020                        Level II Excision/ Biopsy
21013       Exc face tum deep < 2 cm                        T              T            0020                        Level II Excision/ Biopsy
21014       Exc face tum deep = 2 cm                        T              T            0020                        Level II Excision/ Biopsy
21015       Resect face tum < 2 cm                          T              T            0021                        Level III Excision/ Biopsy
21016       Resect face tum = 2 cm                          T              T            0022                        Level IV Excision/ Biopsy
21025       Excision of bone, lower jaw                     T              T            0256                        Level VI ENT Procedures
21026       Excision of facial bone(s)                      T              T            0256                        Level VI ENT Procedures
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                           Description           January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                             (short)            Relative Weights




20982       Ablate, bone tumor(s) perq                     47.3213             3259.30
20985       Cptr-asst dir ms px                             0.0000               0.00

20999       Musculoskeletal surgery                        22.9744             1582.38
21010       Incision of jaw joint                          25.6472             1766.48
21011       Exc face les sc < 2 cm                          8.4929              584.96
21012       Exc face les sc = 2 cm                          8.4929              584.96
21013       Exc face tum deep < 2 cm                        8.4929              584.96
21014       Exc face tum deep = 2 cm                        8.4929              584.96
21015       Resect face tum < 2 cm                         18.0784             1245.17
21016       Resect face tum = 2 cm                         23.8986             1646.04
21025       Excision of bone, lower jaw                    44.6899             3078.06
21026       Excision of facial bone(s)                     44.6899             3078.06
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                           Description           January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                             (short)




20982       Ablate, bone tumor(s) perq                     2,302.18           4,998.08            6,114.86                                    X
20985       Cptr-asst dir ms px                              0.00               0.00                0.00

20999       Musculoskeletal surgery                        1,117.70           2,426.56            2,968.75                                    X
21010       Incision of jaw joint                          1,247.74           2,708.86            3,314.13                                    X
21011       Exc face les sc < 2 cm                          413.18             897.02             1,097.45                                    X
21012       Exc face les sc = 2 cm                          413.18             897.02             1,097.45                                    X
21013       Exc face tum deep < 2 cm                        413.18             897.02             1,097.45                                    X
21014       Exc face tum deep = 2 cm                        413.18             897.02             1,097.45                                    X
21015       Resect face tum < 2 cm                          879.51            1,909.44            2,336.09                                    X
21016       Resect face tum = 2 cm                         1,162.67           2,524.17            3,088.18                                    X
21025       Excision of bone, lower jaw                    2,174.16           4,720.15            5,774.83                                    X
21026       Excision of facial bone(s)                     2,174.16           4,720.15            5,774.83                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011     January 2011 Description
  HCPCS                            (short)



21029       Contour of face bone lesion                     T              T            0256           Level VI ENT Procedures
21030       Excise max/zygoma b9 tumor                      T              T            0254           Level V ENT Procedures
21031       Remove exostosis, mandible                      T              T            0254           Level V ENT Procedures
21032       Remove exostosis, maxilla                       T              T            0254           Level V ENT Procedures
21034       Excise max/zygoma mlg tumor                     T              T            0256           Level VI ENT Procedures
21040       Excise mandible lesion                          T              T            0254           Level V ENT Procedures
21044       Removal of jaw bone lesion                      T              T            0256           Level VI ENT Procedures
21045       Extensive jaw surgery                           C              C
21046       Remove mandible cyst complex                    T              T            0256           Level VI ENT Procedures
21047       Excise lwr jaw cyst w/repair                    T              T            0256           Level VI ENT Procedures
21048       Remove maxilla cyst complex                     T              T            0256           Level VI ENT Procedures
21049       Excis uppr jaw cyst w/repair                    T              T            0256           Level VI ENT Procedures
21050       Removal of jaw joint                            T              T            0256           Level VI ENT Procedures
21060       Remove jaw joint cartilage                      T              T            0256           Level VI ENT Procedures
21070       Remove coronoid process                         T              T            0256           Level VI ENT Procedures
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



21029       Contour of face bone lesion                    44.6899             3078.06
21030       Excise max/zygoma b9 tumor                     25.6472             1766.48
21031       Remove exostosis, mandible                     25.6472             1766.48
21032       Remove exostosis, maxilla                      25.6472             1766.48
21034       Excise max/zygoma mlg tumor                    44.6899             3078.06
21040       Excise mandible lesion                         25.6472             1766.48
21044       Removal of jaw bone lesion                     44.6899             3078.06
21045       Extensive jaw surgery                           0.0000               0.00
21046       Remove mandible cyst complex                   44.6899             3078.06
21047       Excise lwr jaw cyst w/repair                   44.6899             3078.06
21048       Remove maxilla cyst complex                    44.6899             3078.06
21049       Excis uppr jaw cyst w/repair                   44.6899             3078.06
21050       Removal of jaw joint                           44.6899             3078.06
21060       Remove jaw joint cartilage                     44.6899             3078.06
21070       Remove coronoid process                        44.6899             3078.06
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



21029       Contour of face bone lesion                    2,174.16           4,720.15            5,774.83                                    X
21030       Excise max/zygoma b9 tumor                     1,247.74           2,708.86            3,314.13                                    X
21031       Remove exostosis, mandible                     1,247.74           2,708.86            3,314.13                                    X
21032       Remove exostosis, maxilla                      1,247.74           2,708.86            3,314.13                                    X
21034       Excise max/zygoma mlg tumor                    2,174.16           4,720.15            5,774.83                                    X
21040       Excise mandible lesion                         1,247.74           2,708.86            3,314.13                                    X
21044       Removal of jaw bone lesion                     2,174.16           4,720.15            5,774.83                                    X
21045       Extensive jaw surgery                            0.00               0.00                0.00
21046       Remove mandible cyst complex                   2,174.16           4,720.15            5,774.83                                    X
21047       Excise lwr jaw cyst w/repair                   2,174.16           4,720.15            5,774.83                                    X
21048       Remove maxilla cyst complex                    2,174.16           4,720.15            5,774.83                                    X
21049       Excis uppr jaw cyst w/repair                   2,174.16           4,720.15            5,774.83                                    X
21050       Removal of jaw joint                           2,174.16           4,720.15            5,774.83                                    X
21060       Remove jaw joint cartilage                     2,174.16           4,720.15            5,774.83                                    X
21070       Remove coronoid process                        2,174.16           4,720.15            5,774.83                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                           Description          January 2011   January 2011   January 2011     January 2011 Description
  HCPCS                             (short)



21073       Mnpj of tmj w/anesth                            T              T            0252           Level III ENT Procedures
21076       Prepare face/oral prosthesis                    T              T            0254           Level V ENT Procedures
21077       Prepare face/oral prosthesis                    T              T            0256           Level VI ENT Procedures
21079       Prepare face/oral prosthesis                    T              T            0256           Level VI ENT Procedures
21080       Prepare face/oral prosthesis                    T              T            0256           Level VI ENT Procedures
21081       Prepare face/oral prosthesis                    T              T            0256           Level VI ENT Procedures
21082       Prepare face/oral prosthesis                    T              T            0256           Level VI ENT Procedures
21083       Prepare face/oral prosthesis                    T              T            0256           Level VI ENT Procedures
21084       Prepare face/oral prosthesis                    T              T            0256           Level VI ENT Procedures
21085       Prepare face/oral prosthesis                    T              T            0253           Level IV ENT Procedures
21086       Prepare face/oral prosthesis                    T              T            0256           Level VI ENT Procedures
21087       Prepare face/oral prosthesis                    T              T            0256           Level VI ENT Procedures
21088       Prepare face/oral prosthesis                    T              T            0256           Level VI ENT Procedures
21089       Prepare face/oral prosthesis                    T              T            0250            Level I ENT Procedures
21100       Maxillofacial fixation                          T              T            0256           Level VI ENT Procedures
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                           Description           January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                             (short)            Relative Weights



21073       Mnpj of tmj w/anesth                            7.9194              545.46
21076       Prepare face/oral prosthesis                   25.6472             1766.48
21077       Prepare face/oral prosthesis                   44.6899             3078.06
21079       Prepare face/oral prosthesis                   44.6899             3078.06
21080       Prepare face/oral prosthesis                   44.6899             3078.06
21081       Prepare face/oral prosthesis                   44.6899             3078.06
21082       Prepare face/oral prosthesis                   44.6899             3078.06
21083       Prepare face/oral prosthesis                   44.6899             3078.06
21084       Prepare face/oral prosthesis                   44.6899             3078.06
21085       Prepare face/oral prosthesis                   17.3388             1194.23
21086       Prepare face/oral prosthesis                   44.6899             3078.06
21087       Prepare face/oral prosthesis                   44.6899             3078.06
21088       Prepare face/oral prosthesis                   44.6899             3078.06
21089       Prepare face/oral prosthesis                    1.1331               78.04
21100       Maxillofacial fixation                         44.6899             3078.06
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                           Description           January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                             (short)



21073       Mnpj of tmj w/anesth                            385.28             836.45             1,023.34                                    X
21076       Prepare face/oral prosthesis                   1,247.74           2,708.86            3,314.13                                    X
21077       Prepare face/oral prosthesis                   2,174.16           4,720.15            5,774.83                                    X
21079       Prepare face/oral prosthesis                   2,174.16           4,720.15            5,774.83                                    X
21080       Prepare face/oral prosthesis                   2,174.16           4,720.15            5,774.83                                    X
21081       Prepare face/oral prosthesis                   2,174.16           4,720.15            5,774.83                                    X
21082       Prepare face/oral prosthesis                   2,174.16           4,720.15            5,774.83                                    X
21083       Prepare face/oral prosthesis                   2,174.16           4,720.15            5,774.83                                    X
21084       Prepare face/oral prosthesis                   2,174.16           4,720.15            5,774.83                                    X
21085       Prepare face/oral prosthesis                    843.53            1,831.32            2,240.52                                    X
21086       Prepare face/oral prosthesis                   2,174.16           4,720.15            5,774.83                                    X
21087       Prepare face/oral prosthesis                   2,174.16           4,720.15            5,774.83                                    X
21088       Prepare face/oral prosthesis                   2,174.16           4,720.15            5,774.83                                    X
21089       Prepare face/oral prosthesis                     55.13             119.68              146.42                                     X
21100       Maxillofacial fixation                         2,174.16           4,720.15            5,774.83                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011     January 2011 Description
  HCPCS                            (short)



21110       Interdental fixation                            T              T            0252           Level III ENT Procedures
21116       Injection, jaw joint x-ray                      N              N
21120       Reconstruction of chin                          T              T            0254           Level V ENT Procedures
21121       Reconstruction of chin                          T              T            0254           Level V ENT Procedures
21122       Reconstruction of chin                          T              T            0254           Level V ENT Procedures
21123       Reconstruction of chin                          T              T            0254           Level V ENT Procedures
21125       Augmentation, lower jaw bone                    T              T            0254           Level V ENT Procedures
21127       Augmentation, lower jaw bone                    T              T            0256           Level VI ENT Procedures
21137       Reduction of forehead                           T              T            0254           Level V ENT Procedures
21138       Reduction of forehead                           T              T            0256           Level VI ENT Procedures
21139       Reduction of forehead                           T              T            0256           Level VI ENT Procedures
21141       Reconstruct midface, lefort                     C              C
21142       Reconstruct midface, lefort                     C              C
21143       Reconstruct midface, lefort                     C              C
21145       Reconstruct midface, lefort                     C              C
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



21110       Interdental fixation                            7.9194              545.46
21116       Injection, jaw joint x-ray                      0.0000               0.00
21120       Reconstruction of chin                         25.6472             1766.48
21121       Reconstruction of chin                         25.6472             1766.48
21122       Reconstruction of chin                         25.6472             1766.48
21123       Reconstruction of chin                         25.6472             1766.48
21125       Augmentation, lower jaw bone                   25.6472             1766.48
21127       Augmentation, lower jaw bone                   44.6899             3078.06
21137       Reduction of forehead                          25.6472             1766.48
21138       Reduction of forehead                          44.6899             3078.06
21139       Reduction of forehead                          44.6899             3078.06
21141       Reconstruct midface, lefort                     0.0000               0.00
21142       Reconstruct midface, lefort                     0.0000               0.00
21143       Reconstruct midface, lefort                     0.0000               0.00
21145       Reconstruct midface, lefort                     0.0000               0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



21110       Interdental fixation                            385.28             836.45             1,023.34                                    X
21116       Injection, jaw joint x-ray                       0.00               0.00                0.00
21120       Reconstruction of chin                         1,247.74           2,708.86            3,314.13                                    X
21121       Reconstruction of chin                         1,247.74           2,708.86            3,314.13                                    X
21122       Reconstruction of chin                         1,247.74           2,708.86            3,314.13                                    X
21123       Reconstruction of chin                         1,247.74           2,708.86            3,314.13                                    X
21125       Augmentation, lower jaw bone                   1,247.74           2,708.86            3,314.13                                    X
21127       Augmentation, lower jaw bone                   2,174.16           4,720.15            5,774.83                                    X
21137       Reduction of forehead                          1,247.74           2,708.86            3,314.13                                    X
21138       Reduction of forehead                          2,174.16           4,720.15            5,774.83                                    X
21139       Reduction of forehead                          2,174.16           4,720.15            5,774.83                                    X
21141       Reconstruct midface, lefort                      0.00               0.00                0.00
21142       Reconstruct midface, lefort                      0.00               0.00                0.00
21143       Reconstruct midface, lefort                      0.00               0.00                0.00
21145       Reconstruct midface, lefort                      0.00               0.00                0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011     January 2011 Description
  HCPCS                            (short)



21146       Reconstruct midface, lefort                     C              C
21147       Reconstruct midface, lefort                     C              C
21150       Reconstruct midface, lefort                     T              T            0256           Level VI ENT Procedures
21151       Reconstruct midface, lefort                     C              C
21154       Reconstruct midface, lefort                     C              C
21155       Reconstruct midface, lefort                     C              C
21159       Reconstruct midface, lefort                     C              C
21160       Reconstruct midface, lefort                     C              C
21172       Reconstruct orbit/forehead                      T              T            0256           Level VI ENT Procedures
21175       Reconstruct orbit/forehead                      T              T            0256           Level VI ENT Procedures
21179       Reconstruct entire forehead                     C              C
21180       Reconstruct entire forehead                     C              C
21181       Contour cranial bone lesion                     T              T            0254           Level V ENT Procedures
21182       Reconstruct cranial bone                        C              C
21183       Reconstruct cranial bone                        C              C
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



21146       Reconstruct midface, lefort                     0.0000               0.00
21147       Reconstruct midface, lefort                     0.0000               0.00
21150       Reconstruct midface, lefort                    44.6899             3078.06
21151       Reconstruct midface, lefort                     0.0000               0.00
21154       Reconstruct midface, lefort                     0.0000               0.00
21155       Reconstruct midface, lefort                     0.0000               0.00
21159       Reconstruct midface, lefort                     0.0000               0.00
21160       Reconstruct midface, lefort                     0.0000               0.00
21172       Reconstruct orbit/forehead                     44.6899             3078.06
21175       Reconstruct orbit/forehead                     44.6899             3078.06
21179       Reconstruct entire forehead                     0.0000               0.00
21180       Reconstruct entire forehead                     0.0000               0.00
21181       Contour cranial bone lesion                    25.6472             1766.48
21182       Reconstruct cranial bone                        0.0000               0.00
21183       Reconstruct cranial bone                        0.0000               0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



21146       Reconstruct midface, lefort                      0.00               0.00                0.00
21147       Reconstruct midface, lefort                      0.00               0.00                0.00
21150       Reconstruct midface, lefort                    2,174.16           4,720.15            5,774.83                                    X
21151       Reconstruct midface, lefort                      0.00               0.00                0.00
21154       Reconstruct midface, lefort                      0.00               0.00                0.00
21155       Reconstruct midface, lefort                      0.00               0.00                0.00
21159       Reconstruct midface, lefort                      0.00               0.00                0.00
21160       Reconstruct midface, lefort                      0.00               0.00                0.00
21172       Reconstruct orbit/forehead                     2,174.16           4,720.15            5,774.83                                    X
21175       Reconstruct orbit/forehead                     2,174.16           4,720.15            5,774.83                                    X
21179       Reconstruct entire forehead                      0.00               0.00                0.00
21180       Reconstruct entire forehead                      0.00               0.00                0.00
21181       Contour cranial bone lesion                    1,247.74           2,708.86            3,314.13                                    X
21182       Reconstruct cranial bone                         0.00               0.00                0.00
21183       Reconstruct cranial bone                         0.00               0.00                0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011     January 2011 Description
  HCPCS                            (short)



21184       Reconstruct cranial bone                        C              C
21188       Reconstruction of midface                       C              C
21193       Reconst lwr jaw w/o graft                       T              T            0256           Level VI ENT Procedures
21194       Reconst lwr jaw w/graft                         C              C
21195       Reconst lwr jaw w/o fixation                    T              T            0256           Level VI ENT Procedures
21196       Reconst lwr jaw w/fixation                      C              C
21198       Reconstr lwr jaw segment                        T              T            0256           Level VI ENT Procedures
21199       Reconstr lwr jaw w/advance                      T              T            0256           Level VI ENT Procedures
21206       Reconstruct upper jaw bone                      T              T            0256           Level VI ENT Procedures
21208       Augmentation of facial bones                    T              T            0256           Level VI ENT Procedures
21209       Reduction of facial bones                       T              T            0256           Level VI ENT Procedures
21210       Face bone graft                                 T              T            0256           Level VI ENT Procedures
21215       Lower jaw bone graft                            T              T            0256           Level VI ENT Procedures
21230       Rib cartilage graft                             T              T            0256           Level VI ENT Procedures
21235       Ear cartilage graft                             T              T            0254           Level V ENT Procedures
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



21184       Reconstruct cranial bone                        0.0000               0.00
21188       Reconstruction of midface                       0.0000               0.00
21193       Reconst lwr jaw w/o graft                      44.6899             3078.06
21194       Reconst lwr jaw w/graft                         0.0000               0.00
21195       Reconst lwr jaw w/o fixation                   44.6899             3078.06
21196       Reconst lwr jaw w/fixation                      0.0000               0.00
21198       Reconstr lwr jaw segment                       44.6899             3078.06
21199       Reconstr lwr jaw w/advance                     44.6899             3078.06
21206       Reconstruct upper jaw bone                     44.6899             3078.06
21208       Augmentation of facial bones                   44.6899             3078.06
21209       Reduction of facial bones                      44.6899             3078.06
21210       Face bone graft                                44.6899             3078.06
21215       Lower jaw bone graft                           44.6899             3078.06
21230       Rib cartilage graft                            44.6899             3078.06
21235       Ear cartilage graft                            25.6472             1766.48
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



21184       Reconstruct cranial bone                         0.00               0.00                0.00
21188       Reconstruction of midface                        0.00               0.00                0.00
21193       Reconst lwr jaw w/o graft                      2,174.16           4,720.15            5,774.83              X                     X
21194       Reconst lwr jaw w/graft                          0.00               0.00                0.00
21195       Reconst lwr jaw w/o fixation                   2,174.16           4,720.15            5,774.83                                    X
21196       Reconst lwr jaw w/fixation                       0.00               0.00                0.00
21198       Reconstr lwr jaw segment                       2,174.16           4,720.15            5,774.83                                    X
21199       Reconstr lwr jaw w/advance                     2,174.16           4,720.15            5,774.83                                    X
21206       Reconstruct upper jaw bone                     2,174.16           4,720.15            5,774.83                                    X
21208       Augmentation of facial bones                   2,174.16           4,720.15            5,774.83                                    X
21209       Reduction of facial bones                      2,174.16           4,720.15            5,774.83                                    X
21210       Face bone graft                                2,174.16           4,720.15            5,774.83                                    X
21215       Lower jaw bone graft                           2,174.16           4,720.15            5,774.83                                    X
21230       Rib cartilage graft                            2,174.16           4,720.15            5,774.83                                    X
21235       Ear cartilage graft                            1,247.74           2,708.86            3,314.13                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011     January 2011 Description
  HCPCS                            (short)



21240       Reconstruction of jaw joint                     T              T            0256           Level VI ENT Procedures
21242       Reconstruction of jaw joint                     T              T            0256           Level VI ENT Procedures
21243       Reconstruction of jaw joint                     T              T            0256           Level VI ENT Procedures
21244       Reconstruction of lower jaw                     T              T            0256           Level VI ENT Procedures
21245       Reconstruction of jaw                           T              T            0256           Level VI ENT Procedures
21246       Reconstruction of jaw                           T              T            0256           Level VI ENT Procedures
21247       Reconstruct lower jaw bone                      C              C
21248       Reconstruction of jaw                           T              T            0256           Level VI ENT Procedures
21249       Reconstruction of jaw                           T              T            0256           Level VI ENT Procedures
21255       Reconstruct lower jaw bone                      C              C
21256       Reconstruction of orbit                         T              T            0256           Level VI ENT Procedures
21260       Revise eye sockets                              T              T            0256           Level VI ENT Procedures
21261       Revise eye sockets                              T              T            0256           Level VI ENT Procedures
21263       Revise eye sockets                              T              T            0256           Level VI ENT Procedures
21267       Revise eye sockets                              T              T            0256           Level VI ENT Procedures
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



21240       Reconstruction of jaw joint                    44.6899             3078.06
21242       Reconstruction of jaw joint                    44.6899             3078.06
21243       Reconstruction of jaw joint                    44.6899             3078.06
21244       Reconstruction of lower jaw                    44.6899             3078.06
21245       Reconstruction of jaw                          44.6899             3078.06
21246       Reconstruction of jaw                          44.6899             3078.06
21247       Reconstruct lower jaw bone                      0.0000               0.00
21248       Reconstruction of jaw                          44.6899             3078.06
21249       Reconstruction of jaw                          44.6899             3078.06
21255       Reconstruct lower jaw bone                      0.0000               0.00
21256       Reconstruction of orbit                        44.6899             3078.06
21260       Revise eye sockets                             44.6899             3078.06
21261       Revise eye sockets                             44.6899             3078.06
21263       Revise eye sockets                             44.6899             3078.06
21267       Revise eye sockets                             44.6899             3078.06
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



21240       Reconstruction of jaw joint                    2,174.16           4,720.15            5,774.83                                    X
21242       Reconstruction of jaw joint                    2,174.16           4,720.15            5,774.83                                    X
21243       Reconstruction of jaw joint                    2,174.16           4,720.15            5,774.83                                    X
21244       Reconstruction of lower jaw                    2,174.16           4,720.15            5,774.83                                    X
21245       Reconstruction of jaw                          2,174.16           4,720.15            5,774.83                                    X
21246       Reconstruction of jaw                          2,174.16           4,720.15            5,774.83                                    X
21247       Reconstruct lower jaw bone                       0.00               0.00                0.00
21248       Reconstruction of jaw                          2,174.16           4,720.15            5,774.83                                    X
21249       Reconstruction of jaw                          2,174.16           4,720.15            5,774.83                                    X
21255       Reconstruct lower jaw bone                       0.00               0.00                0.00
21256       Reconstruction of orbit                        2,174.16           4,720.15            5,774.83                                    X
21260       Revise eye sockets                             2,174.16           4,720.15            5,774.83                                    X
21261       Revise eye sockets                             2,174.16           4,720.15            5,774.83                                    X
21263       Revise eye sockets                             2,174.16           4,720.15            5,774.83                                    X
21267       Revise eye sockets                             2,174.16           4,720.15            5,774.83                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                     Medicare APC




   CPT/                           Description          January 2011   January 2011   January 2011        January 2011 Description
  HCPCS                             (short)



21268       Revise eye sockets                              C              C
21270       Augmentation, cheek bone                        T              T            0256               Level VI ENT Procedures
21275       Revision, orbitofacial bones                    T              T            0256               Level VI ENT Procedures
21280       Revision of eyelid                              T              T            0256               Level VI ENT Procedures
21282       Revision of eyelid                              T              T            0253               Level IV ENT Procedures
21295       Revision of jaw muscle/bone                     T              T            0252               Level III ENT Procedures
21296       Revision of jaw muscle/bone                     T              T            0254               Level V ENT Procedures
21299       Cranio/maxillofacial surgery                    T              T            0250                Level I ENT Procedures
21310       Treatment of nose fracture                      T              T            0250                Level I ENT Procedures
21315       Treatment of nose fracture                      T              T            0253               Level IV ENT Procedures
21320       Treatment of nose fracture                      T              T            0253               Level IV ENT Procedures
21325       Treatment of nose fracture                      T              T            0254               Level V ENT Procedures
21330       Treatment of nose fracture                      T              T            0254               Level V ENT Procedures
21335       Treatment of nose fracture                      T              T            0254               Level V ENT Procedures
21336       Treat nasal septal fracture                     T              T            0062        Level I Treatment Fracture/Dislocation
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                           Description           January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                             (short)            Relative Weights



21268       Revise eye sockets                              0.0000                0.00
21270       Augmentation, cheek bone                       44.6899             3078.06
21275       Revision, orbitofacial bones                   44.6899             3078.06
21280       Revision of eyelid                             44.6899             3078.06
21282       Revision of eyelid                             17.3388             1194.23
21295       Revision of jaw muscle/bone                     7.9194              545.46
21296       Revision of jaw muscle/bone                    25.6472             1766.48
21299       Cranio/maxillofacial surgery                    1.1331               78.04
21310       Treatment of nose fracture                      1.1331               78.04
21315       Treatment of nose fracture                     17.3388             1194.23
21320       Treatment of nose fracture                     17.3388             1194.23
21325       Treatment of nose fracture                     25.6472             1766.48
21330       Treatment of nose fracture                     25.6472             1766.48
21335       Treatment of nose fracture                     25.6472             1766.48
21336       Treat nasal septal fracture                    26.5543             1828.95
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                           Description           January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                             (short)



21268       Revise eye sockets                                0.00              0.00                0.00
21270       Augmentation, cheek bone                       2,174.16           4,720.15            5,774.83                                    X
21275       Revision, orbitofacial bones                   2,174.16           4,720.15            5,774.83                                    X
21280       Revision of eyelid                             2,174.16           4,720.15            5,774.83                                    X
21282       Revision of eyelid                              843.53            1,831.32            2,240.52                                    X
21295       Revision of jaw muscle/bone                     385.28             836.45             1,023.34                                    X
21296       Revision of jaw muscle/bone                    1,247.74           2,708.86            3,314.13                                    X
21299       Cranio/maxillofacial surgery                     55.13             119.68              146.42                                     X
21310       Treatment of nose fracture                       55.13             119.68              146.42                                     X
21315       Treatment of nose fracture                      843.53            1,831.32            2,240.52                                    X
21320       Treatment of nose fracture                      843.53            1,831.32            2,240.52                                    X
21325       Treatment of nose fracture                     1,247.74           2,708.86            3,314.13                                    X
21330       Treatment of nose fracture                     1,247.74           2,708.86            3,314.13                                    X
21335       Treatment of nose fracture                     1,247.74           2,708.86            3,314.13                                    X
21336       Treat nasal septal fracture                    1,291.87           2,804.67            3,431.35                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                           Description          January 2011   January 2011   January 2011     January 2011 Description
  HCPCS                             (short)



21337       Treat nasal septal fracture                     T              T            0253           Level IV ENT Procedures
21338       Treat nasoethmoid fracture                      T              T            0254           Level V ENT Procedures
21339       Treat nasoethmoid fracture                      T              T            0254           Level V ENT Procedures
21340       Treatment of nose fracture                      T              T            0256           Level VI ENT Procedures
21343       Treatment of sinus fracture                     C              C
21344       Treatment of sinus fracture                     C              C
21345       Treat nose/jaw fracture                         T              T            0254           Level V ENT Procedures
21346       Treat nose/jaw fracture                         C              C
21347       Treat nose/jaw fracture                         C              C
21348       Treat nose/jaw fracture                         C              C
21355       Treat cheek bone fracture                       T              T            0256           Level VI ENT Procedures
21356       Treat cheek bone fracture                       T              T            0254           Level V ENT Procedures
21360       Treat cheek bone fracture                       T              T            0254           Level V ENT Procedures
21365       Treat cheek bone fracture                       T              T            0256           Level VI ENT Procedures
21366       Treat cheek bone fracture                       C              C
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                           Description           January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                             (short)            Relative Weights



21337       Treat nasal septal fracture                    17.3388             1194.23
21338       Treat nasoethmoid fracture                     25.6472             1766.48
21339       Treat nasoethmoid fracture                     25.6472             1766.48
21340       Treatment of nose fracture                     44.6899             3078.06
21343       Treatment of sinus fracture                     0.0000               0.00
21344       Treatment of sinus fracture                     0.0000               0.00
21345       Treat nose/jaw fracture                        25.6472             1766.48
21346       Treat nose/jaw fracture                         0.0000               0.00
21347       Treat nose/jaw fracture                         0.0000               0.00
21348       Treat nose/jaw fracture                         0.0000               0.00
21355       Treat cheek bone fracture                      44.6899             3078.06
21356       Treat cheek bone fracture                      25.6472             1766.48
21360       Treat cheek bone fracture                      25.6472             1766.48
21365       Treat cheek bone fracture                      44.6899             3078.06
21366       Treat cheek bone fracture                       0.0000               0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                           Description           January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                             (short)



21337       Treat nasal septal fracture                     843.53            1,831.32            2,240.52                                    X
21338       Treat nasoethmoid fracture                     1,247.74           2,708.86            3,314.13                                    X
21339       Treat nasoethmoid fracture                     1,247.74           2,708.86            3,314.13                                    X
21340       Treatment of nose fracture                     2,174.16           4,720.15            5,774.83                                    X
21343       Treatment of sinus fracture                      0.00               0.00                0.00
21344       Treatment of sinus fracture                      0.00               0.00                0.00
21345       Treat nose/jaw fracture                        1,247.74           2,708.86            3,314.13                                    X
21346       Treat nose/jaw fracture                          0.00               0.00                0.00
21347       Treat nose/jaw fracture                          0.00               0.00                0.00
21348       Treat nose/jaw fracture                          0.00               0.00                0.00
21355       Treat cheek bone fracture                      2,174.16           4,720.15            5,774.83                                    X
21356       Treat cheek bone fracture                      1,247.74           2,708.86            3,314.13                                    X
21360       Treat cheek bone fracture                      1,247.74           2,708.86            3,314.13                                    X
21365       Treat cheek bone fracture                      2,174.16           4,720.15            5,774.83                                    X
21366       Treat cheek bone fracture                        0.00               0.00                0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                            Description         January 2011   January 2011   January 2011     January 2011 Description
  HCPCS                              (short)



21385       Treat eye socket fracture                       T              T            0256           Level VI ENT Procedures
21386       Treat eye socket fracture                       T              T            0256           Level VI ENT Procedures
21387       Treat eye socket fracture                       T              T            0256           Level VI ENT Procedures
21390       Treat eye socket fracture                       T              T            0256           Level VI ENT Procedures
21395       Treat eye socket fracture                       T              T            0256           Level VI ENT Procedures
21400       Treat eye socket fracture                       T              T            0252           Level III ENT Procedures
21401       Treat eye socket fracture                       T              T            0253           Level IV ENT Procedures
21406       Treat eye socket fracture                       T              T            0256           Level VI ENT Procedures
21407       Treat eye socket fracture                       T              T            0256           Level VI ENT Procedures
21408       Treat eye socket fracture                       T              T            0256           Level VI ENT Procedures
21421       Treat mouth roof fracture                       T              T            0254           Level V ENT Procedures
21422       Treat mouth roof fracture                       C              C
21423       Treat mouth roof fracture                       C              C
21431       Treat craniofacial fracture                     C              C
21432       Treat craniofacial fracture                     C              C
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                            Description          January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                              (short)           Relative Weights



21385       Treat eye socket fracture                      44.6899             3078.06
21386       Treat eye socket fracture                      44.6899             3078.06
21387       Treat eye socket fracture                      44.6899             3078.06
21390       Treat eye socket fracture                      44.6899             3078.06
21395       Treat eye socket fracture                      44.6899             3078.06
21400       Treat eye socket fracture                       7.9194              545.46
21401       Treat eye socket fracture                      17.3388             1194.23
21406       Treat eye socket fracture                      44.6899             3078.06
21407       Treat eye socket fracture                      44.6899             3078.06
21408       Treat eye socket fracture                      44.6899             3078.06
21421       Treat mouth roof fracture                      25.6472             1766.48
21422       Treat mouth roof fracture                       0.0000               0.00
21423       Treat mouth roof fracture                       0.0000               0.00
21431       Treat craniofacial fracture                     0.0000               0.00
21432       Treat craniofacial fracture                     0.0000               0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                            Description          January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                              (short)



21385       Treat eye socket fracture                      2,174.16           4,720.15            5,774.83                                    X
21386       Treat eye socket fracture                      2,174.16           4,720.15            5,774.83                                    X
21387       Treat eye socket fracture                      2,174.16           4,720.15            5,774.83                                    X
21390       Treat eye socket fracture                      2,174.16           4,720.15            5,774.83                                    X
21395       Treat eye socket fracture                      2,174.16           4,720.15            5,774.83              X                     X
21400       Treat eye socket fracture                       385.28             836.45             1,023.34                                    X
21401       Treat eye socket fracture                       843.53            1,831.32            2,240.52                                    X
21406       Treat eye socket fracture                      2,174.16           4,720.15            5,774.83                                    X
21407       Treat eye socket fracture                      2,174.16           4,720.15            5,774.83                                    X
21408       Treat eye socket fracture                      2,174.16           4,720.15            5,774.83                                    X
21421       Treat mouth roof fracture                      1,247.74           2,708.86            3,314.13                                    X
21422       Treat mouth roof fracture                        0.00               0.00                0.00
21423       Treat mouth roof fracture                        0.00               0.00                0.00
21431       Treat craniofacial fracture                      0.00               0.00                0.00
21432       Treat craniofacial fracture                      0.00               0.00                0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                            Description         January 2011   January 2011   January 2011     January 2011 Description
  HCPCS                              (short)



21433       Treat craniofacial fracture                     C              C
21435       Treat craniofacial fracture                     C              C
21436       Treat craniofacial fracture                     C              C
21440       Treat dental ridge fracture                     T              T            0254           Level V ENT Procedures
21445       Treat dental ridge fracture                     T              T            0254           Level V ENT Procedures
21450       Treat lower jaw fracture                        T              T            0251           Level II ENT Procedures
21451       Treat lower jaw fracture                        T              T            0252           Level III ENT Procedures
21452       Treat lower jaw fracture                        T              T            0253           Level IV ENT Procedures
21453       Treat lower jaw fracture                        T              T            0256           Level VI ENT Procedures
21454       Treat lower jaw fracture                        T              T            0254           Level V ENT Procedures
21461       Treat lower jaw fracture                        T              T            0256           Level VI ENT Procedures
21462       Treat lower jaw fracture                        T              T            0256           Level VI ENT Procedures
21465       Treat lower jaw fracture                        T              T            0256           Level VI ENT Procedures
21470       Treat lower jaw fracture                        T              T            0256           Level VI ENT Procedures
21480       Reset dislocated jaw                            T              T            0250            Level I ENT Procedures
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                            Description          January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                              (short)           Relative Weights



21433       Treat craniofacial fracture                     0.0000                0.00
21435       Treat craniofacial fracture                     0.0000                0.00
21436       Treat craniofacial fracture                     0.0000                0.00
21440       Treat dental ridge fracture                    25.6472             1766.48
21445       Treat dental ridge fracture                    25.6472             1766.48
21450       Treat lower jaw fracture                        3.5538              244.77
21451       Treat lower jaw fracture                        7.9194              545.46
21452       Treat lower jaw fracture                       17.3388             1194.23
21453       Treat lower jaw fracture                       44.6899             3078.06
21454       Treat lower jaw fracture                       25.6472             1766.48
21461       Treat lower jaw fracture                       44.6899             3078.06
21462       Treat lower jaw fracture                       44.6899             3078.06
21465       Treat lower jaw fracture                       44.6899             3078.06
21470       Treat lower jaw fracture                       44.6899             3078.06
21480       Reset dislocated jaw                            1.1331               78.04
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                            Description          January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                              (short)



21433       Treat craniofacial fracture                       0.00              0.00                0.00
21435       Treat craniofacial fracture                       0.00              0.00                0.00
21436       Treat craniofacial fracture                       0.00              0.00                0.00
21440       Treat dental ridge fracture                    1,247.74           2,708.86            3,314.13                                    X
21445       Treat dental ridge fracture                    1,247.74           2,708.86            3,314.13                                    X
21450       Treat lower jaw fracture                        172.89             375.35              459.22                                     X
21451       Treat lower jaw fracture                        385.28             836.45             1,023.34                                    X
21452       Treat lower jaw fracture                        843.53            1,831.32            2,240.52                                    X
21453       Treat lower jaw fracture                       2,174.16           4,720.15            5,774.83                                    X
21454       Treat lower jaw fracture                       1,247.74           2,708.86            3,314.13                                    X
21461       Treat lower jaw fracture                       2,174.16           4,720.15            5,774.83                                    X
21462       Treat lower jaw fracture                       2,174.16           4,720.15            5,774.83                                    X
21465       Treat lower jaw fracture                       2,174.16           4,720.15            5,774.83                                    X
21470       Treat lower jaw fracture                       2,174.16           4,720.15            5,774.83                                    X
21480       Reset dislocated jaw                             55.13             119.68              146.42                                     X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                              Medicare APC




   CPT/                           Description          January 2011   January 2011   January 2011                 January 2011 Description
  HCPCS                             (short)



21485       Reset dislocated jaw                            T              T            0253                       Level IV ENT Procedures
21490       Repair dislocated jaw                           T              T            0256                       Level VI ENT Procedures
21495       Treat hyoid bone fracture                       T              T            0253                       Level IV ENT Procedures
21497       Interdental wiring                              T              T            0253                       Level IV ENT Procedures
21499       Head surgery procedure                          T              T            0250                        Level I ENT Procedures
21501       Drain neck/chest lesion                         T              T            0008                     Level III Incision and Drainage

21502       Drain chest lesion                              T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot
21510       Drainage of bone lesion                         C              C
21550       Biopsy of neck/chest                            T              T            0021                       Level III Excision/ Biopsy
21552       Exc neck les sc = 3 cm                          T              T            0022                       Level IV Excision/ Biopsy
21554       Exc neck tum deep = 5 cm                        T              T            0022                       Level IV Excision/ Biopsy
21555       Exc neck les sc < 3 cm                          T              T            0021                       Level III Excision/ Biopsy
21556       Exc neck tum deep < 5 cm                        T              T            0022                       Level IV Excision/ Biopsy
21557       Resect neck tum < 5 cm                          T              T            0021                       Level III Excision/ Biopsy
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                           Description           January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                             (short)            Relative Weights



21485       Reset dislocated jaw                           17.3388             1194.23
21490       Repair dislocated jaw                          44.6899             3078.06
21495       Treat hyoid bone fracture                      17.3388             1194.23
21497       Interdental wiring                             17.3388             1194.23
21499       Head surgery procedure                          1.1331              78.04
21501       Drain neck/chest lesion                        20.1996             1391.27

21502       Drain chest lesion                             22.9744             1582.38
21510       Drainage of bone lesion                         0.0000               0.00
21550       Biopsy of neck/chest                           18.0784             1245.17
21552       Exc neck les sc = 3 cm                         23.8986             1646.04
21554       Exc neck tum deep = 5 cm                       23.8986             1646.04
21555       Exc neck les sc < 3 cm                         18.0784             1245.17
21556       Exc neck tum deep < 5 cm                       23.8986             1646.04
21557       Resect neck tum < 5 cm                         18.0784             1245.17
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                           Description           January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                             (short)



21485       Reset dislocated jaw                            843.53            1,831.32            2,240.52                                    X
21490       Repair dislocated jaw                          2,174.16           4,720.15            5,774.83                                    X
21495       Treat hyoid bone fracture                       843.53            1,831.32            2,240.52                                    X
21497       Interdental wiring                              843.53            1,831.32            2,240.52                                    X
21499       Head surgery procedure                           55.13             119.68              146.42                                     X
21501       Drain neck/chest lesion                         982.71            2,133.48            2,610.19                                    X

21502       Drain chest lesion                             1,117.70           2,426.56            2,968.75                                    X
21510       Drainage of bone lesion                          0.00               0.00                0.00
21550       Biopsy of neck/chest                            879.51            1,909.44            2,336.09                                    X
21552       Exc neck les sc = 3 cm                         1,162.67           2,524.17            3,088.18                                    X
21554       Exc neck tum deep = 5 cm                       1,162.67           2,524.17            3,088.18                                    X
21555       Exc neck les sc < 3 cm                          879.51            1,909.44            2,336.09                                    X
21556       Exc neck tum deep < 5 cm                       1,162.67           2,524.17            3,088.18                                    X
21557       Resect neck tum < 5 cm                          879.51            1,909.44            2,336.09                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                              Description       January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                                (short)



21558       Resect neck tum = 5 cm                          T              T            0022                        Level IV Excision/ Biopsy

21600       Partial removal of rib                          T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

21610       Partial removal of rib                          T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot
21615       Removal of rib                                  C              C
21616       Removal of rib and nerves                       C              C
21620       Partial removal of sternum                      C              C
21627       Sternal debridement                             C              C
21630       Extensive sternum surgery                       C              C
21632       Extensive sternum surgery                       C              C
21685       Hyoid myotomy & suspension                      T              T            0252                        Level III ENT Procedures

21700       Revision of neck muscle                         T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                              Description        January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                                (short)         Relative Weights



21558       Resect neck tum = 5 cm                         23.8986             1646.04

21600       Partial removal of rib                         32.2439             2220.83

21610       Partial removal of rib                         32.2439             2220.83
21615       Removal of rib                                  0.0000               0.00
21616       Removal of rib and nerves                       0.0000               0.00
21620       Partial removal of sternum                      0.0000               0.00
21627       Sternal debridement                             0.0000               0.00
21630       Extensive sternum surgery                       0.0000               0.00
21632       Extensive sternum surgery                       0.0000               0.00
21685       Hyoid myotomy & suspension                      7.9194              545.46

21700       Revision of neck muscle                        22.9744             1582.38
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                              Description        January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                                (short)



21558       Resect neck tum = 5 cm                         1,162.67           2,524.17            3,088.18                                    X

21600       Partial removal of rib                         1,568.67           3,405.60            4,166.56                                    X

21610       Partial removal of rib                         1,568.67           3,405.60            4,166.56                                    X
21615       Removal of rib                                   0.00               0.00                0.00
21616       Removal of rib and nerves                        0.00               0.00                0.00
21620       Partial removal of sternum                       0.00               0.00                0.00
21627       Sternal debridement                              0.00               0.00                0.00
21630       Extensive sternum surgery                        0.00               0.00                0.00
21632       Extensive sternum surgery                        0.00               0.00                0.00
21685       Hyoid myotomy & suspension                      385.28             836.45             1,023.34                                    X

21700       Revision of neck muscle                        1,117.70           2,426.56            2,968.75                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                           Description          January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                             (short)



21705       Revision of neck muscle/rib                     C              C

21720       Revision of neck muscle                         T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot
21725       Revision of neck muscle                         T              T            0006                       Level I Incision & Drainage
21740       Reconstruction of sternum                       C              C

21742       Repair stern/nuss w/o scope                     T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot

21743       Repair sternum/nuss w/scope                     T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot
21750       Repair of sternum separation                    C              C
21800       Treatment of rib fracture                       T              T            0129           Level I Closed Treatment Fracture Finger/Toe/Trunk
21805       Treatment of rib fracture                       T              T            0062                   Level I Treatment Fracture/Dislocation
21810       Treatment of rib fracture(s)                    C              C
21820       Treat sternum fracture                          T              T            0129           Level I Closed Treatment Fracture Finger/Toe/Trunk
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                           Description           January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                             (short)            Relative Weights



21705       Revision of neck muscle/rib                     0.0000               0.00

21720       Revision of neck muscle                        22.9744             1582.38
21725       Revision of neck muscle                         1.4906              102.67
21740       Reconstruction of sternum                       0.0000               0.00

21742       Repair stern/nuss w/o scope                    47.3213             3259.30

21743       Repair sternum/nuss w/scope                    47.3213             3259.30
21750       Repair of sternum separation                    0.0000               0.00
21800       Treatment of rib fracture                       1.5787              108.73
21805       Treatment of rib fracture                      26.5543             1828.95
21810       Treatment of rib fracture(s)                    0.0000               0.00
21820       Treat sternum fracture                          1.5787              108.73
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                           Description           January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                             (short)



21705       Revision of neck muscle/rib                      0.00               0.00                0.00

21720       Revision of neck muscle                        1,117.70           2,426.56            2,968.75                                    X
21725       Revision of neck muscle                          72.52             157.44              192.62                                     X
21740       Reconstruction of sternum                         0.00              0.00                0.00

21742       Repair stern/nuss w/o scope                    2,302.18           4,998.08            6,114.86                                    X

21743       Repair sternum/nuss w/scope                    2,302.18           4,998.08            6,114.86                                    X
21750       Repair of sternum separation                      0.00              0.00                0.00
21800       Treatment of rib fracture                        76.80             166.74              204.00                                     X
21805       Treatment of rib fracture                      1,291.87           2,804.67            3,431.35                                    X
21810       Treatment of rib fracture(s)                      0.00              0.00                0.00
21820       Treat sternum fracture                           76.80             166.74              204.00                                     X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011      January 2011 Description
  HCPCS                            (short)



21825       Treat sternum fracture                          C              C
21899       Neck/chest surgery procedure                    T              T            0250            Level I ENT Procedures
21920       Biopsy soft tissue of back                      T              T            0020            Level II Excision/ Biopsy
21925       Biopsy soft tissue of back                      T              T            0022            Level IV Excision/ Biopsy
21930       Exc back les sc < 3 cm                          T              T            0021            Level III Excision/ Biopsy
21931       Exc back les sc = 3 cm                          T              T            0022            Level IV Excision/ Biopsy
21932       Exc back tum deep < 5 cm                        T              T            0021            Level III Excision/ Biopsy
21933       Exc back tum deep = 5 cm                        T              T            0022            Level IV Excision/ Biopsy
21935       Resect back tum < 5 cm                          T              T            0021            Level III Excision/ Biopsy
21936       Resect back tum = 5 cm                          T              T            0022            Level IV Excision/ Biopsy
22010       I&d, p-spine, c/t/cerv-thor                     C              C
22015       I&d, p-spine, l/s/ls                            C              C
22100       Remove part of neck vertebra                    T              T            0208        Laminotomies and Laminectomies
22101       Remove part, thorax vertebra                    T              T            0208        Laminotomies and Laminectomies
22102       Remove part, lumbar vertebra                    T              T            0208        Laminotomies and Laminectomies
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



21825       Treat sternum fracture                          0.0000                0.00
21899       Neck/chest surgery procedure                    1.1331               78.04
21920       Biopsy soft tissue of back                      8.4929              584.96
21925       Biopsy soft tissue of back                     23.8986             1646.04
21930       Exc back les sc < 3 cm                         18.0784             1245.17
21931       Exc back les sc = 3 cm                         23.8986             1646.04
21932       Exc back tum deep < 5 cm                       18.0784             1245.17
21933       Exc back tum deep = 5 cm                       23.8986             1646.04
21935       Resect back tum < 5 cm                         18.0784             1245.17
21936       Resect back tum = 5 cm                         23.8986             1646.04
22010       I&d, p-spine, c/t/cerv-thor                     0.0000                0.00
22015       I&d, p-spine, l/s/ls                            0.0000                0.00
22100       Remove part of neck vertebra                   51.3375             3535.92
22101       Remove part, thorax vertebra                   51.3375             3535.92
22102       Remove part, lumbar vertebra                   51.3375             3535.92
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



21825       Treat sternum fracture                            0.00              0.00                0.00
21899       Neck/chest surgery procedure                     55.13             119.68              146.42                                     X
21920       Biopsy soft tissue of back                      413.18             897.02             1,097.45                                    X
21925       Biopsy soft tissue of back                     1,162.67           2,524.17            3,088.18                                    X
21930       Exc back les sc < 3 cm                          879.51            1,909.44            2,336.09                                    X
21931       Exc back les sc = 3 cm                         1,162.67           2,524.17            3,088.18                                    X
21932       Exc back tum deep < 5 cm                        879.51            1,909.44            2,336.09                                    X
21933       Exc back tum deep = 5 cm                       1,162.67           2,524.17            3,088.18                                    X
21935       Resect back tum < 5 cm                          879.51            1,909.44            2,336.09                                    X
21936       Resect back tum = 5 cm                         1,162.67           2,524.17            3,088.18                                    X
22010       I&d, p-spine, c/t/cerv-thor                       0.00              0.00                0.00
22015       I&d, p-spine, l/s/ls                              0.00              0.00                0.00
22100       Remove part of neck vertebra                   2,497.57           5,422.27            6,633.83                                    X
22101       Remove part, thorax vertebra                   2,497.57           5,422.27            6,633.83                                    X
22102       Remove part, lumbar vertebra                   2,497.57           5,422.27            6,633.83                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011      January 2011 Description
  HCPCS                            (short)



22103       Remove extra spine segment                      T              T            0208        Laminotomies and Laminectomies
22110       Remove part of neck vertebra                    C              C
22112       Remove part, thorax vertebra                    C              C
22114       Remove part, lumbar vertebra                    C              C
22116       Remove extra spine segment                      C              C
22206       Cut spine 3 col, thor                           C              C
22207       Cut spine 3 col, lumb                           C              C
22208       Cut spine 3 col, addl seg                       C              C
22210       Revision of neck spine                          C              C
22212       Revision of thorax spine                        C              C
22214       Revision of lumbar spine                        C              C
22216       Revise, extra spine segment                     C              C
22220       Revision of neck spine                          C              C
22222       Revision of thorax spine                        T              T            0208        Laminotomies and Laminectomies
22224       Revision of lumbar spine                        C              C
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



22103       Remove extra spine segment                     51.3375             3535.92
22110       Remove part of neck vertebra                    0.0000               0.00
22112       Remove part, thorax vertebra                    0.0000               0.00
22114       Remove part, lumbar vertebra                    0.0000               0.00
22116       Remove extra spine segment                      0.0000               0.00
22206       Cut spine 3 col, thor                           0.0000               0.00
22207       Cut spine 3 col, lumb                           0.0000               0.00
22208       Cut spine 3 col, addl seg                       0.0000               0.00
22210       Revision of neck spine                          0.0000               0.00
22212       Revision of thorax spine                        0.0000               0.00
22214       Revision of lumbar spine                        0.0000               0.00
22216       Revise, extra spine segment                     0.0000               0.00
22220       Revision of neck spine                          0.0000               0.00
22222       Revision of thorax spine                       51.3375             3535.92
22224       Revision of lumbar spine                        0.0000               0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



22103       Remove extra spine segment                     2,497.57           5,422.27            6,633.83                                    X
22110       Remove part of neck vertebra                     0.00               0.00                0.00
22112       Remove part, thorax vertebra                     0.00               0.00                0.00
22114       Remove part, lumbar vertebra                     0.00               0.00                0.00
22116       Remove extra spine segment                       0.00               0.00                0.00
22206       Cut spine 3 col, thor                            0.00               0.00                0.00
22207       Cut spine 3 col, lumb                            0.00               0.00                0.00
22208       Cut spine 3 col, addl seg                        0.00               0.00                0.00
22210       Revision of neck spine                           0.00               0.00                0.00
22212       Revision of thorax spine                         0.00               0.00                0.00
22214       Revision of lumbar spine                         0.00               0.00                0.00
22216       Revise, extra spine segment                      0.00               0.00                0.00
22220       Revision of neck spine                           0.00               0.00                0.00
22222       Revision of thorax spine                       2,497.57           5,422.27            6,633.83                                    X
22224       Revision of lumbar spine                         0.00               0.00                0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                           Description          January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                             (short)



22226       Revise, extra spine segment                     C              C
22305       Treat spine process fracture                    T              T            0129          Level I Closed Treatment Fracture Finger/Toe/Trunk
22310       Treat spine fracture                            T              T            0138          Level II Closed Treatment Fracture Finger/Toe/Trunk
22315       Treat spine fracture                            T              T            0139          Level III Closed Treatment Fracture Finger/Toe/Trunk
22318       Treat odontoid fx w/o graft                     C              C
22319       Treat odontoid fx w/graft                       C              C
22325       Treat spine fracture                            C              C
22326       Treat neck spine fracture                       C              C
22327       Treat thorax spine fracture                     C              C
22328       Treat each add spine fx                         C              C
22505       Manipulation of spine                           T              T            0045               Bone/Joint Manipulation Under Anesthesia

22520       Percut vertebroplasty thor                      T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                           Description           January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                             (short)            Relative Weights



22226       Revise, extra spine segment                     0.0000               0.00
22305       Treat spine process fracture                    1.5787              108.73
22310       Treat spine fracture                            5.5050              379.16
22315       Treat spine fracture                           20.8356             1435.07
22318       Treat odontoid fx w/o graft                     0.0000               0.00
22319       Treat odontoid fx w/graft                       0.0000               0.00
22325       Treat spine fracture                            0.0000               0.00
22326       Treat neck spine fracture                       0.0000               0.00
22327       Treat thorax spine fracture                     0.0000               0.00
22328       Treat each add spine fx                         0.0000               0.00
22505       Manipulation of spine                          15.5512             1071.10

22520       Percut vertebroplasty thor                     32.2439             2220.83
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                           Description           January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                             (short)



22226       Revise, extra spine segment                       0.00              0.00                0.00
22305       Treat spine process fracture                     76.80             166.74              204.00                                     X
22310       Treat spine fracture                            267.82             581.44              711.36                                     X
22315       Treat spine fracture                           1,013.65           2,200.66            2,692.38                                    X
22318       Treat odontoid fx w/o graft                       0.00              0.00                0.00
22319       Treat odontoid fx w/graft                         0.00              0.00                0.00
22325       Treat spine fracture                              0.00              0.00                0.00
22326       Treat neck spine fracture                         0.00              0.00                0.00
22327       Treat thorax spine fracture                       0.00              0.00                0.00
22328       Treat each add spine fx                           0.00              0.00                0.00
22505       Manipulation of spine                           756.57            1,642.52            2,009.53                                    X

22520       Percut vertebroplasty thor                     1,568.67           3,405.60            4,166.56                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                           Description          January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                             (short)




22521       Percut vertebroplasty lumb                      T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

22522       Percut vertebroplasty addl                      T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

22523       Percut kyphoplasty, thor                        T              T            0052        Level IV Musculoskeletal Procedures Except Hand and Foot

22524       Percut kyphoplasty, lumbar                      T              T            0052        Level IV Musculoskeletal Procedures Except Hand and Foot

22525       Percut kyphoplasty, add-on                      T              T            0052        Level IV Musculoskeletal Procedures Except Hand and Foot
22526       Idet, single level                              E              1
22527       Idet, 1 or more levels                          E              1
22532       Lat thorax spine fusion                         C              C
22533       Lat lumbar spine fusion                         C              C
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                           Description           January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                             (short)            Relative Weights




22521       Percut vertebroplasty lumb                     32.2439             2220.83

22522       Percut vertebroplasty addl                     32.2439             2220.83

22523       Percut kyphoplasty, thor                       88.9869             6129.06

22524       Percut kyphoplasty, lumbar                     88.9869             6129.06

22525       Percut kyphoplasty, add-on                     88.9869             6129.06
22526       Idet, single level                              0.0000               0.00
22527       Idet, 1 or more levels                          0.0000               0.00
22532       Lat thorax spine fusion                         0.0000               0.00
22533       Lat lumbar spine fusion                         0.0000               0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                           Description           January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                             (short)




22521       Percut vertebroplasty lumb                     1,568.67           3,405.60            4,166.56                                    X

22522       Percut vertebroplasty addl                     1,568.67           3,405.60            4,166.56                                    X

22523       Percut kyphoplasty, thor                       4,329.21           9,398.80           11,498.89                                    X

22524       Percut kyphoplasty, lumbar                     4,329.21           9,398.80           11,498.89                                    X

22525       Percut kyphoplasty, add-on                     4,329.21           9,398.80           11,498.89                                    X
22526       Idet, single level                               0.00               0.00                0.00
22527       Idet, 1 or more levels                           0.00               0.00                0.00
22532       Lat thorax spine fusion                          0.00               0.00                0.00
22533       Lat lumbar spine fusion                          0.00               0.00                0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011      January 2011 Description
  HCPCS                            (short)



22534       Lat thor/lumb, addl seg                         C              C
22548       Neck spine fusion                               C              C
22551       Neck spine fuse&remove addl                     C              C
22552       Addl neck spine fusion                          C              C
22554       Neck spine fusion                               C              C
22556       Thorax spine fusion                             C              C
22558       Lumbar spine fusion                             C              C
22585       Additional spinal fusion                        C              C
22590       Spine & skull spinal fusion                     C              C
22595       Neck spinal fusion                              C              C
22600       Neck spine fusion                               C              C
22610       Thorax spine fusion                             C              C
22612       Lumbar spine fusion                             T              T            0208        Laminotomies and Laminectomies
22614       Spine fusion, extra segment                     T              T            0208        Laminotomies and Laminectomies
22630       Lumbar spine fusion                             C              C
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



22534       Lat thor/lumb, addl seg                         0.0000               0.00
22548       Neck spine fusion                               0.0000               0.00
22551       Neck spine fuse&remove addl                     0.0000               0.00
22552       Addl neck spine fusion                          0.0000               0.00
22554       Neck spine fusion                               0.0000               0.00
22556       Thorax spine fusion                             0.0000               0.00
22558       Lumbar spine fusion                             0.0000               0.00
22585       Additional spinal fusion                        0.0000               0.00
22590       Spine & skull spinal fusion                     0.0000               0.00
22595       Neck spinal fusion                              0.0000               0.00
22600       Neck spine fusion                               0.0000               0.00
22610       Thorax spine fusion                             0.0000               0.00
22612       Lumbar spine fusion                            51.3375             3535.92
22614       Spine fusion, extra segment                    51.3375             3535.92
22630       Lumbar spine fusion                             0.0000               0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



22534       Lat thor/lumb, addl seg                          0.00               0.00                0.00
22548       Neck spine fusion                                0.00               0.00                0.00
22551       Neck spine fuse&remove addl                      0.00               0.00                0.00                X                     X
22552       Addl neck spine fusion                           0.00               0.00                0.00                X                     X
22554       Neck spine fusion                                0.00               0.00                0.00
22556       Thorax spine fusion                              0.00               0.00                0.00
22558       Lumbar spine fusion                              0.00               0.00                0.00
22585       Additional spinal fusion                         0.00               0.00                0.00
22590       Spine & skull spinal fusion                      0.00               0.00                0.00
22595       Neck spinal fusion                               0.00               0.00                0.00
22600       Neck spine fusion                                0.00               0.00                0.00
22610       Thorax spine fusion                              0.00               0.00                0.00
22612       Lumbar spine fusion                            2,497.57           5,422.27            6,633.83                                    X
22614       Spine fusion, extra segment                    2,497.57           5,422.27            6,633.83                                    X
22630       Lumbar spine fusion                              0.00               0.00                0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                   Medicare APC




   CPT/                           Description          January 2011   January 2011   January 2011     January 2011 Description
  HCPCS                             (short)



22632       Spine fusion, extra segment                     C              C
22800       Fusion of spine                                 C              C
22802       Fusion of spine                                 C              C
22804       Fusion of spine                                 C              C
22808       Fusion of spine                                 C              C
22810       Fusion of spine                                 C              C
22812       Fusion of spine                                 C              C
22818       Kyphectomy, 1-2 segments                        C              C
22819       Kyphectomy, 3 or more                           C              C
22830       Exploration of spinal fusion                    C              C
22840       Insert spine fixation device                    C              C
22841       Insert spine fixation device                    C              C
22842       Insert spine fixation device                    C              C
22843       Insert spine fixation device                    C              C
22844       Insert spine fixation device                    C              C
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                           Description           January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                             (short)            Relative Weights



22632       Spine fusion, extra segment                     0.0000               0.00
22800       Fusion of spine                                 0.0000               0.00
22802       Fusion of spine                                 0.0000               0.00
22804       Fusion of spine                                 0.0000               0.00
22808       Fusion of spine                                 0.0000               0.00
22810       Fusion of spine                                 0.0000               0.00
22812       Fusion of spine                                 0.0000               0.00
22818       Kyphectomy, 1-2 segments                        0.0000               0.00
22819       Kyphectomy, 3 or more                           0.0000               0.00
22830       Exploration of spinal fusion                    0.0000               0.00
22840       Insert spine fixation device                    0.0000               0.00
22841       Insert spine fixation device                    0.0000               0.00
22842       Insert spine fixation device                    0.0000               0.00
22843       Insert spine fixation device                    0.0000               0.00
22844       Insert spine fixation device                    0.0000               0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                           Description           January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                             (short)



22632       Spine fusion, extra segment                     0.00                0.00                0.00
22800       Fusion of spine                                 0.00                0.00                0.00
22802       Fusion of spine                                 0.00                0.00                0.00
22804       Fusion of spine                                 0.00                0.00                0.00
22808       Fusion of spine                                 0.00                0.00                0.00
22810       Fusion of spine                                 0.00                0.00                0.00
22812       Fusion of spine                                 0.00                0.00                0.00
22818       Kyphectomy, 1-2 segments                        0.00                0.00                0.00
22819       Kyphectomy, 3 or more                           0.00                0.00                0.00
22830       Exploration of spinal fusion                    0.00                0.00                0.00
22840       Insert spine fixation device                    0.00                0.00                0.00
22841       Insert spine fixation device                    0.00                0.00                0.00
22842       Insert spine fixation device                    0.00                0.00                0.00
22843       Insert spine fixation device                    0.00                0.00                0.00
22844       Insert spine fixation device                    0.00                0.00                0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                              Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011                 January 2011 Description
  HCPCS                            (short)



22845       Insert spine fixation device                    C              C
22846       Insert spine fixation device                    C              C
22847       Insert spine fixation device                    C              C
22848       Insert pelv fixation device                     C              C
22849       Reinsert spinal fixation                        C              C
22850       Remove spine fixation device                    C              C

22851       Apply spine prosth device                       T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot
22852       Remove spine fixation device                    C              C
22855       Remove spine fixation device                    C              C
22856       Cerv artific diskectomy                         C              C
22857       Lumbar artif diskectomy                         C              C
22861       Revise cerv artific disc                        C              C
22862       Revise lumbar artif disc                        C              C
22864       Remove cerv artif disc                          C              C
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



22845       Insert spine fixation device                    0.0000               0.00
22846       Insert spine fixation device                    0.0000               0.00
22847       Insert spine fixation device                    0.0000               0.00
22848       Insert pelv fixation device                     0.0000               0.00
22849       Reinsert spinal fixation                        0.0000               0.00
22850       Remove spine fixation device                    0.0000               0.00

22851       Apply spine prosth device                      22.9744             1582.38
22852       Remove spine fixation device                    0.0000               0.00
22855       Remove spine fixation device                    0.0000               0.00
22856       Cerv artific diskectomy                         0.0000               0.00
22857       Lumbar artif diskectomy                         0.0000               0.00
22861       Revise cerv artific disc                        0.0000               0.00
22862       Revise lumbar artif disc                        0.0000               0.00
22864       Remove cerv artif disc                          0.0000               0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



22845       Insert spine fixation device                     0.00               0.00                0.00
22846       Insert spine fixation device                     0.00               0.00                0.00
22847       Insert spine fixation device                     0.00               0.00                0.00
22848       Insert pelv fixation device                      0.00               0.00                0.00
22849       Reinsert spinal fixation                         0.00               0.00                0.00
22850       Remove spine fixation device                     0.00               0.00                0.00

22851       Apply spine prosth device                      1,117.70           2,426.56            2,968.75                                    X
22852       Remove spine fixation device                     0.00               0.00                0.00
22855       Remove spine fixation device                     0.00               0.00                0.00
22856       Cerv artific diskectomy                          0.00               0.00                0.00
22857       Lumbar artif diskectomy                          0.00               0.00                0.00
22861       Revise cerv artific disc                         0.00               0.00                0.00
22862       Revise lumbar artif disc                         0.00               0.00                0.00
22864       Remove cerv artif disc                           0.00               0.00                0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                              Description       January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                                (short)



22865       Remove lumb artif disc                          C              C

22899       Spine surgery procedure                         T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot
22900       Exc back tum deep < 5 cm                        T              T            0022                        Level IV Excision/ Biopsy
22901       Exc back tum deep = 5 cm                        T              T            0022                        Level IV Excision/ Biopsy
22902       Exc abd les sc < 3 cm                           T              T            0021                        Level III Excision/ Biopsy
22903       Exc abd les sc > 3 cm                           T              T            0022                        Level IV Excision/ Biopsy
22904       Resect abd tum < 5 cm                           T              T            0021                        Level III Excision/ Biopsy
22905       Resect abd tum > 5 cm                           T              T            0022                        Level IV Excision/ Biopsy

22999       Abdomen surgery procedure                       T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot
23000       Removal of calcium deposits                     T              T            0021                        Level III Excision/ Biopsy

23020       Release shoulder joint                          T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                              Description        January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                                (short)         Relative Weights



22865       Remove lumb artif disc                          0.0000               0.00

22899       Spine surgery procedure                        22.9744             1582.38
22900       Exc back tum deep < 5 cm                       23.8986             1646.04
22901       Exc back tum deep = 5 cm                       23.8986             1646.04
22902       Exc abd les sc < 3 cm                          18.0784             1245.17
22903       Exc abd les sc > 3 cm                          23.8986             1646.04
22904       Resect abd tum < 5 cm                          18.0784             1245.17
22905       Resect abd tum > 5 cm                          23.8986             1646.04

22999       Abdomen surgery procedure                      22.9744             1582.38
23000       Removal of calcium deposits                    18.0784             1245.17

23020       Release shoulder joint                         47.3213             3259.30
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                              Description        January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                                (short)



22865       Remove lumb artif disc                           0.00               0.00                0.00

22899       Spine surgery procedure                        1,117.70           2,426.56            2,968.75                                    X
22900       Exc back tum deep < 5 cm                       1,162.67           2,524.17            3,088.18                                    X
22901       Exc back tum deep = 5 cm                       1,162.67           2,524.17            3,088.18                                    X
22902       Exc abd les sc < 3 cm                           879.51            1,909.44            2,336.09                                    X
22903       Exc abd les sc > 3 cm                          1,162.67           2,524.17            3,088.18                                    X
22904       Resect abd tum < 5 cm                           879.51            1,909.44            2,336.09                                    X
22905       Resect abd tum > 5 cm                          1,162.67           2,524.17            3,088.18                                    X

22999       Abdomen surgery procedure                      1,117.70           2,426.56            2,968.75                                    X
23000       Removal of calcium deposits                     879.51            1,909.44            2,336.09                                    X

23020       Release shoulder joint                         2,302.18           4,998.08            6,114.86                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                             Description        January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                               (short)



23030       Drain shoulder lesion                           T              T            0008                     Level III Incision and Drainage
23031       Drain shoulder bursa                            T              T            0008                     Level III Incision and Drainage

23035       Drain shoulder bone lesion                      T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot

23040       Exploratory shoulder surgery                    T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

23044       Exploratory shoulder surgery                    T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot
23065       Biopsy shoulder tissues                         T              T            0020                         Level II Excision/ Biopsy
23066       Biopsy shoulder tissues                         T              T            0022                         Level IV Excision/ Biopsy
23071       Exc shoulder les sc > 3 cm                      T              T            0022                         Level IV Excision/ Biopsy
23073       Exc shoulder tum deep > 5 cm                    T              T            0022                         Level IV Excision/ Biopsy
23075       Exc shoulder les sc < 3 cm                      T              T            0021                         Level III Excision/ Biopsy
23076       Exc shoulder tum deep < 5 cm                    T              T            0021                         Level III Excision/ Biopsy
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                             Description         January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                               (short)          Relative Weights



23030       Drain shoulder lesion                          20.1996             1391.27
23031       Drain shoulder bursa                           20.1996             1391.27

23035       Drain shoulder bone lesion                     22.9744             1582.38

23040       Exploratory shoulder surgery                   32.2439             2220.83

23044       Exploratory shoulder surgery                   32.2439             2220.83
23065       Biopsy shoulder tissues                         8.4929              584.96
23066       Biopsy shoulder tissues                        23.8986             1646.04
23071       Exc shoulder les sc > 3 cm                     23.8986             1646.04
23073       Exc shoulder tum deep > 5 cm                   23.8986             1646.04
23075       Exc shoulder les sc < 3 cm                     18.0784             1245.17
23076       Exc shoulder tum deep < 5 cm                   18.0784             1245.17
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                             Description         January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                               (short)



23030       Drain shoulder lesion                          982.71             2,133.48            2,610.19                                    X
23031       Drain shoulder bursa                           982.71             2,133.48            2,610.19                                    X

23035       Drain shoulder bone lesion                     1,117.70           2,426.56            2,968.75                                    X

23040       Exploratory shoulder surgery                   1,568.67           3,405.60            4,166.56                                    X

23044       Exploratory shoulder surgery                   1,568.67           3,405.60            4,166.56                                    X
23065       Biopsy shoulder tissues                         413.18             897.02             1,097.45                                    X
23066       Biopsy shoulder tissues                        1,162.67           2,524.17            3,088.18                                    X
23071       Exc shoulder les sc > 3 cm                     1,162.67           2,524.17            3,088.18                                    X
23073       Exc shoulder tum deep > 5 cm                   1,162.67           2,524.17            3,088.18                                    X
23075       Exc shoulder les sc < 3 cm                      879.51            1,909.44            2,336.09                                    X
23076       Exc shoulder tum deep < 5 cm                    879.51            1,909.44            2,336.09                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                              Description       January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                                (short)



23077       Resect shoulder tum < 5 cm                      T              T            0021                        Level III Excision/ Biopsy
23078       Resect shoulder tum > 5 cm                      T              T            0022                        Level IV Excision/ Biopsy

23100       Biopsy of shoulder joint                        T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot

23101       Shoulder joint surgery                          T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

23105       Remove shoulder joint lining                    T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

23106       Incision of collarbone joint                    T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

23107       Explore treat shoulder joint                    T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

23120       Partial removal, collar bone                    T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                              Description        January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                                (short)         Relative Weights



23077       Resect shoulder tum < 5 cm                     18.0784             1245.17
23078       Resect shoulder tum > 5 cm                     23.8986             1646.04

23100       Biopsy of shoulder joint                       22.9744             1582.38

23101       Shoulder joint surgery                         32.2439             2220.83

23105       Remove shoulder joint lining                   32.2439             2220.83

23106       Incision of collarbone joint                   32.2439             2220.83

23107       Explore treat shoulder joint                   32.2439             2220.83

23120       Partial removal, collar bone                   32.2439             2220.83
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                              Description        January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                                (short)



23077       Resect shoulder tum < 5 cm                      879.51            1,909.44            2,336.09                                    X
23078       Resect shoulder tum > 5 cm                     1,162.67           2,524.17            3,088.18                                    X

23100       Biopsy of shoulder joint                       1,117.70           2,426.56            2,968.75                                    X

23101       Shoulder joint surgery                         1,568.67           3,405.60            4,166.56                                    X

23105       Remove shoulder joint lining                   1,568.67           3,405.60            4,166.56                                    X

23106       Incision of collarbone joint                   1,568.67           3,405.60            4,166.56                                    X

23107       Explore treat shoulder joint                   1,568.67           3,405.60            4,166.56                                    X

23120       Partial removal, collar bone                   1,568.67           3,405.60            4,166.56                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                            (short)




23125       Removal of collar bone                          T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

23130       Remove shoulder bone, part                      T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot

23140       Removal of bone lesion                          T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot

23145       Removal of bone lesion                          T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

23146       Removal of bone lesion                          T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

23150       Removal of humerus lesion                       T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

23155       Removal of humerus lesion                       T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights




23125       Removal of collar bone                         32.2439             2220.83

23130       Remove shoulder bone, part                     47.3213             3259.30

23140       Removal of bone lesion                         22.9744             1582.38

23145       Removal of bone lesion                         32.2439             2220.83

23146       Removal of bone lesion                         32.2439             2220.83

23150       Removal of humerus lesion                      32.2439             2220.83

23155       Removal of humerus lesion                      32.2439             2220.83
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)




23125       Removal of collar bone                         1,568.67           3,405.60            4,166.56                                    X

23130       Remove shoulder bone, part                     2,302.18           4,998.08            6,114.86                                    X

23140       Removal of bone lesion                         1,117.70           2,426.56            2,968.75                                    X

23145       Removal of bone lesion                         1,568.67           3,405.60            4,166.56                                    X

23146       Removal of bone lesion                         1,568.67           3,405.60            4,166.56                                    X

23150       Removal of humerus lesion                      1,568.67           3,405.60            4,166.56                                    X

23155       Removal of humerus lesion                      1,568.67           3,405.60            4,166.56                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                            (short)




23156       Removal of humerus lesion                       T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

23170       Remove collar bone lesion                       T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

23172       Remove shoulder blade lesion                    T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

23174       Remove humerus lesion                           T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

23180       Remove collar bone lesion                       T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

23182       Remove shoulder blade lesion                    T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

23184       Remove humerus lesion                           T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights




23156       Removal of humerus lesion                      32.2439             2220.83

23170       Remove collar bone lesion                      32.2439             2220.83

23172       Remove shoulder blade lesion                   32.2439             2220.83

23174       Remove humerus lesion                          32.2439             2220.83

23180       Remove collar bone lesion                      32.2439             2220.83

23182       Remove shoulder blade lesion                   32.2439             2220.83

23184       Remove humerus lesion                          32.2439             2220.83
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)




23156       Removal of humerus lesion                      1,568.67           3,405.60            4,166.56                                    X

23170       Remove collar bone lesion                      1,568.67           3,405.60            4,166.56                                    X

23172       Remove shoulder blade lesion                   1,568.67           3,405.60            4,166.56                                    X

23174       Remove humerus lesion                          1,568.67           3,405.60            4,166.56                                    X

23180       Remove collar bone lesion                      1,568.67           3,405.60            4,166.56                                    X

23182       Remove shoulder blade lesion                   1,568.67           3,405.60            4,166.56                                    X

23184       Remove humerus lesion                          1,568.67           3,405.60            4,166.56                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                           Description          January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                             (short)




23190       Partial removal of scapula                      T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

23195       Removal of head of humerus                      T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot
23200       Resect clavicle tumor                           C              C
23210       Resect scapula tumor                            C              C
23220       Resect prox humerus tumor                       C              C
23330       Remove shoulder foreign body                    T              T            0020                        Level II Excision/ Biopsy
23331       Remove shoulder foreign body                    T              T            0022                        Level IV Excision/ Biopsy
23332       Remove shoulder foreign body                    C              C
23350       Injection for shoulder x-ray                    N              N

23395       Muscle transfer,shoulder/arm                    T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                           Description           January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                             (short)            Relative Weights




23190       Partial removal of scapula                     32.2439             2220.83

23195       Removal of head of humerus                     32.2439             2220.83
23200       Resect clavicle tumor                           0.0000               0.00
23210       Resect scapula tumor                            0.0000               0.00
23220       Resect prox humerus tumor                       0.0000               0.00
23330       Remove shoulder foreign body                    8.4929              584.96
23331       Remove shoulder foreign body                   23.8986             1646.04
23332       Remove shoulder foreign body                    0.0000               0.00
23350       Injection for shoulder x-ray                    0.0000               0.00

23395       Muscle transfer,shoulder/arm                   47.3213             3259.30
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                           Description           January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                             (short)




23190       Partial removal of scapula                     1,568.67           3,405.60            4,166.56                                    X

23195       Removal of head of humerus                     1,568.67           3,405.60            4,166.56                                    X
23200       Resect clavicle tumor                            0.00               0.00                0.00
23210       Resect scapula tumor                             0.00               0.00                0.00
23220       Resect prox humerus tumor                        0.00               0.00                0.00
23330       Remove shoulder foreign body                    413.18             897.02             1,097.45                                    X
23331       Remove shoulder foreign body                   1,162.67           2,524.17            3,088.18                                    X
23332       Remove shoulder foreign body                     0.00               0.00                0.00
23350       Injection for shoulder x-ray                     0.00               0.00                0.00

23395       Muscle transfer,shoulder/arm                   2,302.18           4,998.08            6,114.86                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                            Description         January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                              (short)




23397       Muscle transfers                                T              T            0052        Level IV Musculoskeletal Procedures Except Hand and Foot

23400       Fixation of shoulder blade                      T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

23405       Incision of tendon & muscle                     T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

23406       Incise tendon(s) & muscle(s)                    T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

23410       Repair rotator cuff, acute                      T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot

23412       Repair rotator cuff, chronic                    T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot

23415       Release of shoulder ligament                    T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                            Description          January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                              (short)           Relative Weights




23397       Muscle transfers                               88.9869             6129.06

23400       Fixation of shoulder blade                     32.2439             2220.83

23405       Incision of tendon & muscle                    32.2439             2220.83

23406       Incise tendon(s) & muscle(s)                   32.2439             2220.83

23410       Repair rotator cuff, acute                     47.3213             3259.30

23412       Repair rotator cuff, chronic                   47.3213             3259.30

23415       Release of shoulder ligament                   47.3213             3259.30
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                            Description          January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                              (short)




23397       Muscle transfers                               4,329.21           9,398.80           11,498.89                                    X

23400       Fixation of shoulder blade                     1,568.67           3,405.60            4,166.56                                    X

23405       Incision of tendon & muscle                    1,568.67           3,405.60            4,166.56                                    X

23406       Incise tendon(s) & muscle(s)                   1,568.67           3,405.60            4,166.56                                    X

23410       Repair rotator cuff, acute                     2,302.18           4,998.08            6,114.86                                    X

23412       Repair rotator cuff, chronic                   2,302.18           4,998.08            6,114.86                                    X

23415       Release of shoulder ligament                   2,302.18           4,998.08            6,114.86                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                            Description         January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                              (short)




23420       Repair of shoulder                              T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot

23430       Repair biceps tendon                            T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot

23440       Remove/transplant tendon                        T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot

23450       Repair shoulder capsule                         T              T            0052        Level IV Musculoskeletal Procedures Except Hand and Foot

23455       Repair shoulder capsule                         T              T            0052        Level IV Musculoskeletal Procedures Except Hand and Foot

23460       Repair shoulder capsule                         T              T            0052        Level IV Musculoskeletal Procedures Except Hand and Foot

23462       Repair shoulder capsule                         T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                            Description          January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                              (short)           Relative Weights




23420       Repair of shoulder                             47.3213             3259.30

23430       Repair biceps tendon                           47.3213             3259.30

23440       Remove/transplant tendon                       47.3213             3259.30

23450       Repair shoulder capsule                        88.9869             6129.06

23455       Repair shoulder capsule                        88.9869             6129.06

23460       Repair shoulder capsule                        88.9869             6129.06

23462       Repair shoulder capsule                        47.3213             3259.30
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                            Description          January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                              (short)




23420       Repair of shoulder                             2,302.18           4,998.08            6,114.86                                    X

23430       Repair biceps tendon                           2,302.18           4,998.08            6,114.86                                    X

23440       Remove/transplant tendon                       2,302.18           4,998.08            6,114.86                                    X

23450       Repair shoulder capsule                        4,329.21           9,398.80           11,498.89                                    X

23455       Repair shoulder capsule                        4,329.21           9,398.80           11,498.89                                    X

23460       Repair shoulder capsule                        4,329.21           9,398.80           11,498.89                                    X

23462       Repair shoulder capsule                        2,302.18           4,998.08            6,114.86                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                           Description          January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                             (short)




23465       Repair shoulder capsule                         T              T            0052        Level IV Musculoskeletal Procedures Except Hand and Foot

23466       Repair shoulder capsule                         T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot
23470       Reconstruct shoulder joint                      T              T            0425            Level II Arthroplasty or Implantation with Prosthesis
23472       Reconstruct shoulder joint                      C              C

23480       Revision of collar bone                         T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot

23485       Revision of collar bone                         T              T            0052        Level IV Musculoskeletal Procedures Except Hand and Foot

23490       Reinforce clavicle                              T              T            0052        Level IV Musculoskeletal Procedures Except Hand and Foot

23491       Reinforce shoulder bones                        T              T            0052        Level IV Musculoskeletal Procedures Except Hand and Foot
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                           Description           January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                             (short)            Relative Weights




23465       Repair shoulder capsule                        88.9869             6129.06

23466       Repair shoulder capsule                         47.3213            3259.30
23470       Reconstruct shoulder joint                     124.8075            8596.24                                59                  30
23472       Reconstruct shoulder joint                       0.0000              0.00

23480       Revision of collar bone                        47.3213             3259.30

23485       Revision of collar bone                        88.9869             6129.06

23490       Reinforce clavicle                             88.9869             6129.06

23491       Reinforce shoulder bones                       88.9869             6129.06
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                           Description           January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                             (short)




23465       Repair shoulder capsule                        4,329.21           9,398.80           11,498.89                                    X

23466       Repair shoulder capsule                        2,302.18           4,998.08            6,114.86                                    X
23470       Reconstruct shoulder joint                     6,071.88          13,182.17           16,127.63                                    X
23472       Reconstruct shoulder joint                       0.00               0.00                0.00

23480       Revision of collar bone                        2,302.18           4,998.08            6,114.86                                    X

23485       Revision of collar bone                        4,329.21           9,398.80           11,498.89                                    X

23490       Reinforce clavicle                             4,329.21           9,398.80           11,498.89                                    X

23491       Reinforce shoulder bones                       4,329.21           9,398.80           11,498.89                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                            Medicare APC




   CPT/                            Description         January 2011   January 2011   January 2011               January 2011 Description
  HCPCS                              (short)



23500       Treat clavicle fracture                         T              T            0129        Level I Closed Treatment Fracture Finger/Toe/Trunk
23505       Treat clavicle fracture                         T              T            0139        Level III Closed Treatment Fracture Finger/Toe/Trunk
23515       Treat clavicle fracture                         T              T            0064                Level III Treatment Fracture/Dislocation
23520       Treat clavicle dislocation                      T              T            0138        Level II Closed Treatment Fracture Finger/Toe/Trunk
23525       Treat clavicle dislocation                      T              T            0138        Level II Closed Treatment Fracture Finger/Toe/Trunk
23530       Treat clavicle dislocation                      T              T            0063                Level II Treatment Fracture/Dislocation
23532       Treat clavicle dislocation                      T              T            0062                 Level I Treatment Fracture/Dislocation
23540       Treat clavicle dislocation                      T              T            0129        Level I Closed Treatment Fracture Finger/Toe/Trunk
23545       Treat clavicle dislocation                      T              T            0138        Level II Closed Treatment Fracture Finger/Toe/Trunk
23550       Treat clavicle dislocation                      T              T            0063                Level II Treatment Fracture/Dislocation
23552       Treat clavicle dislocation                      T              T            0063                Level II Treatment Fracture/Dislocation
23570       Treat shoulder blade fx                         T              T            0129        Level I Closed Treatment Fracture Finger/Toe/Trunk
23575       Treat shoulder blade fx                         T              T            0138        Level II Closed Treatment Fracture Finger/Toe/Trunk
23585       Treat scapula fracture                          T              T            0064                Level III Treatment Fracture/Dislocation
23600       Treat humerus fracture                          T              T            0129        Level I Closed Treatment Fracture Finger/Toe/Trunk
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                            Description          January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                              (short)           Relative Weights



23500       Treat clavicle fracture                         1.5787              108.73
23505       Treat clavicle fracture                        20.8356             1435.07
23515       Treat clavicle fracture                        66.9057             4608.20
23520       Treat clavicle dislocation                      5.5050              379.16
23525       Treat clavicle dislocation                      5.5050              379.16
23530       Treat clavicle dislocation                     48.1318             3315.13
23532       Treat clavicle dislocation                     26.5543             1828.95
23540       Treat clavicle dislocation                      1.5787              108.73
23545       Treat clavicle dislocation                      5.5050              379.16
23550       Treat clavicle dislocation                     48.1318             3315.13
23552       Treat clavicle dislocation                     48.1318             3315.13
23570       Treat shoulder blade fx                         1.5787              108.73
23575       Treat shoulder blade fx                         5.5050              379.16
23585       Treat scapula fracture                         66.9057             4608.20
23600       Treat humerus fracture                          1.5787              108.73
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                            Description          January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                              (short)



23500       Treat clavicle fracture                          76.80             166.74              204.00                                     X
23505       Treat clavicle fracture                        1,013.65           2,200.66            2,692.38                                    X
23515       Treat clavicle fracture                        3,254.96           7,066.58            8,645.55                                    X
23520       Treat clavicle dislocation                      267.82             581.44              711.36                                     X
23525       Treat clavicle dislocation                      267.82             581.44              711.36                                     X
23530       Treat clavicle dislocation                     2,341.61           5,083.68            6,219.59                                    X
23532       Treat clavicle dislocation                     1,291.87           2,804.67            3,431.35                                    X
23540       Treat clavicle dislocation                       76.80             166.74              204.00                                     X
23545       Treat clavicle dislocation                      267.82             581.44              711.36                                     X
23550       Treat clavicle dislocation                     2,341.61           5,083.68            6,219.59                                    X
23552       Treat clavicle dislocation                     2,341.61           5,083.68            6,219.59                                    X
23570       Treat shoulder blade fx                          76.80             166.74              204.00                                     X
23575       Treat shoulder blade fx                         267.82             581.44              711.36                                     X
23585       Treat scapula fracture                         3,254.96           7,066.58            8,645.55                                    X
23600       Treat humerus fracture                           76.80             166.74              204.00                                     X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                            Medicare APC




   CPT/                           Description          January 2011   January 2011   January 2011               January 2011 Description
  HCPCS                             (short)



23605       Treat humerus fracture                          T              T            0139        Level III Closed Treatment Fracture Finger/Toe/Trunk
23615       Treat humerus fracture                          T              T            0064                Level III Treatment Fracture/Dislocation
23616       Treat humerus fracture                          T              T            0064                Level III Treatment Fracture/Dislocation
23620       Treat humerus fracture                          T              T            0129        Level I Closed Treatment Fracture Finger/Toe/Trunk
23625       Treat humerus fracture                          T              T            0139        Level III Closed Treatment Fracture Finger/Toe/Trunk
23630       Treat humerus fracture                          T              T            0064                Level III Treatment Fracture/Dislocation
23650       Treat shoulder dislocation                      T              T            0129        Level I Closed Treatment Fracture Finger/Toe/Trunk
23655       Treat shoulder dislocation                      T              T            0045             Bone/Joint Manipulation Under Anesthesia
23660       Treat shoulder dislocation                      T              T            0063                Level II Treatment Fracture/Dislocation
23665       Treat dislocation/fracture                      T              T            0138        Level II Closed Treatment Fracture Finger/Toe/Trunk
23670       Treat dislocation/fracture                      T              T            0064                Level III Treatment Fracture/Dislocation
23675       Treat dislocation/fracture                      T              T            0129        Level I Closed Treatment Fracture Finger/Toe/Trunk
23680       Treat dislocation/fracture                      T              T            0063                Level II Treatment Fracture/Dislocation
23700       Fixation of shoulder                            T              T            0045             Bone/Joint Manipulation Under Anesthesia
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                           Description           January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                             (short)            Relative Weights



23605       Treat humerus fracture                         20.8356             1435.07
23615       Treat humerus fracture                         66.9057             4608.20
23616       Treat humerus fracture                         66.9057             4608.20
23620       Treat humerus fracture                          1.5787              108.73
23625       Treat humerus fracture                         20.8356             1435.07
23630       Treat humerus fracture                         66.9057             4608.20
23650       Treat shoulder dislocation                      1.5787              108.73
23655       Treat shoulder dislocation                     15.5512             1071.10
23660       Treat shoulder dislocation                     48.1318             3315.13
23665       Treat dislocation/fracture                      5.5050              379.16
23670       Treat dislocation/fracture                     66.9057             4608.20
23675       Treat dislocation/fracture                      1.5787              108.73
23680       Treat dislocation/fracture                     48.1318             3315.13
23700       Fixation of shoulder                           15.5512             1071.10
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                           Description           January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                             (short)



23605       Treat humerus fracture                         1,013.65           2,200.66            2,692.38                                    X
23615       Treat humerus fracture                         3,254.96           7,066.58            8,645.55                                    X
23616       Treat humerus fracture                         3,254.96           7,066.58            8,645.55                                    X
23620       Treat humerus fracture                           76.80             166.74              204.00                                     X
23625       Treat humerus fracture                         1,013.65           2,200.66            2,692.38                                    X
23630       Treat humerus fracture                         3,254.96           7,066.58            8,645.55                                    X
23650       Treat shoulder dislocation                       76.80             166.74              204.00                                     X
23655       Treat shoulder dislocation                      756.57            1,642.52            2,009.53                                    X
23660       Treat shoulder dislocation                     2,341.61           5,083.68            6,219.59                                    X
23665       Treat dislocation/fracture                      267.82             581.44              711.36                                     X
23670       Treat dislocation/fracture                     3,254.96           7,066.58            8,645.55                                    X
23675       Treat dislocation/fracture                       76.80             166.74              204.00                                     X
23680       Treat dislocation/fracture                     2,341.61           5,083.68            6,219.59                                    X
23700       Fixation of shoulder                            756.57            1,642.52            2,009.53                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                            Description         January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                              (short)




23800       Fusion of shoulder joint                        T              T            0052        Level IV Musculoskeletal Procedures Except Hand and Foot

23802       Fusion of shoulder joint                        T              T            0052        Level IV Musculoskeletal Procedures Except Hand and Foot
23900       Amputation of arm & girdle                      C              C
23920       Amputation at shoulder joint                    C              C
23921       Amputation follow-up surgery                    T              T            0136                           Level IV Skin Repair
23929       Shoulder surgery procedure                      T              T            0129           Level I Closed Treatment Fracture Finger/Toe/Trunk
23930       Drainage of arm lesion                          T              T            0008                      Level III Incision and Drainage
23931       Drainage of arm bursa                           T              T            0008                      Level III Incision and Drainage

23935       Drain arm/elbow bone lesion                     T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot

24000       Exploratory elbow surgery                       T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                            Description          January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                              (short)           Relative Weights




23800       Fusion of shoulder joint                       88.9869             6129.06

23802       Fusion of shoulder joint                       88.9869             6129.06
23900       Amputation of arm & girdle                      0.0000               0.00
23920       Amputation at shoulder joint                    0.0000               0.00
23921       Amputation follow-up surgery                   17.2117             1185.47
23929       Shoulder surgery procedure                      1.5787              108.73
23930       Drainage of arm lesion                         20.1996             1391.27
23931       Drainage of arm bursa                          20.1996             1391.27

23935       Drain arm/elbow bone lesion                    22.9744             1582.38

24000       Exploratory elbow surgery                      32.2439             2220.83
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                            Description          January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                              (short)




23800       Fusion of shoulder joint                       4,329.21           9,398.80           11,498.89                                    X

23802       Fusion of shoulder joint                       4,329.21           9,398.80           11,498.89                                    X
23900       Amputation of arm & girdle                        0.00              0.00                0.00
23920       Amputation at shoulder joint                      0.00              0.00                0.00
23921       Amputation follow-up surgery                    837.35            1,817.90            2,224.10                                    X
23929       Shoulder surgery procedure                       76.80             166.74              204.00                                     X
23930       Drainage of arm lesion                          982.71            2,133.48            2,610.19                                    X
23931       Drainage of arm bursa                           982.71            2,133.48            2,610.19                                    X

23935       Drain arm/elbow bone lesion                    1,117.70           2,426.56            2,968.75                                    X

24000       Exploratory elbow surgery                      1,568.67           3,405.60            4,166.56                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                            Description         January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                              (short)




24006       Release elbow joint                             T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot
24065       Biopsy arm/elbow soft tissue                    T              T            0021                         Level III Excision/ Biopsy
24066       Biopsy arm/elbow soft tissue                    T              T            0021                         Level III Excision/ Biopsy
24071       Exc arm/elbow les sc = 3 cm                     T              T            0022                         Level IV Excision/ Biopsy
24073       Ex arm/elbow tum deep > 5 cm                    T              T            0022                         Level IV Excision/ Biopsy
24075       Exc arm/elbow les sc < 3 cm                     T              T            0021                         Level III Excision/ Biopsy
24076       Ex arm/elbow tum deep < 5 cm                    T              T            0021                         Level III Excision/ Biopsy
24077       Resect arm/elbow tum < 5 cm                     T              T            0021                         Level III Excision/ Biopsy
24079       Resect arm/elbow tum > 5 cm                     T              T            0022                         Level IV Excision/ Biopsy

24100       Biopsy elbow joint lining                       T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot

24101       Explore/treat elbow joint                       T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                            Description          January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                              (short)           Relative Weights




24006       Release elbow joint                            32.2439             2220.83
24065       Biopsy arm/elbow soft tissue                   18.0784             1245.17
24066       Biopsy arm/elbow soft tissue                   18.0784             1245.17
24071       Exc arm/elbow les sc = 3 cm                    23.8986             1646.04
24073       Ex arm/elbow tum deep > 5 cm                   23.8986             1646.04
24075       Exc arm/elbow les sc < 3 cm                    18.0784             1245.17
24076       Ex arm/elbow tum deep < 5 cm                   18.0784             1245.17
24077       Resect arm/elbow tum < 5 cm                    18.0784             1245.17
24079       Resect arm/elbow tum > 5 cm                    23.8986             1646.04

24100       Biopsy elbow joint lining                      22.9744             1582.38

24101       Explore/treat elbow joint                      32.2439             2220.83
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                            Description          January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                              (short)




24006       Release elbow joint                            1,568.67           3,405.60            4,166.56                                    X
24065       Biopsy arm/elbow soft tissue                    879.51            1,909.44            2,336.09                                    X
24066       Biopsy arm/elbow soft tissue                    879.51            1,909.44            2,336.09                                    X
24071       Exc arm/elbow les sc = 3 cm                    1,162.67           2,524.17            3,088.18                                    X
24073       Ex arm/elbow tum deep > 5 cm                   1,162.67           2,524.17            3,088.18                                    X
24075       Exc arm/elbow les sc < 3 cm                     879.51            1,909.44            2,336.09                                    X
24076       Ex arm/elbow tum deep < 5 cm                    879.51            1,909.44            2,336.09                                    X
24077       Resect arm/elbow tum < 5 cm                     879.51            1,909.44            2,336.09                                    X
24079       Resect arm/elbow tum > 5 cm                    1,162.67           2,524.17            3,088.18                                    X

24100       Biopsy elbow joint lining                      1,117.70           2,426.56            2,968.75                                    X

24101       Explore/treat elbow joint                      1,568.67           3,405.60            4,166.56                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                           Description          January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                             (short)




24102       Remove elbow joint lining                       T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

24105       Removal of elbow bursa                          T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot

24110       Remove humerus lesion                           T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot

24115       Remove/graft bone lesion                        T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

24116       Remove/graft bone lesion                        T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

24120       Remove elbow lesion                             T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot

24125       Remove/graft bone lesion                        T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                           Description           January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                             (short)            Relative Weights




24102       Remove elbow joint lining                      32.2439             2220.83

24105       Removal of elbow bursa                         22.9744             1582.38

24110       Remove humerus lesion                          22.9744             1582.38

24115       Remove/graft bone lesion                       32.2439             2220.83

24116       Remove/graft bone lesion                       32.2439             2220.83

24120       Remove elbow lesion                            22.9744             1582.38

24125       Remove/graft bone lesion                       32.2439             2220.83
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                           Description           January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                             (short)




24102       Remove elbow joint lining                      1,568.67           3,405.60            4,166.56                                    X

24105       Removal of elbow bursa                         1,117.70           2,426.56            2,968.75                                    X

24110       Remove humerus lesion                          1,117.70           2,426.56            2,968.75                                    X

24115       Remove/graft bone lesion                       1,568.67           3,405.60            4,166.56                                    X

24116       Remove/graft bone lesion                       1,568.67           3,405.60            4,166.56                                    X

24120       Remove elbow lesion                            1,117.70           2,426.56            2,968.75                                    X

24125       Remove/graft bone lesion                       1,568.67           3,405.60            4,166.56                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                            Description         January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                              (short)




24126       Remove/graft bone lesion                        T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

24130       Removal of head of radius                       T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

24134       Removal of arm bone lesion                      T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

24136       Remove radius bone lesion                       T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

24138       Remove elbow bone lesion                        T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

24140       Partial removal of arm bone                     T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

24145       Partial removal of radius                       T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                            Description          January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                              (short)           Relative Weights




24126       Remove/graft bone lesion                       32.2439             2220.83

24130       Removal of head of radius                      32.2439             2220.83

24134       Removal of arm bone lesion                     32.2439             2220.83

24136       Remove radius bone lesion                      32.2439             2220.83

24138       Remove elbow bone lesion                       32.2439             2220.83

24140       Partial removal of arm bone                    32.2439             2220.83

24145       Partial removal of radius                      32.2439             2220.83
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                            Description          January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                              (short)




24126       Remove/graft bone lesion                       1,568.67           3,405.60            4,166.56                                    X

24130       Removal of head of radius                      1,568.67           3,405.60            4,166.56                                    X

24134       Removal of arm bone lesion                     1,568.67           3,405.60            4,166.56                                    X

24136       Remove radius bone lesion                      1,568.67           3,405.60            4,166.56                                    X

24138       Remove elbow bone lesion                       1,568.67           3,405.60            4,166.56                                    X

24140       Partial removal of arm bone                    1,568.67           3,405.60            4,166.56                                    X

24145       Partial removal of radius                      1,568.67           3,405.60            4,166.56                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                           Description          January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                             (short)




24147       Partial removal of elbow                        T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

24149       Radical resection of elbow                      T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

24150       Resect distal humerus tumor                     T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot

24152       Resect radius tumor                             T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot

24155       Removal of elbow joint                          T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot

24160       Remove elbow joint implant                      T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

24164       Remove radius head implant                      T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                           Description           January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                             (short)            Relative Weights




24147       Partial removal of elbow                       32.2439             2220.83

24149       Radical resection of elbow                     32.2439             2220.83

24150       Resect distal humerus tumor                    47.3213             3259.30

24152       Resect radius tumor                            47.3213             3259.30

24155       Removal of elbow joint                         47.3213             3259.30

24160       Remove elbow joint implant                     32.2439             2220.83

24164       Remove radius head implant                     32.2439             2220.83
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                           Description           January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                             (short)




24147       Partial removal of elbow                       1,568.67           3,405.60            4,166.56                                    X

24149       Radical resection of elbow                     1,568.67           3,405.60            4,166.56                                    X

24150       Resect distal humerus tumor                    2,302.18           4,998.08            6,114.86                                    X

24152       Resect radius tumor                            2,302.18           4,998.08            6,114.86                                    X

24155       Removal of elbow joint                         2,302.18           4,998.08            6,114.86                                    X

24160       Remove elbow joint implant                     1,568.67           3,405.60            4,166.56                                    X

24164       Remove radius head implant                     1,568.67           3,405.60            4,166.56                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                            Description         January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                              (short)



24200       Removal of arm foreign body                     T              T            0019                        Level I Excision/ Biopsy
24201       Removal of arm foreign body                     T              T            0021                        Level III Excision/ Biopsy
24220       Injection for elbow x-ray                       N              N
24300       Manipulate elbow w/anesth                       T              T            0045                Bone/Joint Manipulation Under Anesthesia

24301       Muscle/tendon transfer                          T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

24305       Arm tendon lengthening                          T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

24310       Revision of arm tendon                          T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot

24320       Repair of arm tendon                            T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot

24330       Revision of arm muscles                         T              T            0052        Level IV Musculoskeletal Procedures Except Hand and Foot
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                            Description          January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                              (short)           Relative Weights



24200       Removal of arm foreign body                     5.0887              350.49
24201       Removal of arm foreign body                    18.0784             1245.17
24220       Injection for elbow x-ray                       0.0000               0.00
24300       Manipulate elbow w/anesth                      15.5512             1071.10

24301       Muscle/tendon transfer                         32.2439             2220.83

24305       Arm tendon lengthening                         32.2439             2220.83

24310       Revision of arm tendon                         22.9744             1582.38

24320       Repair of arm tendon                           47.3213             3259.30

24330       Revision of arm muscles                        88.9869             6129.06
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                            Description          January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                              (short)



24200       Removal of arm foreign body                    247.57              537.47              657.56                                     X
24201       Removal of arm foreign body                    879.51             1,909.44            2,336.09                                    X
24220       Injection for elbow x-ray                       0.00                0.00                0.00
24300       Manipulate elbow w/anesth                      756.57             1,642.52            2,009.53                                    X

24301       Muscle/tendon transfer                         1,568.67           3,405.60            4,166.56                                    X

24305       Arm tendon lengthening                         1,568.67           3,405.60            4,166.56                                    X

24310       Revision of arm tendon                         1,117.70           2,426.56            2,968.75                                    X

24320       Repair of arm tendon                           2,302.18           4,998.08            6,114.86                                    X

24330       Revision of arm muscles                        4,329.21           9,398.80           11,498.89                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                            Description         January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                              (short)




24331       Revision of arm muscles                         T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot

24332       Tenolysis, triceps                              T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot

24340       Repair of biceps tendon                         T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot

24341       Repair arm tendon/muscle                        T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot

24342       Repair of ruptured tendon                       T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot

24343       Repr elbow lat ligmnt w/tiss                    T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

24344       Reconstruct elbow lat ligmnt                    T              T            0052        Level IV Musculoskeletal Procedures Except Hand and Foot
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                            Description          January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                              (short)           Relative Weights




24331       Revision of arm muscles                        47.3213             3259.30

24332       Tenolysis, triceps                             22.9744             1582.38

24340       Repair of biceps tendon                        47.3213             3259.30

24341       Repair arm tendon/muscle                       47.3213             3259.30

24342       Repair of ruptured tendon                      47.3213             3259.30

24343       Repr elbow lat ligmnt w/tiss                   32.2439             2220.83

24344       Reconstruct elbow lat ligmnt                   88.9869             6129.06
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                            Description          January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                              (short)




24331       Revision of arm muscles                        2,302.18           4,998.08            6,114.86                                    X

24332       Tenolysis, triceps                             1,117.70           2,426.56            2,968.75                                    X

24340       Repair of biceps tendon                        2,302.18           4,998.08            6,114.86                                    X

24341       Repair arm tendon/muscle                       2,302.18           4,998.08            6,114.86                                    X

24342       Repair of ruptured tendon                      2,302.18           4,998.08            6,114.86                                    X

24343       Repr elbow lat ligmnt w/tiss                   1,568.67           3,405.60            4,166.56                                    X

24344       Reconstruct elbow lat ligmnt                   4,329.21           9,398.80           11,498.89                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                            (short)




24345       Repr elbw med ligmnt w/tissu                    T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

24346       Reconstruct elbow med ligmnt                    T              T            0052        Level IV Musculoskeletal Procedures Except Hand and Foot

24357       Repair elbow, perc                              T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

24358       Repair elbow w/deb, open                        T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

24359       Repair elbow deb/attch open                     T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot
24360       Reconstruct elbow joint                         T              T            0047                       Arthroplasty without Prosthesis
24361       Reconstruct elbow joint                         T              T            0425           Level II Arthroplasty or Implantation with Prosthesis
24362       Reconstruct elbow joint                         T              T            0048            Level I Arthroplasty or Implantation with Prosthesis
24363       Replace elbow joint                             T              T            0425           Level II Arthroplasty or Implantation with Prosthesis
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights




24345       Repr elbw med ligmnt w/tissu                   32.2439             2220.83

24346       Reconstruct elbow med ligmnt                   88.9869             6129.06

24357       Repair elbow, perc                             32.2439             2220.83

24358       Repair elbow w/deb, open                       32.2439             2220.83

24359       Repair elbow deb/attch open                     32.2439            2220.83
24360       Reconstruct elbow joint                         39.2855            2705.83
24361       Reconstruct elbow joint                        124.8075            8596.24                                59                  30
24362       Reconstruct elbow joint                         59.9568            4129.58
24363       Replace elbow joint                            124.8075            8596.24                                59                  30
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)




24345       Repr elbw med ligmnt w/tissu                   1,568.67           3,405.60            4,166.56                                    X

24346       Reconstruct elbow med ligmnt                   4,329.21           9,398.80           11,498.89                                    X

24357       Repair elbow, perc                             1,568.67           3,405.60            4,166.56                                    X

24358       Repair elbow w/deb, open                       1,568.67           3,405.60            4,166.56                                    X

24359       Repair elbow deb/attch open                    1,568.67           3,405.60            4,166.56                                    X
24360       Reconstruct elbow joint                        1,911.24           4,149.33            5,076.47                                    X
24361       Reconstruct elbow joint                        6,071.88          13,182.17           16,127.63                                    X
24362       Reconstruct elbow joint                        2,916.90           6,332.64            7,747.62                                    X
24363       Replace elbow joint                            6,071.88          13,182.17           16,127.63                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                                Medicare APC




   CPT/                               Description      January 2011   January 2011   January 2011                   January 2011 Description
  HCPCS                                 (short)



24365       Reconstruct head of radius                      T              T            0047                       Arthroplasty without Prosthesis
24366       Reconstruct head of radius                      T              T            0425            Level II Arthroplasty or Implantation with Prosthesis

24400       Revision of humerus                             T              T            0052        Level IV Musculoskeletal Procedures Except Hand and Foot

24410       Revision of humerus                             T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot

24420       Revision of humerus                             T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot

24430       Repair of humerus                               T              T            0052        Level IV Musculoskeletal Procedures Except Hand and Foot

24435       Repair humerus with graft                       T              T            0052        Level IV Musculoskeletal Procedures Except Hand and Foot

24470       Revision of elbow joint                         T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                               Description       January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                                 (short)        Relative Weights



24365       Reconstruct head of radius                      39.2855            2705.83
24366       Reconstruct head of radius                     124.8075            8596.24                                59                  30

24400       Revision of humerus                            88.9869             6129.06

24410       Revision of humerus                            47.3213             3259.30

24420       Revision of humerus                            47.3213             3259.30

24430       Repair of humerus                              88.9869             6129.06

24435       Repair humerus with graft                      88.9869             6129.06

24470       Revision of elbow joint                        47.3213             3259.30
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                               Description       January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                                 (short)



24365       Reconstruct head of radius                     1,911.24           4,149.33            5,076.47                                    X
24366       Reconstruct head of radius                     6,071.88          13,182.17           16,127.63                                    X

24400       Revision of humerus                            4,329.21           9,398.80           11,498.89                                    X

24410       Revision of humerus                            2,302.18           4,998.08            6,114.86                                    X

24420       Revision of humerus                            2,302.18           4,998.08            6,114.86                                    X

24430       Repair of humerus                              4,329.21           9,398.80           11,498.89                                    X

24435       Repair humerus with graft                      4,329.21           9,398.80           11,498.89                                    X

24470       Revision of elbow joint                        2,302.18           4,998.08            6,114.86                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                            (short)




24495       Decompression of forearm                        T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

24498       Reinforce humerus                               T              T            0052        Level IV Musculoskeletal Procedures Except Hand and Foot
24500       Treat humerus fracture                          T              T            0129           Level I Closed Treatment Fracture Finger/Toe/Trunk
24505       Treat humerus fracture                          T              T            0129           Level I Closed Treatment Fracture Finger/Toe/Trunk
24515       Treat humerus fracture                          T              T            0064                  Level III Treatment Fracture/Dislocation
24516       Treat humerus fracture                          T              T            0064                  Level III Treatment Fracture/Dislocation
24530       Treat humerus fracture                          T              T            0129           Level I Closed Treatment Fracture Finger/Toe/Trunk
24535       Treat humerus fracture                          T              T            0138           Level II Closed Treatment Fracture Finger/Toe/Trunk
24538       Treat humerus fracture                          T              T            0062                   Level I Treatment Fracture/Dislocation
24545       Treat humerus fracture                          T              T            0064                  Level III Treatment Fracture/Dislocation
24546       Treat humerus fracture                          T              T            0064                  Level III Treatment Fracture/Dislocation
24560       Treat humerus fracture                          T              T            0129           Level I Closed Treatment Fracture Finger/Toe/Trunk
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights




24495       Decompression of forearm                       32.2439             2220.83

24498       Reinforce humerus                              88.9869             6129.06
24500       Treat humerus fracture                          1.5787              108.73
24505       Treat humerus fracture                          1.5787              108.73
24515       Treat humerus fracture                         66.9057             4608.20
24516       Treat humerus fracture                         66.9057             4608.20
24530       Treat humerus fracture                          1.5787              108.73
24535       Treat humerus fracture                          5.5050              379.16
24538       Treat humerus fracture                         26.5543             1828.95
24545       Treat humerus fracture                         66.9057             4608.20
24546       Treat humerus fracture                         66.9057             4608.20
24560       Treat humerus fracture                          1.5787              108.73
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)




24495       Decompression of forearm                       1,568.67           3,405.60            4,166.56                                    X

24498       Reinforce humerus                              4,329.21           9,398.80           11,498.89                                    X
24500       Treat humerus fracture                           76.80             166.74              204.00                                     X
24505       Treat humerus fracture                           76.80             166.74              204.00                                     X
24515       Treat humerus fracture                         3,254.96           7,066.58            8,645.55                                    X
24516       Treat humerus fracture                         3,254.96           7,066.58            8,645.55                                    X
24530       Treat humerus fracture                           76.80             166.74              204.00                                     X
24535       Treat humerus fracture                          267.82             581.44              711.36                                     X
24538       Treat humerus fracture                         1,291.87           2,804.67            3,431.35                                    X
24545       Treat humerus fracture                         3,254.96           7,066.58            8,645.55                                    X
24546       Treat humerus fracture                         3,254.96           7,066.58            8,645.55                                    X
24560       Treat humerus fracture                           76.80             166.74              204.00                                     X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                            Medicare APC




   CPT/                           Description          January 2011   January 2011   January 2011               January 2011 Description
  HCPCS                             (short)



24565       Treat humerus fracture                          T              T            0129        Level I Closed Treatment Fracture Finger/Toe/Trunk
24566       Treat humerus fracture                          T              T            0062                 Level I Treatment Fracture/Dislocation
24575       Treat humerus fracture                          T              T            0064                Level III Treatment Fracture/Dislocation
24576       Treat humerus fracture                          T              T            0129        Level I Closed Treatment Fracture Finger/Toe/Trunk
24577       Treat humerus fracture                          T              T            0129        Level I Closed Treatment Fracture Finger/Toe/Trunk
24579       Treat humerus fracture                          T              T            0064                Level III Treatment Fracture/Dislocation
24582       Treat humerus fracture                          T              T            0062                 Level I Treatment Fracture/Dislocation
24586       Treat elbow fracture                            T              T            0064                Level III Treatment Fracture/Dislocation
24587       Treat elbow fracture                            T              T            0064                Level III Treatment Fracture/Dislocation
24600       Treat elbow dislocation                         T              T            0129        Level I Closed Treatment Fracture Finger/Toe/Trunk
24605       Treat elbow dislocation                         T              T            0045             Bone/Joint Manipulation Under Anesthesia
24615       Treat elbow dislocation                         T              T            0064                Level III Treatment Fracture/Dislocation
24620       Treat elbow fracture                            T              T            0139        Level III Closed Treatment Fracture Finger/Toe/Trunk
24635       Treat elbow fracture                            T              T            0064                Level III Treatment Fracture/Dislocation
24640       Treat elbow dislocation                         T              T            0129        Level I Closed Treatment Fracture Finger/Toe/Trunk
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                           Description           January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                             (short)            Relative Weights



24565       Treat humerus fracture                          1.5787              108.73
24566       Treat humerus fracture                         26.5543             1828.95
24575       Treat humerus fracture                         66.9057             4608.20
24576       Treat humerus fracture                          1.5787              108.73
24577       Treat humerus fracture                          1.5787              108.73
24579       Treat humerus fracture                         66.9057             4608.20
24582       Treat humerus fracture                         26.5543             1828.95
24586       Treat elbow fracture                           66.9057             4608.20
24587       Treat elbow fracture                           66.9057             4608.20
24600       Treat elbow dislocation                         1.5787              108.73
24605       Treat elbow dislocation                        15.5512             1071.10
24615       Treat elbow dislocation                        66.9057             4608.20
24620       Treat elbow fracture                           20.8356             1435.07
24635       Treat elbow fracture                           66.9057             4608.20
24640       Treat elbow dislocation                         1.5787              108.73
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                           Description           January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                             (short)



24565       Treat humerus fracture                           76.80             166.74              204.00                                     X
24566       Treat humerus fracture                         1,291.87           2,804.67            3,431.35                                    X
24575       Treat humerus fracture                         3,254.96           7,066.58            8,645.55                                    X
24576       Treat humerus fracture                           76.80             166.74              204.00                                     X
24577       Treat humerus fracture                           76.80             166.74              204.00                                     X
24579       Treat humerus fracture                         3,254.96           7,066.58            8,645.55                                    X
24582       Treat humerus fracture                         1,291.87           2,804.67            3,431.35                                    X
24586       Treat elbow fracture                           3,254.96           7,066.58            8,645.55                                    X
24587       Treat elbow fracture                           3,254.96           7,066.58            8,645.55                                    X
24600       Treat elbow dislocation                          76.80             166.74              204.00                                     X
24605       Treat elbow dislocation                         756.57            1,642.52            2,009.53                                    X
24615       Treat elbow dislocation                        3,254.96           7,066.58            8,645.55                                    X
24620       Treat elbow fracture                           1,013.65           2,200.66            2,692.38                                    X
24635       Treat elbow fracture                           3,254.96           7,066.58            8,645.55                                    X
24640       Treat elbow dislocation                          76.80             166.74              204.00                                     X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                             Description        January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                               (short)



24650       Treat radius fracture                           T              T            0129           Level I Closed Treatment Fracture Finger/Toe/Trunk
24655       Treat radius fracture                           T              T            0138           Level II Closed Treatment Fracture Finger/Toe/Trunk
24665       Treat radius fracture                           T              T            0063                   Level II Treatment Fracture/Dislocation
24666       Treat radius fracture                           T              T            0064                  Level III Treatment Fracture/Dislocation
24670       Treat ulnar fracture                            T              T            0129           Level I Closed Treatment Fracture Finger/Toe/Trunk
24675       Treat ulnar fracture                            T              T            0129           Level I Closed Treatment Fracture Finger/Toe/Trunk
24685       Treat ulnar fracture                            T              T            0063                   Level II Treatment Fracture/Dislocation

24800       Fusion of elbow joint                           T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot

24802       Fusion/graft of elbow joint                     T              T            0052        Level IV Musculoskeletal Procedures Except Hand and Foot
24900       Amputation of upper arm                         C              C
24920       Amputation of upper arm                         C              C
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                             Description         January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                               (short)          Relative Weights



24650       Treat radius fracture                           1.5787              108.73
24655       Treat radius fracture                           5.5050              379.16
24665       Treat radius fracture                          48.1318             3315.13
24666       Treat radius fracture                          66.9057             4608.20
24670       Treat ulnar fracture                            1.5787              108.73
24675       Treat ulnar fracture                            1.5787              108.73
24685       Treat ulnar fracture                           48.1318             3315.13

24800       Fusion of elbow joint                          47.3213             3259.30

24802       Fusion/graft of elbow joint                    88.9869             6129.06
24900       Amputation of upper arm                         0.0000               0.00
24920       Amputation of upper arm                         0.0000               0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                             Description         January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                               (short)



24650       Treat radius fracture                            76.80             166.74              204.00                                     X
24655       Treat radius fracture                           267.82             581.44              711.36                                     X
24665       Treat radius fracture                          2,341.61           5,083.68            6,219.59                                    X
24666       Treat radius fracture                          3,254.96           7,066.58            8,645.55                                    X
24670       Treat ulnar fracture                             76.80             166.74              204.00                                     X
24675       Treat ulnar fracture                             76.80             166.74              204.00                                     X
24685       Treat ulnar fracture                           2,341.61           5,083.68            6,219.59                                    X

24800       Fusion of elbow joint                          2,302.18           4,998.08            6,114.86                                    X

24802       Fusion/graft of elbow joint                    4,329.21           9,398.80           11,498.89                                    X
24900       Amputation of upper arm                          0.00               0.00                0.00
24920       Amputation of upper arm                          0.00               0.00                0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                             Description        January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                               (short)




24925       Amputation follow-up surgery                    T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot
24930       Amputation follow-up surgery                    C              C
24931       Amputate upper arm & implant                    C              C

24935       Revision of amputation                          T              T            0052        Level IV Musculoskeletal Procedures Except Hand and Foot
24940       Revision of upper arm                           C              C
24999       Upper arm/elbow surgery                         T              T            0129           Level I Closed Treatment Fracture Finger/Toe/Trunk

25000       Incision of tendon sheath                       T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot

25001       Incise flexor carpi radialis                    T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot

25020       Decompress forearm 1 space                      T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                             Description         January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                               (short)          Relative Weights




24925       Amputation follow-up surgery                   22.9744             1582.38
24930       Amputation follow-up surgery                    0.0000               0.00
24931       Amputate upper arm & implant                    0.0000               0.00

24935       Revision of amputation                         88.9869             6129.06
24940       Revision of upper arm                           0.0000               0.00
24999       Upper arm/elbow surgery                         1.5787              108.73

25000       Incision of tendon sheath                      22.9744             1582.38

25001       Incise flexor carpi radialis                   22.9744             1582.38

25020       Decompress forearm 1 space                     32.2439             2220.83
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                             Description         January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                               (short)




24925       Amputation follow-up surgery                   1,117.70           2,426.56            2,968.75                                    X
24930       Amputation follow-up surgery                     0.00               0.00                0.00
24931       Amputate upper arm & implant                     0.00               0.00                0.00

24935       Revision of amputation                         4,329.21           9,398.80           11,498.89                                    X
24940       Revision of upper arm                             0.00              0.00                0.00
24999       Upper arm/elbow surgery                          76.80             166.74             204.00                                      X

25000       Incision of tendon sheath                      1,117.70           2,426.56            2,968.75                                    X

25001       Incise flexor carpi radialis                   1,117.70           2,426.56            2,968.75                                    X

25020       Decompress forearm 1 space                     1,568.67           3,405.60            4,166.56                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                             Description        January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                               (short)




25023       Decompress forearm 1 space                      T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

25024       Decompress forearm 2 spaces                     T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

25025       Decompress forearm 2 spaces                     T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

25028       Drainage of forearm lesion                      T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot

25031       Drainage of forearm bursa                       T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot

25035       Treat forearm bone lesion                       T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot

25040       Explore/treat wrist joint                       T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                             Description         January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                               (short)          Relative Weights




25023       Decompress forearm 1 space                     32.2439             2220.83

25024       Decompress forearm 2 spaces                    32.2439             2220.83

25025       Decompress forearm 2 spaces                    32.2439             2220.83

25028       Drainage of forearm lesion                     22.9744             1582.38

25031       Drainage of forearm bursa                      22.9744             1582.38

25035       Treat forearm bone lesion                      22.9744             1582.38

25040       Explore/treat wrist joint                      32.2439             2220.83
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                             Description         January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                               (short)




25023       Decompress forearm 1 space                     1,568.67           3,405.60            4,166.56                                    X

25024       Decompress forearm 2 spaces                    1,568.67           3,405.60            4,166.56                                    X

25025       Decompress forearm 2 spaces                    1,568.67           3,405.60            4,166.56                                    X

25028       Drainage of forearm lesion                     1,117.70           2,426.56            2,968.75                                    X

25031       Drainage of forearm bursa                      1,117.70           2,426.56            2,968.75                                    X

25035       Treat forearm bone lesion                      1,117.70           2,426.56            2,968.75                                    X

25040       Explore/treat wrist joint                      1,568.67           3,405.60            4,166.56                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                             Description        January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                               (short)



25065       Biopsy forearm soft tissues                     T              T            0020                        Level II Excision/ Biopsy
25066       Biopsy forearm soft tissues                     T              T            0022                        Level IV Excision/ Biopsy
25071       Exc forearm les sc > 3 cm                       T              T            0022                        Level IV Excision/ Biopsy
25073       Exc forearm tum deep = 3 cm                     T              T            0022                        Level IV Excision/ Biopsy
25075       Exc forearm les sc < 3 cm                       T              T            0021                        Level III Excision/ Biopsy
25076       Exc forearm tum deep < 3 cm                     T              T            0021                        Level III Excision/ Biopsy
25077       Resect forearm/wrist tum<3cm                    T              T            0021                        Level III Excision/ Biopsy
25078       Resect forearm/wrist tum=3cm                    T              T            0022                        Level IV Excision/ Biopsy

25085       Incision of wrist capsule                       T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot

25100       Biopsy of wrist joint                           T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot

25101       Explore/treat wrist joint                       T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                             Description         January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                               (short)          Relative Weights



25065       Biopsy forearm soft tissues                     8.4929              584.96
25066       Biopsy forearm soft tissues                    23.8986             1646.04
25071       Exc forearm les sc > 3 cm                      23.8986             1646.04
25073       Exc forearm tum deep = 3 cm                    23.8986             1646.04
25075       Exc forearm les sc < 3 cm                      18.0784             1245.17
25076       Exc forearm tum deep < 3 cm                    18.0784             1245.17
25077       Resect forearm/wrist tum<3cm                   18.0784             1245.17
25078       Resect forearm/wrist tum=3cm                   23.8986             1646.04

25085       Incision of wrist capsule                      22.9744             1582.38

25100       Biopsy of wrist joint                          22.9744             1582.38

25101       Explore/treat wrist joint                      32.2439             2220.83
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                             Description         January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                               (short)



25065       Biopsy forearm soft tissues                     413.18             897.02             1,097.45                                    X
25066       Biopsy forearm soft tissues                    1,162.67           2,524.17            3,088.18                                    X
25071       Exc forearm les sc > 3 cm                      1,162.67           2,524.17            3,088.18                                    X
25073       Exc forearm tum deep = 3 cm                    1,162.67           2,524.17            3,088.18                                    X
25075       Exc forearm les sc < 3 cm                       879.51            1,909.44            2,336.09                                    X
25076       Exc forearm tum deep < 3 cm                     879.51            1,909.44            2,336.09                                    X
25077       Resect forearm/wrist tum<3cm                    879.51            1,909.44            2,336.09                                    X
25078       Resect forearm/wrist tum=3cm                   1,162.67           2,524.17            3,088.18                                    X

25085       Incision of wrist capsule                      1,117.70           2,426.56            2,968.75                                    X

25100       Biopsy of wrist joint                          1,117.70           2,426.56            2,968.75                                    X

25101       Explore/treat wrist joint                      1,568.67           3,405.60            4,166.56                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                            Description         January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                              (short)




25105       Remove wrist joint lining                       T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

25107       Remove wrist joint cartilage                    T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

25109       Excise tendon forearm/wrist                     T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot

25110       Remove wrist tendon lesion                      T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot

25111       Remove wrist tendon lesion                      T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot

25112       Reremove wrist tendon lesion                    T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot

25115       Remove wrist/forearm lesion                     T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                            Description          January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                              (short)           Relative Weights




25105       Remove wrist joint lining                      32.2439             2220.83

25107       Remove wrist joint cartilage                   32.2439             2220.83

25109       Excise tendon forearm/wrist                    22.9744             1582.38

25110       Remove wrist tendon lesion                     22.9744             1582.38

25111       Remove wrist tendon lesion                     22.9744             1582.38

25112       Reremove wrist tendon lesion                   22.9744             1582.38

25115       Remove wrist/forearm lesion                    22.9744             1582.38
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                            Description          January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                              (short)




25105       Remove wrist joint lining                      1,568.67           3,405.60            4,166.56                                    X

25107       Remove wrist joint cartilage                   1,568.67           3,405.60            4,166.56                                    X

25109       Excise tendon forearm/wrist                    1,117.70           2,426.56            2,968.75                                    X

25110       Remove wrist tendon lesion                     1,117.70           2,426.56            2,968.75                                    X

25111       Remove wrist tendon lesion                     1,117.70           2,426.56            2,968.75                                    X

25112       Reremove wrist tendon lesion                   1,117.70           2,426.56            2,968.75                                    X

25115       Remove wrist/forearm lesion                    1,117.70           2,426.56            2,968.75                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                               Description      January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                                 (short)




25116       Remove wrist/forearm lesion                     T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot

25118       Excise wrist tendon sheath                      T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

25119       Partial removal of ulna                         T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

25120       Removal of forearm lesion                       T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

25125       Remove/graft forearm lesion                     T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

25126       Remove/graft forearm lesion                     T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

25130       Removal of wrist lesion                         T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                               Description       January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                                 (short)        Relative Weights




25116       Remove wrist/forearm lesion                    22.9744             1582.38

25118       Excise wrist tendon sheath                     32.2439             2220.83

25119       Partial removal of ulna                        32.2439             2220.83

25120       Removal of forearm lesion                      32.2439             2220.83

25125       Remove/graft forearm lesion                    32.2439             2220.83

25126       Remove/graft forearm lesion                    32.2439             2220.83

25130       Removal of wrist lesion                        32.2439             2220.83
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                               Description       January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                                 (short)




25116       Remove wrist/forearm lesion                    1,117.70           2,426.56            2,968.75                                    X

25118       Excise wrist tendon sheath                     1,568.67           3,405.60            4,166.56                                    X

25119       Partial removal of ulna                        1,568.67           3,405.60            4,166.56                                    X

25120       Removal of forearm lesion                      1,568.67           3,405.60            4,166.56                                    X

25125       Remove/graft forearm lesion                    1,568.67           3,405.60            4,166.56                                    X

25126       Remove/graft forearm lesion                    1,568.67           3,405.60            4,166.56                                    X

25130       Removal of wrist lesion                        1,568.67           3,405.60            4,166.56                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                               Description      January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                                 (short)




25135       Remove & graft wrist lesion                     T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

25136       Remove & graft wrist lesion                     T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

25145       Remove forearm bone lesion                      T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

25150       Partial removal of ulna                         T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

25151       Partial removal of radius                       T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

25170       Resect radius/ulnar tumor                       T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot

25210       Removal of wrist bone                           T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                               Description       January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                                 (short)        Relative Weights




25135       Remove & graft wrist lesion                    32.2439             2220.83

25136       Remove & graft wrist lesion                    32.2439             2220.83

25145       Remove forearm bone lesion                     32.2439             2220.83

25150       Partial removal of ulna                        32.2439             2220.83

25151       Partial removal of radius                      32.2439             2220.83

25170       Resect radius/ulnar tumor                      47.3213             3259.30

25210       Removal of wrist bone                          32.2439             2220.83
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                               Description       January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                                 (short)




25135       Remove & graft wrist lesion                    1,568.67           3,405.60            4,166.56                                    X

25136       Remove & graft wrist lesion                    1,568.67           3,405.60            4,166.56                                    X

25145       Remove forearm bone lesion                     1,568.67           3,405.60            4,166.56                                    X

25150       Partial removal of ulna                        1,568.67           3,405.60            4,166.56                                    X

25151       Partial removal of radius                      1,568.67           3,405.60            4,166.56                                    X

25170       Resect radius/ulnar tumor                      2,302.18           4,998.08            6,114.86                                    X

25210       Removal of wrist bone                          1,568.67           3,405.60            4,166.56                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                             Description        January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                               (short)




25215       Removal of wrist bones                          T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

25230       Partial removal of radius                       T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

25240       Partial removal of ulna                         T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot
25246       Injection for wrist x-ray                       N              N

25248       Remove forearm foreign body                     T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot

25250       Removal of wrist prosthesis                     T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

25251       Removal of wrist prosthesis                     T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot
25259       Manipulate wrist w/anesthes                     T              T            0139          Level III Closed Treatment Fracture Finger/Toe/Trunk
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                             Description         January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                               (short)          Relative Weights




25215       Removal of wrist bones                         32.2439             2220.83

25230       Partial removal of radius                      32.2439             2220.83

25240       Partial removal of ulna                        32.2439             2220.83
25246       Injection for wrist x-ray                       0.0000               0.00

25248       Remove forearm foreign body                    22.9744             1582.38

25250       Removal of wrist prosthesis                    32.2439             2220.83

25251       Removal of wrist prosthesis                    32.2439             2220.83
25259       Manipulate wrist w/anesthes                    20.8356             1435.07
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                             Description         January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                               (short)




25215       Removal of wrist bones                         1,568.67           3,405.60            4,166.56                                    X

25230       Partial removal of radius                      1,568.67           3,405.60            4,166.56                                    X

25240       Partial removal of ulna                        1,568.67           3,405.60            4,166.56                                    X
25246       Injection for wrist x-ray                        0.00               0.00                0.00

25248       Remove forearm foreign body                    1,117.70           2,426.56            2,968.75                                    X

25250       Removal of wrist prosthesis                    1,568.67           3,405.60            4,166.56                                    X

25251       Removal of wrist prosthesis                    1,568.67           3,405.60            4,166.56                                    X
25259       Manipulate wrist w/anesthes                    1,013.65           2,200.66            2,692.38                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                            (short)




25260       Repair forearm tendon/muscle                    T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

25263       Repair forearm tendon/muscle                    T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

25265       Repair forearm tendon/muscle                    T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

25270       Repair forearm tendon/muscle                    T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

25272       Repair forearm tendon/muscle                    T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

25274       Repair forearm tendon/muscle                    T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

25275       Repair forearm tendon sheath                    T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights




25260       Repair forearm tendon/muscle                   32.2439             2220.83

25263       Repair forearm tendon/muscle                   32.2439             2220.83

25265       Repair forearm tendon/muscle                   32.2439             2220.83

25270       Repair forearm tendon/muscle                   32.2439             2220.83

25272       Repair forearm tendon/muscle                   32.2439             2220.83

25274       Repair forearm tendon/muscle                   32.2439             2220.83

25275       Repair forearm tendon sheath                   32.2439             2220.83
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)




25260       Repair forearm tendon/muscle                   1,568.67           3,405.60            4,166.56                                    X

25263       Repair forearm tendon/muscle                   1,568.67           3,405.60            4,166.56                                    X

25265       Repair forearm tendon/muscle                   1,568.67           3,405.60            4,166.56                                    X

25270       Repair forearm tendon/muscle                   1,568.67           3,405.60            4,166.56                                    X

25272       Repair forearm tendon/muscle                   1,568.67           3,405.60            4,166.56                                    X

25274       Repair forearm tendon/muscle                   1,568.67           3,405.60            4,166.56                                    X

25275       Repair forearm tendon sheath                   1,568.67           3,405.60            4,166.56                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                           Description          January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                             (short)




25280       Revise wrist/forearm tendon                     T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

25290       Incise wrist/forearm tendon                     T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

25295       Release wrist/forearm tendon                    T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot

25300       Fusion of tendons at wrist                      T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

25301       Fusion of tendons at wrist                      T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

25310       Transplant forearm tendon                       T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot

25312       Transplant forearm tendon                       T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                           Description           January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                             (short)            Relative Weights




25280       Revise wrist/forearm tendon                    32.2439             2220.83

25290       Incise wrist/forearm tendon                    32.2439             2220.83

25295       Release wrist/forearm tendon                   22.9744             1582.38

25300       Fusion of tendons at wrist                     32.2439             2220.83

25301       Fusion of tendons at wrist                     32.2439             2220.83

25310       Transplant forearm tendon                      47.3213             3259.30

25312       Transplant forearm tendon                      47.3213             3259.30
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                           Description           January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                             (short)




25280       Revise wrist/forearm tendon                    1,568.67           3,405.60            4,166.56                                    X

25290       Incise wrist/forearm tendon                    1,568.67           3,405.60            4,166.56                                    X

25295       Release wrist/forearm tendon                   1,117.70           2,426.56            2,968.75                                    X

25300       Fusion of tendons at wrist                     1,568.67           3,405.60            4,166.56                                    X

25301       Fusion of tendons at wrist                     1,568.67           3,405.60            4,166.56                                    X

25310       Transplant forearm tendon                      2,302.18           4,998.08            6,114.86                                    X

25312       Transplant forearm tendon                      2,302.18           4,998.08            6,114.86                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                             Description        January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                               (short)




25315       Revise palsy hand tendon(s)                     T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot

25316       Revise palsy hand tendon(s)                     T              T            0052        Level IV Musculoskeletal Procedures Except Hand and Foot

25320       Repair/revise wrist joint                       T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot
25332       Revise wrist joint                              T              T            0047                      Arthroplasty without Prosthesis

25335       Realignment of hand                             T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot

25337       Reconstruct ulna/radioulnar                     T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot

25350       Revision of radius                              T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                             Description         January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                               (short)          Relative Weights




25315       Revise palsy hand tendon(s)                    47.3213             3259.30

25316       Revise palsy hand tendon(s)                    88.9869             6129.06

25320       Repair/revise wrist joint                      47.3213             3259.30
25332       Revise wrist joint                             39.2855             2705.83

25335       Realignment of hand                            47.3213             3259.30

25337       Reconstruct ulna/radioulnar                    47.3213             3259.30

25350       Revision of radius                             47.3213             3259.30
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                             Description         January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                               (short)




25315       Revise palsy hand tendon(s)                    2,302.18           4,998.08            6,114.86                                    X

25316       Revise palsy hand tendon(s)                    4,329.21           9,398.80           11,498.89                                    X

25320       Repair/revise wrist joint                      2,302.18           4,998.08            6,114.86                                    X
25332       Revise wrist joint                             1,911.24           4,149.33            5,076.47                                    X

25335       Realignment of hand                            2,302.18           4,998.08            6,114.86                                    X

25337       Reconstruct ulna/radioulnar                    2,302.18           4,998.08            6,114.86                                    X

25350       Revision of radius                             2,302.18           4,998.08            6,114.86                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                              Description       January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                                (short)




25355       Revision of radius                              T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot

25360       Revision of ulna                                T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot

25365       Revise radius & ulna                            T              T            0052        Level IV Musculoskeletal Procedures Except Hand and Foot

25370       Revise radius or ulna                           T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot

25375       Revise radius & ulna                            T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot

25390       Shorten radius or ulna                          T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot

25391       Lengthen radius or ulna                         T              T            0052        Level IV Musculoskeletal Procedures Except Hand and Foot
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                              Description        January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                                (short)         Relative Weights




25355       Revision of radius                             47.3213             3259.30

25360       Revision of ulna                               47.3213             3259.30

25365       Revise radius & ulna                           88.9869             6129.06

25370       Revise radius or ulna                          47.3213             3259.30

25375       Revise radius & ulna                           47.3213             3259.30

25390       Shorten radius or ulna                         47.3213             3259.30

25391       Lengthen radius or ulna                        88.9869             6129.06
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                              Description        January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                                (short)




25355       Revision of radius                             2,302.18           4,998.08            6,114.86                                    X

25360       Revision of ulna                               2,302.18           4,998.08            6,114.86                                    X

25365       Revise radius & ulna                           4,329.21           9,398.80           11,498.89                                    X

25370       Revise radius or ulna                          2,302.18           4,998.08            6,114.86                                    X

25375       Revise radius & ulna                           2,302.18           4,998.08            6,114.86                                    X

25390       Shorten radius or ulna                         2,302.18           4,998.08            6,114.86                                    X

25391       Lengthen radius or ulna                        4,329.21           9,398.80           11,498.89                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                             Description        January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                               (short)




25392       Shorten radius & ulna                           T              T            0050        Level II Musculoskeletal Procedures Except Hand and Foot

25393       Lengthen radius & ulna                          T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot

25394       Repair carpal bone, shorten                     T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot

25400       Repair radius or ulna                           T              T            0052        Level IV Musculoskeletal Procedures Except Hand and Foot

25405       Repair/graft radius or ulna                     T              T            0052        Level IV Musculoskeletal Procedures Except Hand and Foot

25415       Repair radius & ulna                            T              T            0052        Level IV Musculoskeletal Procedures Except Hand and Foot

25420       Repair/graft radius & ulna                      T              T            0052        Level IV Musculoskeletal Procedures Except Hand and Foot
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                             Description         January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                               (short)          Relative Weights




25392       Shorten radius & ulna                          32.2439             2220.83

25393       Lengthen radius & ulna                         47.3213             3259.30

25394       Repair carpal bone, shorten                    47.3213             3259.30

25400       Repair radius or ulna                          88.9869             6129.06

25405       Repair/graft radius or ulna                    88.9869             6129.06

25415       Repair radius & ulna                           88.9869             6129.06

25420       Repair/graft radius & ulna                     88.9869             6129.06
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                             Description         January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                               (short)




25392       Shorten radius & ulna                          1,568.67           3,405.60            4,166.56                                    X

25393       Lengthen radius & ulna                         2,302.18           4,998.08            6,114.86                                    X

25394       Repair carpal bone, shorten                    2,302.18           4,998.08            6,114.86                                    X

25400       Repair radius or ulna                          4,329.21           9,398.80           11,498.89                                    X

25405       Repair/graft radius or ulna                    4,329.21           9,398.80           11,498.89                                    X

25415       Repair radius & ulna                           4,329.21           9,398.80           11,498.89                                    X

25420       Repair/graft radius & ulna                     4,329.21           9,398.80           11,498.89                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                            Description         January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                              (short)




25425       Repair/graft radius or ulna                     T              T            0052        Level IV Musculoskeletal Procedures Except Hand and Foot

25426       Repair/graft radius & ulna                      T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot

25430       Vasc graft into carpal bone                     T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot

25431       Repair nonunion carpal bone                     T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot

25440       Repair/graft wrist bone                         T              T            0052        Level IV Musculoskeletal Procedures Except Hand and Foot
25441       Reconstruct wrist joint                         T              T            0425            Level II Arthroplasty or Implantation with Prosthesis
25442       Reconstruct wrist joint                         T              T            0425            Level II Arthroplasty or Implantation with Prosthesis
25443       Reconstruct wrist joint                         T              T            0048            Level I Arthroplasty or Implantation with Prosthesis
25444       Reconstruct wrist joint                         T              T            0048            Level I Arthroplasty or Implantation with Prosthesis
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                            Description          January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                              (short)           Relative Weights




25425       Repair/graft radius or ulna                    88.9869             6129.06

25426       Repair/graft radius & ulna                     47.3213             3259.30

25430       Vasc graft into carpal bone                    47.3213             3259.30

25431       Repair nonunion carpal bone                    47.3213             3259.30

25440       Repair/graft wrist bone                         88.9869            6129.06
25441       Reconstruct wrist joint                        124.8075            8596.24                                59                  30
25442       Reconstruct wrist joint                        124.8075            8596.24                                59                  30
25443       Reconstruct wrist joint                         59.9568            4129.58
25444       Reconstruct wrist joint                         59.9568            4129.58
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                            Description          January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                              (short)




25425       Repair/graft radius or ulna                    4,329.21           9,398.80           11,498.89                                    X

25426       Repair/graft radius & ulna                     2,302.18           4,998.08            6,114.86                                    X

25430       Vasc graft into carpal bone                    2,302.18           4,998.08            6,114.86                                    X

25431       Repair nonunion carpal bone                    2,302.18           4,998.08            6,114.86                                    X

25440       Repair/graft wrist bone                        4,329.21           9,398.80           11,498.89                                    X
25441       Reconstruct wrist joint                        6,071.88          13,182.17           16,127.63                                    X
25442       Reconstruct wrist joint                        6,071.88          13,182.17           16,127.63                                    X
25443       Reconstruct wrist joint                        2,916.90           6,332.64            7,747.62                                    X
25444       Reconstruct wrist joint                        2,916.90           6,332.64            7,747.62                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                                Medicare APC




   CPT/                               Description      January 2011   January 2011   January 2011                   January 2011 Description
  HCPCS                                 (short)



25445       Reconstruct wrist joint                         T              T            0048            Level I Arthroplasty or Implantation with Prosthesis
25446       Wrist replacement                               T              T            0425            Level II Arthroplasty or Implantation with Prosthesis
25447       Repair wrist joint(s)                           T              T            0047                       Arthroplasty without Prosthesis
25449       Remove wrist joint implant                      T              T            0047                       Arthroplasty without Prosthesis

25450       Revision of wrist joint                         T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot

25455       Revision of wrist joint                         T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot

25490       Reinforce radius                                T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot

25491       Reinforce ulna                                  T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot

25492       Reinforce radius and ulna                       T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                               Description       January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                                 (short)        Relative Weights



25445       Reconstruct wrist joint                         59.9568            4129.58
25446       Wrist replacement                              124.8075            8596.24                                59                  30
25447       Repair wrist joint(s)                           39.2855            2705.83
25449       Remove wrist joint implant                      39.2855            2705.83

25450       Revision of wrist joint                        47.3213             3259.30

25455       Revision of wrist joint                        47.3213             3259.30

25490       Reinforce radius                               47.3213             3259.30

25491       Reinforce ulna                                 47.3213             3259.30

25492       Reinforce radius and ulna                      47.3213             3259.30
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                               Description       January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                                 (short)



25445       Reconstruct wrist joint                        2,916.90           6,332.64            7,747.62                                    X
25446       Wrist replacement                              6,071.88          13,182.17           16,127.63                                    X
25447       Repair wrist joint(s)                          1,911.24           4,149.33            5,076.47                                    X
25449       Remove wrist joint implant                     1,911.24           4,149.33            5,076.47                                    X

25450       Revision of wrist joint                        2,302.18           4,998.08            6,114.86                                    X

25455       Revision of wrist joint                        2,302.18           4,998.08            6,114.86                                    X

25490       Reinforce radius                               2,302.18           4,998.08            6,114.86                                    X

25491       Reinforce ulna                                 2,302.18           4,998.08            6,114.86                                    X

25492       Reinforce radius and ulna                      2,302.18           4,998.08            6,114.86                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                            Medicare APC




   CPT/                            Description         January 2011   January 2011   January 2011               January 2011 Description
  HCPCS                              (short)



25500       Treat fracture of radius                        T              T            0129        Level I Closed Treatment Fracture Finger/Toe/Trunk
25505       Treat fracture of radius                        T              T            0138        Level II Closed Treatment Fracture Finger/Toe/Trunk
25515       Treat fracture of radius                        T              T            0063                Level II Treatment Fracture/Dislocation
25520       Treat fracture of radius                        T              T            0138        Level II Closed Treatment Fracture Finger/Toe/Trunk
25525       Treat fracture of radius                        T              T            0063                Level II Treatment Fracture/Dislocation
25526       Treat fracture of radius                        T              T            0063                Level II Treatment Fracture/Dislocation
25530       Treat fracture of ulna                          T              T            0129        Level I Closed Treatment Fracture Finger/Toe/Trunk
25535       Treat fracture of ulna                          T              T            0129        Level I Closed Treatment Fracture Finger/Toe/Trunk
25545       Treat fracture of ulna                          T              T            0063                Level II Treatment Fracture/Dislocation
25560       Treat fracture radius & ulna                    T              T            0129        Level I Closed Treatment Fracture Finger/Toe/Trunk
25565       Treat fracture radius & ulna                    T              T            0138        Level II Closed Treatment Fracture Finger/Toe/Trunk
25574       Treat fracture radius & ulna                    T              T            0064               Level III Treatment Fracture/Dislocation
25575       Treat fracture radius/ulna                      T              T            0064               Level III Treatment Fracture/Dislocation
25600       Treat fracture radius/ulna                      T              T            0129        Level I Closed Treatment Fracture Finger/Toe/Trunk
25605       Treat fracture radius/ulna                      T              T            0138        Level II Closed Treatment Fracture Finger/Toe/Trunk
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                            Description          January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                              (short)           Relative Weights



25500       Treat fracture of radius                        1.5787              108.73
25505       Treat fracture of radius                        5.5050              379.16
25515       Treat fracture of radius                       48.1318             3315.13
25520       Treat fracture of radius                        5.5050              379.16
25525       Treat fracture of radius                       48.1318             3315.13
25526       Treat fracture of radius                       48.1318             3315.13
25530       Treat fracture of ulna                          1.5787              108.73
25535       Treat fracture of ulna                          1.5787              108.73
25545       Treat fracture of ulna                         48.1318             3315.13
25560       Treat fracture radius & ulna                    1.5787              108.73
25565       Treat fracture radius & ulna                    5.5050              379.16
25574       Treat fracture radius & ulna                   66.9057             4608.20
25575       Treat fracture radius/ulna                     66.9057             4608.20
25600       Treat fracture radius/ulna                      1.5787              108.73
25605       Treat fracture radius/ulna                      5.5050              379.16
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                            Description          January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                              (short)



25500       Treat fracture of radius                         76.80             166.74              204.00                                     X
25505       Treat fracture of radius                        267.82             581.44              711.36                                     X
25515       Treat fracture of radius                       2,341.61           5,083.68            6,219.59                                    X
25520       Treat fracture of radius                        267.82             581.44              711.36                                     X
25525       Treat fracture of radius                       2,341.61           5,083.68            6,219.59                                    X
25526       Treat fracture of radius                       2,341.61           5,083.68            6,219.59                                    X
25530       Treat fracture of ulna                           76.80             166.74              204.00                                     X
25535       Treat fracture of ulna                           76.80             166.74              204.00                                     X
25545       Treat fracture of ulna                         2,341.61           5,083.68            6,219.59                                    X
25560       Treat fracture radius & ulna                     76.80             166.74              204.00                                     X
25565       Treat fracture radius & ulna                    267.82             581.44              711.36                                     X
25574       Treat fracture radius & ulna                   3,254.96           7,066.58            8,645.55                                    X
25575       Treat fracture radius/ulna                     3,254.96           7,066.58            8,645.55                                    X
25600       Treat fracture radius/ulna                       76.80             166.74              204.00                                     X
25605       Treat fracture radius/ulna                      267.82             581.44              711.36                                     X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                            Medicare APC




   CPT/                             Description        January 2011   January 2011   January 2011               January 2011 Description
  HCPCS                               (short)



25606       Treat fx distal radial                          T              T            0062                Level I Treatment Fracture/Dislocation
25607       Treat fx rad extra-articul                      T              T            0064               Level III Treatment Fracture/Dislocation
25608       Treat fx rad intra-articul                      T              T            0064               Level III Treatment Fracture/Dislocation
25609       Treat fx radial 3+ frag                         T              T            0064               Level III Treatment Fracture/Dislocation
25622       Treat wrist bone fracture                       T              T            0129        Level I Closed Treatment Fracture Finger/Toe/Trunk
25624       Treat wrist bone fracture                       T              T            0138        Level II Closed Treatment Fracture Finger/Toe/Trunk
25628       Treat wrist bone fracture                       T              T            0063                Level II Treatment Fracture/Dislocation
25630       Treat wrist bone fracture                       T              T            0129        Level I Closed Treatment Fracture Finger/Toe/Trunk
25635       Treat wrist bone fracture                       T              T            0129        Level I Closed Treatment Fracture Finger/Toe/Trunk
25645       Treat wrist bone fracture                       T              T            0063                Level II Treatment Fracture/Dislocation
25650       Treat wrist bone fracture                       T              T            0129        Level I Closed Treatment Fracture Finger/Toe/Trunk
25651       Pin ulnar styloid fracture                      T              T            0062                Level I Treatment Fracture/Dislocation
25652       Treat fracture ulnar styloid                    T              T            0063                Level II Treatment Fracture/Dislocation
25660       Treat wrist dislocation                         T              T            0129        Level I Closed Treatment Fracture Finger/Toe/Trunk
25670       Treat wrist dislocation                         T              T            0062                Level I Treatment Fracture/Dislocation
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                             Description         January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                               (short)          Relative Weights



25606       Treat fx distal radial                         26.5543             1828.95
25607       Treat fx rad extra-articul                     66.9057             4608.20
25608       Treat fx rad intra-articul                     66.9057             4608.20
25609       Treat fx radial 3+ frag                        66.9057             4608.20
25622       Treat wrist bone fracture                       1.5787              108.73
25624       Treat wrist bone fracture                       5.5050              379.16
25628       Treat wrist bone fracture                      48.1318             3315.13
25630       Treat wrist bone fracture                       1.5787              108.73
25635       Treat wrist bone fracture                       1.5787              108.73
25645       Treat wrist bone fracture                      48.1318             3315.13
25650       Treat wrist bone fracture                       1.5787              108.73
25651       Pin ulnar styloid fracture                     26.5543             1828.95
25652       Treat fracture ulnar styloid                   48.1318             3315.13
25660       Treat wrist dislocation                         1.5787              108.73
25670       Treat wrist dislocation                        26.5543             1828.95
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                             Description         January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                               (short)



25606       Treat fx distal radial                         1,291.87           2,804.67            3,431.35                                    X
25607       Treat fx rad extra-articul                     3,254.96           7,066.58            8,645.55                                    X
25608       Treat fx rad intra-articul                     3,254.96           7,066.58            8,645.55                                    X
25609       Treat fx radial 3+ frag                        3,254.96           7,066.58            8,645.55                                    X
25622       Treat wrist bone fracture                        76.80             166.74              204.00                                     X
25624       Treat wrist bone fracture                       267.82             581.44              711.36                                     X
25628       Treat wrist bone fracture                      2,341.61           5,083.68            6,219.59                                    X
25630       Treat wrist bone fracture                        76.80             166.74              204.00                                     X
25635       Treat wrist bone fracture                        76.80             166.74              204.00                                     X
25645       Treat wrist bone fracture                      2,341.61           5,083.68            6,219.59                                    X
25650       Treat wrist bone fracture                        76.80             166.74              204.00                                     X
25651       Pin ulnar styloid fracture                     1,291.87           2,804.67            3,431.35                                    X
25652       Treat fracture ulnar styloid                   2,341.61           5,083.68            6,219.59                                    X
25660       Treat wrist dislocation                          76.80             166.74              204.00                                     X
25670       Treat wrist dislocation                        1,291.87           2,804.67            3,431.35                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                             Description        January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                               (short)



25671       Pin radioulnar dislocation                      T              T            0062                    Level I Treatment Fracture/Dislocation
25675       Treat wrist dislocation                         T              T            0129           Level I Closed Treatment Fracture Finger/Toe/Trunk
25676       Treat wrist dislocation                         T              T            0062                    Level I Treatment Fracture/Dislocation
25680       Treat wrist fracture                            T              T            0129           Level I Closed Treatment Fracture Finger/Toe/Trunk
25685       Treat wrist fracture                            T              T            0062                    Level I Treatment Fracture/Dislocation
25690       Treat wrist dislocation                         T              T            0139           Level III Closed Treatment Fracture Finger/Toe/Trunk
25695       Treat wrist dislocation                         T              T            0062                    Level I Treatment Fracture/Dislocation

25800       Fusion of wrist joint                           T              T            0052        Level IV Musculoskeletal Procedures Except Hand and Foot

25805       Fusion/graft of wrist joint                     T              T            0052        Level IV Musculoskeletal Procedures Except Hand and Foot

25810       Fusion/graft of wrist joint                     T              T            0052        Level IV Musculoskeletal Procedures Except Hand and Foot
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                             Description         January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                               (short)          Relative Weights



25671       Pin radioulnar dislocation                     26.5543             1828.95
25675       Treat wrist dislocation                         1.5787              108.73
25676       Treat wrist dislocation                        26.5543             1828.95
25680       Treat wrist fracture                            1.5787              108.73
25685       Treat wrist fracture                           26.5543             1828.95
25690       Treat wrist dislocation                        20.8356             1435.07
25695       Treat wrist dislocation                        26.5543             1828.95

25800       Fusion of wrist joint                          88.9869             6129.06

25805       Fusion/graft of wrist joint                    88.9869             6129.06

25810       Fusion/graft of wrist joint                    88.9869             6129.06
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                             Description         January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                               (short)



25671       Pin radioulnar dislocation                     1,291.87           2,804.67            3,431.35                                    X
25675       Treat wrist dislocation                          76.80             166.74              204.00                                     X
25676       Treat wrist dislocation                        1,291.87           2,804.67            3,431.35                                    X
25680       Treat wrist fracture                             76.80             166.74              204.00                                     X
25685       Treat wrist fracture                           1,291.87           2,804.67            3,431.35                                    X
25690       Treat wrist dislocation                        1,013.65           2,200.66            2,692.38                                    X
25695       Treat wrist dislocation                        1,291.87           2,804.67            3,431.35                                    X

25800       Fusion of wrist joint                          4,329.21           9,398.80           11,498.89                                    X

25805       Fusion/graft of wrist joint                    4,329.21           9,398.80           11,498.89                                    X

25810       Fusion/graft of wrist joint                    4,329.21           9,398.80           11,498.89                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                               Medicare APC




   CPT/                            Description         January 2011   January 2011   January 2011                  January 2011 Description
  HCPCS                              (short)




25820       Fusion of hand bones                            T              T            0051        Level III Musculoskeletal Procedures Except Hand and Foot

25825       Fuse hand bones with graft                      T              T            0052        Level IV Musculoskeletal Procedures Except Hand and Foot

25830       Fusion, radioulnar jnt/ulna                     T              T            0052        Level IV Musculoskeletal Procedures Except Hand and Foot
25900       Amputation of forearm                           C              C
25905       Amputation of forearm                           C              C

25907       Amputation follow-up surgery                    T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot

25909       Amputation follow-up surgery                    T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot
25915       Amputation of forearm                           C              C
25920       Amputate hand at wrist                          C              C
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                            Description          January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                              (short)           Relative Weights




25820       Fusion of hand bones                           47.3213             3259.30

25825       Fuse hand bones with graft                     88.9869             6129.06

25830       Fusion, radioulnar jnt/ulna                    88.9869             6129.06
25900       Amputation of forearm                           0.0000               0.00
25905       Amputation of forearm                           0.0000               0.00

25907       Amputation follow-up surgery                   22.9744             1582.38

25909       Amputation follow-up surgery                   22.9744             1582.38
25915       Amputation of forearm                           0.0000               0.00
25920       Amputate hand at wrist                          0.0000               0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                            Description          January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                              (short)




25820       Fusion of hand bones                           2,302.18           4,998.08            6,114.86                                    X

25825       Fuse hand bones with graft                     4,329.21           9,398.80           11,498.89                                    X

25830       Fusion, radioulnar jnt/ulna                    4,329.21           9,398.80           11,498.89                                    X
25900       Amputation of forearm                            0.00               0.00                0.00
25905       Amputation of forearm                            0.00               0.00                0.00

25907       Amputation follow-up surgery                   1,117.70           2,426.56            2,968.75                                    X

25909       Amputation follow-up surgery                   1,117.70           2,426.56            2,968.75              X                     X
25915       Amputation of forearm                            0.00               0.00                0.00
25920       Amputate hand at wrist                           0.00               0.00                0.00
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                              Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011                 January 2011 Description
  HCPCS                            (short)




25922       Amputate hand at wrist                          T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot
25924       Amputation follow-up surgery                    C              C
25927       Amputation of hand                              C              C
25929       Amputation follow-up surgery                    T              T            0136                         Level IV Skin Repair

25931       Amputation follow-up surgery                    T              T            0049        Level I Musculoskeletal Procedures Except Hand and Foot
25999       Forearm or wrist surgery                        T              T            0129           Level I Closed Treatment Fracture Finger/Toe/Trunk
26010       Drainage of finger abscess                      T              T            0006                         Level I Incision & Drainage
26011       Drainage of finger abscess                      T              T            0007                         Level II Incision & Drainage
26020       Drain hand tendon sheath                        T              T            0053                 Level I Hand Musculoskeletal Procedures
26025       Drainage of palm bursa                          T              T            0053                 Level I Hand Musculoskeletal Procedures
26030       Drainage of palm bursa(s)                       T              T            0053                 Level I Hand Musculoskeletal Procedures
26034       Treat hand bone lesion                          T              T            0053                 Level I Hand Musculoskeletal Procedures
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights




25922       Amputate hand at wrist                         22.9744             1582.38
25924       Amputation follow-up surgery                    0.0000               0.00
25927       Amputation of hand                              0.0000               0.00
25929       Amputation follow-up surgery                   17.2117             1185.47

25931       Amputation follow-up surgery                   22.9744             1582.38
25999       Forearm or wrist surgery                        1.5787              108.73
26010       Drainage of finger abscess                      1.4906              102.67
26011       Drainage of finger abscess                     13.0129              896.28
26020       Drain hand tendon sheath                       17.1642             1182.20
26025       Drainage of palm bursa                         17.1642             1182.20
26030       Drainage of palm bursa(s)                      17.1642             1182.20
26034       Treat hand bone lesion                         17.1642             1182.20
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)




25922       Amputate hand at wrist                         1,117.70           2,426.56            2,968.75                                    X
25924       Amputation follow-up surgery                     0.00               0.00                0.00
25927       Amputation of hand                               0.00               0.00                0.00
25929       Amputation follow-up surgery                    837.35            1,817.90            2,224.10                                    X

25931       Amputation follow-up surgery                   1,117.70           2,426.56            2,968.75                                    X
25999       Forearm or wrist surgery                         76.80             166.74              204.00                                     X
26010       Drainage of finger abscess                       72.52             157.44              192.62                                     X
26011       Drainage of finger abscess                      633.08            1,374.42            1,681.53                                    X
26020       Drain hand tendon sheath                        835.04            1,812.88            2,217.96                                    X
26025       Drainage of palm bursa                          835.04            1,812.88            2,217.96                                    X
26030       Drainage of palm bursa(s)                       835.04            1,812.88            2,217.96                                    X
26034       Treat hand bone lesion                          835.04            1,812.88            2,217.96                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                      Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011          January 2011 Description
  HCPCS                            (short)



26035       Decompress fingers/hand                         T              T            0053        Level I Hand Musculoskeletal Procedures
26037       Decompress fingers/hand                         T              T            0053        Level I Hand Musculoskeletal Procedures
26040       Release palm contracture                        T              T            0053        Level I Hand Musculoskeletal Procedures
26045       Release palm contracture                        T              T            0054        Level II Hand Musculoskeletal Procedures
26055       Incise finger tendon sheath                     T              T            0053        Level I Hand Musculoskeletal Procedures
26060       Incision of finger tendon                       T              T            0053        Level I Hand Musculoskeletal Procedures
26070       Explore/treat hand joint                        T              T            0053        Level I Hand Musculoskeletal Procedures
26075       Explore/treat finger joint                      T              T            0053        Level I Hand Musculoskeletal Procedures
26080       Explore/treat finger joint                      T              T            0053        Level I Hand Musculoskeletal Procedures
26100       Biopsy hand joint lining                        T              T            0053        Level I Hand Musculoskeletal Procedures
26105       Biopsy finger joint lining                      T              T            0053        Level I Hand Musculoskeletal Procedures
26110       Biopsy finger joint lining                      T              T            0053        Level I Hand Musculoskeletal Procedures
26111       Exc hand les sc > 1.5 cm                        T              T            0022                 Level IV Excision/ Biopsy
26113       Exc hand tum deep > 1.5 cm                      T              T            0022                 Level IV Excision/ Biopsy
26115       Exc hand les sc < 1.5 cm                        T              T            0021                 Level III Excision/ Biopsy
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



26035       Decompress fingers/hand                        17.1642             1182.20
26037       Decompress fingers/hand                        17.1642             1182.20
26040       Release palm contracture                       17.1642             1182.20
26045       Release palm contracture                       29.7686             2050.34
26055       Incise finger tendon sheath                    17.1642             1182.20
26060       Incision of finger tendon                      17.1642             1182.20
26070       Explore/treat hand joint                       17.1642             1182.20
26075       Explore/treat finger joint                     17.1642             1182.20
26080       Explore/treat finger joint                     17.1642             1182.20
26100       Biopsy hand joint lining                       17.1642             1182.20
26105       Biopsy finger joint lining                     17.1642             1182.20
26110       Biopsy finger joint lining                     17.1642             1182.20
26111       Exc hand les sc > 1.5 cm                       23.8986             1646.04
26113       Exc hand tum deep > 1.5 cm                     23.8986             1646.04
26115       Exc hand les sc < 1.5 cm                       18.0784             1245.17
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



26035       Decompress fingers/hand                         835.04            1,812.88            2,217.96                                    X
26037       Decompress fingers/hand                         835.04            1,812.88            2,217.96                                    X
26040       Release palm contracture                        835.04            1,812.88            2,217.96                                    X
26045       Release palm contracture                       1,448.24           3,144.16            3,846.70                                    X
26055       Incise finger tendon sheath                     835.04            1,812.88            2,217.96                                    X
26060       Incision of finger tendon                       835.04            1,812.88            2,217.96                                    X
26070       Explore/treat hand joint                        835.04            1,812.88            2,217.96                                    X
26075       Explore/treat finger joint                      835.04            1,812.88            2,217.96                                    X
26080       Explore/treat finger joint                      835.04            1,812.88            2,217.96                                    X
26100       Biopsy hand joint lining                        835.04            1,812.88            2,217.96                                    X
26105       Biopsy finger joint lining                      835.04            1,812.88            2,217.96                                    X
26110       Biopsy finger joint lining                      835.04            1,812.88            2,217.96                                    X
26111       Exc hand les sc > 1.5 cm                       1,162.67           2,524.17            3,088.18                                    X
26113       Exc hand tum deep > 1.5 cm                     1,162.67           2,524.17            3,088.18                                    X
26115       Exc hand les sc < 1.5 cm                        879.51            1,909.44            2,336.09                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                      Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011          January 2011 Description
  HCPCS                            (short)



26116       Exc hand tum deep < 1.5 cm                      T              T            0021                 Level III Excision/ Biopsy
26117       Exc hand tum ra < 3 cm                          T              T            0021                 Level III Excision/ Biopsy
26118       Exc hand tum ra > 3 cm                          T              T            0022                 Level IV Excision/ Biopsy
26121       Release palm contracture                        T              T            0054        Level II Hand Musculoskeletal Procedures
26123       Release palm contracture                        T              T            0054        Level II Hand Musculoskeletal Procedures
26125       Release palm contracture                        T              T            0053        Level I Hand Musculoskeletal Procedures
26130       Remove wrist joint lining                       T              T            0053        Level I Hand Musculoskeletal Procedures
26135       Revise finger joint, each                       T              T            0054        Level II Hand Musculoskeletal Procedures
26140       Revise finger joint, each                       T              T            0053        Level I Hand Musculoskeletal Procedures
26145       Tendon excision, palm/finger                    T              T            0053        Level I Hand Musculoskeletal Procedures
26160       Remove tendon sheath lesion                     T              T            0053        Level I Hand Musculoskeletal Procedures
26170       Removal of palm tendon, each                    T              T            0053        Level I Hand Musculoskeletal Procedures
26180       Removal of finger tendon                        T              T            0053        Level I Hand Musculoskeletal Procedures
26185       Remove finger bone                              T              T            0053        Level I Hand Musculoskeletal Procedures
26200       Remove hand bone lesion                         T              T            0053        Level I Hand Musculoskeletal Procedures
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



26116       Exc hand tum deep < 1.5 cm                     18.0784             1245.17
26117       Exc hand tum ra < 3 cm                         18.0784             1245.17
26118       Exc hand tum ra > 3 cm                         23.8986             1646.04
26121       Release palm contracture                       29.7686             2050.34
26123       Release palm contracture                       29.7686             2050.34
26125       Release palm contracture                       17.1642             1182.20
26130       Remove wrist joint lining                      17.1642             1182.20
26135       Revise finger joint, each                      29.7686             2050.34
26140       Revise finger joint, each                      17.1642             1182.20
26145       Tendon excision, palm/finger                   17.1642             1182.20
26160       Remove tendon sheath lesion                    17.1642             1182.20
26170       Removal of palm tendon, each                   17.1642             1182.20
26180       Removal of finger tendon                       17.1642             1182.20
26185       Remove finger bone                             17.1642             1182.20
26200       Remove hand bone lesion                        17.1642             1182.20
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



26116       Exc hand tum deep < 1.5 cm                      879.51            1,909.44            2,336.09                                    X
26117       Exc hand tum ra < 3 cm                          879.51            1,909.44            2,336.09                                    X
26118       Exc hand tum ra > 3 cm                         1,162.67           2,524.17            3,088.18                                    X
26121       Release palm contracture                       1,448.24           3,144.16            3,846.70                                    X
26123       Release palm contracture                       1,448.24           3,144.16            3,846.70                                    X
26125       Release palm contracture                        835.04            1,812.88            2,217.96                                    X
26130       Remove wrist joint lining                       835.04            1,812.88            2,217.96                                    X
26135       Revise finger joint, each                      1,448.24           3,144.16            3,846.70                                    X
26140       Revise finger joint, each                       835.04            1,812.88            2,217.96                                    X
26145       Tendon excision, palm/finger                    835.04            1,812.88            2,217.96                                    X
26160       Remove tendon sheath lesion                     835.04            1,812.88            2,217.96                                    X
26170       Removal of palm tendon, each                    835.04            1,812.88            2,217.96                                    X
26180       Removal of finger tendon                        835.04            1,812.88            2,217.96                                    X
26185       Remove finger bone                              835.04            1,812.88            2,217.96                                    X
26200       Remove hand bone lesion                         835.04            1,812.88            2,217.96                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                            Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011               January 2011 Description
  HCPCS                            (short)



26205       Remove/graft bone lesion                        T              T            0054             Level II Hand Musculoskeletal Procedures
26210       Removal of finger lesion                        T              T            0053              Level I Hand Musculoskeletal Procedures
26215       Remove/graft finger lesion                      T              T            0053              Level I Hand Musculoskeletal Procedures
26230       Partial removal of hand bone                    T              T            0053              Level I Hand Musculoskeletal Procedures
26235       Partial removal, finger bone                    T              T            0053              Level I Hand Musculoskeletal Procedures
26236       Partial removal, finger bone                    T              T            0053              Level I Hand Musculoskeletal Procedures
26250       Extensive hand surgery                          T              T            0053              Level I Hand Musculoskeletal Procedures
26260       Resect prox finger tumor                        T              T            0053              Level I Hand Musculoskeletal Procedures
26262       Resect distal finger tumor                      T              T            0053              Level I Hand Musculoskeletal Procedures
26320       Removal of implant from hand                    T              T            0021                       Level III Excision/ Biopsy
26340       Manipulate finger w/anesth                      T              T            0138        Level II Closed Treatment Fracture Finger/Toe/Trunk
26350       Repair finger/hand tendon                       T              T            0054             Level II Hand Musculoskeletal Procedures
26352       Repair/graft hand tendon                        T              T            0054             Level II Hand Musculoskeletal Procedures
26356       Repair finger/hand tendon                       T              T            0054             Level II Hand Musculoskeletal Procedures
26357       Repair finger/hand tendon                       T              T            0054             Level II Hand Musculoskeletal Procedures
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



26205       Remove/graft bone lesion                       29.7686             2050.34
26210       Removal of finger lesion                       17.1642             1182.20
26215       Remove/graft finger lesion                     17.1642             1182.20
26230       Partial removal of hand bone                   17.1642             1182.20
26235       Partial removal, finger bone                   17.1642             1182.20
26236       Partial removal, finger bone                   17.1642             1182.20
26250       Extensive hand surgery                         17.1642             1182.20
26260       Resect prox finger tumor                       17.1642             1182.20
26262       Resect distal finger tumor                     17.1642             1182.20
26320       Removal of implant from hand                   18.0784             1245.17
26340       Manipulate finger w/anesth                      5.5050              379.16
26350       Repair finger/hand tendon                      29.7686             2050.34
26352       Repair/graft hand tendon                       29.7686             2050.34
26356       Repair finger/hand tendon                      29.7686             2050.34
26357       Repair finger/hand tendon                      29.7686             2050.34
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



26205       Remove/graft bone lesion                       1,448.24           3,144.16            3,846.70                                    X
26210       Removal of finger lesion                        835.04            1,812.88            2,217.96                                    X
26215       Remove/graft finger lesion                      835.04            1,812.88            2,217.96                                    X
26230       Partial removal of hand bone                    835.04            1,812.88            2,217.96                                    X
26235       Partial removal, finger bone                    835.04            1,812.88            2,217.96                                    X
26236       Partial removal, finger bone                    835.04            1,812.88            2,217.96                                    X
26250       Extensive hand surgery                          835.04            1,812.88            2,217.96                                    X
26260       Resect prox finger tumor                        835.04            1,812.88            2,217.96                                    X
26262       Resect distal finger tumor                      835.04            1,812.88            2,217.96                                    X
26320       Removal of implant from hand                    879.51            1,909.44            2,336.09                                    X
26340       Manipulate finger w/anesth                      267.82             581.44              711.36                                     X
26350       Repair finger/hand tendon                      1,448.24           3,144.16            3,846.70                                    X
26352       Repair/graft hand tendon                       1,448.24           3,144.16            3,846.70                                    X
26356       Repair finger/hand tendon                      1,448.24           3,144.16            3,846.70                                    X
26357       Repair finger/hand tendon                      1,448.24           3,144.16            3,846.70                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                      Medicare APC




   CPT/                           Description          January 2011   January 2011   January 2011          January 2011 Description
  HCPCS                             (short)



26358       Repair/graft hand tendon                        T              T            0054        Level II Hand Musculoskeletal Procedures
26370       Repair finger/hand tendon                       T              T            0054        Level II Hand Musculoskeletal Procedures
26372       Repair/graft hand tendon                        T              T            0054        Level II Hand Musculoskeletal Procedures
26373       Repair finger/hand tendon                       T              T            0054        Level II Hand Musculoskeletal Procedures
26390       Revise hand/finger tendon                       T              T            0054        Level II Hand Musculoskeletal Procedures
26392       Repair/graft hand tendon                        T              T            0054        Level II Hand Musculoskeletal Procedures
26410       Repair hand tendon                              T              T            0053        Level I Hand Musculoskeletal Procedures
26412       Repair/graft hand tendon                        T              T            0054        Level II Hand Musculoskeletal Procedures
26415       Excision, hand/finger tendon                    T              T            0054        Level II Hand Musculoskeletal Procedures
26416       Graft hand or finger tendon                     T              T            0054        Level II Hand Musculoskeletal Procedures
26418       Repair finger tendon                            T              T            0053        Level I Hand Musculoskeletal Procedures
26420       Repair/graft finger tendon                      T              T            0054        Level II Hand Musculoskeletal Procedures
26426       Repair finger/hand tendon                       T              T            0054        Level II Hand Musculoskeletal Procedures
26428       Repair/graft finger tendon                      T              T            0054        Level II Hand Musculoskeletal Procedures
26432       Repair finger tendon                            T              T            0053        Level I Hand Musculoskeletal Procedures
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                           Description           January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                             (short)            Relative Weights



26358       Repair/graft hand tendon                       29.7686             2050.34
26370       Repair finger/hand tendon                      29.7686             2050.34
26372       Repair/graft hand tendon                       29.7686             2050.34
26373       Repair finger/hand tendon                      29.7686             2050.34
26390       Revise hand/finger tendon                      29.7686             2050.34
26392       Repair/graft hand tendon                       29.7686             2050.34
26410       Repair hand tendon                             17.1642             1182.20
26412       Repair/graft hand tendon                       29.7686             2050.34
26415       Excision, hand/finger tendon                   29.7686             2050.34
26416       Graft hand or finger tendon                    29.7686             2050.34
26418       Repair finger tendon                           17.1642             1182.20
26420       Repair/graft finger tendon                     29.7686             2050.34
26426       Repair finger/hand tendon                      29.7686             2050.34
26428       Repair/graft finger tendon                     29.7686             2050.34
26432       Repair finger tendon                           17.1642             1182.20
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                           Description           January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                             (short)



26358       Repair/graft hand tendon                       1,448.24           3,144.16            3,846.70                                    X
26370       Repair finger/hand tendon                      1,448.24           3,144.16            3,846.70                                    X
26372       Repair/graft hand tendon                       1,448.24           3,144.16            3,846.70                                    X
26373       Repair finger/hand tendon                      1,448.24           3,144.16            3,846.70                                    X
26390       Revise hand/finger tendon                      1,448.24           3,144.16            3,846.70                                    X
26392       Repair/graft hand tendon                       1,448.24           3,144.16            3,846.70                                    X
26410       Repair hand tendon                              835.04            1,812.88            2,217.96                                    X
26412       Repair/graft hand tendon                       1,448.24           3,144.16            3,846.70                                    X
26415       Excision, hand/finger tendon                   1,448.24           3,144.16            3,846.70                                    X
26416       Graft hand or finger tendon                    1,448.24           3,144.16            3,846.70                                    X
26418       Repair finger tendon                            835.04            1,812.88            2,217.96                                    X
26420       Repair/graft finger tendon                     1,448.24           3,144.16            3,846.70                                    X
26426       Repair finger/hand tendon                      1,448.24           3,144.16            3,846.70                                    X
26428       Repair/graft finger tendon                     1,448.24           3,144.16            3,846.70                                    X
26432       Repair finger tendon                            835.04            1,812.88            2,217.96                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                      Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011          January 2011 Description
  HCPCS                            (short)



26433       Repair finger tendon                            T              T            0053        Level I Hand Musculoskeletal Procedures
26434       Repair/graft finger tendon                      T              T            0054        Level II Hand Musculoskeletal Procedures
26437       Realignment of tendons                          T              T            0053        Level I Hand Musculoskeletal Procedures
26440       Release palm/finger tendon                      T              T            0053        Level I Hand Musculoskeletal Procedures
26442       Release palm & finger tendon                    T              T            0054        Level II Hand Musculoskeletal Procedures
26445       Release hand/finger tendon                      T              T            0053        Level I Hand Musculoskeletal Procedures
26449       Release forearm/hand tendon                     T              T            0054        Level II Hand Musculoskeletal Procedures
26450       Incision of palm tendon                         T              T            0053        Level I Hand Musculoskeletal Procedures
26455       Incision of finger tendon                       T              T            0053        Level I Hand Musculoskeletal Procedures
26460       Incise hand/finger tendon                       T              T            0053        Level I Hand Musculoskeletal Procedures
26471       Fusion of finger tendons                        T              T            0053        Level I Hand Musculoskeletal Procedures
26474       Fusion of finger tendons                        T              T            0053        Level I Hand Musculoskeletal Procedures
26476       Tendon lengthening                              T              T            0053        Level I Hand Musculoskeletal Procedures
26477       Tendon shortening                               T              T            0053        Level I Hand Musculoskeletal Procedures
26478       Lengthening of hand tendon                      T              T            0053        Level I Hand Musculoskeletal Procedures
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



26433       Repair finger tendon                           17.1642             1182.20
26434       Repair/graft finger tendon                     29.7686             2050.34
26437       Realignment of tendons                         17.1642             1182.20
26440       Release palm/finger tendon                     17.1642             1182.20
26442       Release palm & finger tendon                   29.7686             2050.34
26445       Release hand/finger tendon                     17.1642             1182.20
26449       Release forearm/hand tendon                    29.7686             2050.34
26450       Incision of palm tendon                        17.1642             1182.20
26455       Incision of finger tendon                      17.1642             1182.20
26460       Incise hand/finger tendon                      17.1642             1182.20
26471       Fusion of finger tendons                       17.1642             1182.20
26474       Fusion of finger tendons                       17.1642             1182.20
26476       Tendon lengthening                             17.1642             1182.20
26477       Tendon shortening                              17.1642             1182.20
26478       Lengthening of hand tendon                     17.1642             1182.20
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



26433       Repair finger tendon                            835.04            1,812.88            2,217.96                                    X
26434       Repair/graft finger tendon                     1,448.24           3,144.16            3,846.70                                    X
26437       Realignment of tendons                          835.04            1,812.88            2,217.96                                    X
26440       Release palm/finger tendon                      835.04            1,812.88            2,217.96                                    X
26442       Release palm & finger tendon                   1,448.24           3,144.16            3,846.70                                    X
26445       Release hand/finger tendon                      835.04            1,812.88            2,217.96                                    X
26449       Release forearm/hand tendon                    1,448.24           3,144.16            3,846.70                                    X
26450       Incision of palm tendon                         835.04            1,812.88            2,217.96                                    X
26455       Incision of finger tendon                       835.04            1,812.88            2,217.96                                    X
26460       Incise hand/finger tendon                       835.04            1,812.88            2,217.96                                    X
26471       Fusion of finger tendons                        835.04            1,812.88            2,217.96                                    X
26474       Fusion of finger tendons                        835.04            1,812.88            2,217.96                                    X
26476       Tendon lengthening                              835.04            1,812.88            2,217.96                                    X
26477       Tendon shortening                               835.04            1,812.88            2,217.96                                    X
26478       Lengthening of hand tendon                      835.04            1,812.88            2,217.96                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                      Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011          January 2011 Description
  HCPCS                            (short)



26479       Shortening of hand tendon                       T              T            0053        Level I Hand Musculoskeletal Procedures
26480       Transplant hand tendon                          T              T            0054        Level II Hand Musculoskeletal Procedures
26483       Transplant/graft hand tendon                    T              T            0054        Level II Hand Musculoskeletal Procedures
26485       Transplant palm tendon                          T              T            0054        Level II Hand Musculoskeletal Procedures
26489       Transplant/graft palm tendon                    T              T            0054        Level II Hand Musculoskeletal Procedures
26490       Revise thumb tendon                             T              T            0054        Level II Hand Musculoskeletal Procedures
26492       Tendon transfer with graft                      T              T            0054        Level II Hand Musculoskeletal Procedures
26494       Hand tendon/muscle transfer                     T              T            0054        Level II Hand Musculoskeletal Procedures
26496       Revise thumb tendon                             T              T            0054        Level II Hand Musculoskeletal Procedures
26497       Finger tendon transfer                          T              T            0054        Level II Hand Musculoskeletal Procedures
26498       Finger tendon transfer                          T              T            0054        Level II Hand Musculoskeletal Procedures
26499       Revision of finger                              T              T            0054        Level II Hand Musculoskeletal Procedures
26500       Hand tendon reconstruction                      T              T            0053        Level I Hand Musculoskeletal Procedures
26502       Hand tendon reconstruction                      T              T            0054        Level II Hand Musculoskeletal Procedures
26508       Release thumb contracture                       T              T            0053        Level I Hand Musculoskeletal Procedures
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



26479       Shortening of hand tendon                      17.1642             1182.20
26480       Transplant hand tendon                         29.7686             2050.34
26483       Transplant/graft hand tendon                   29.7686             2050.34
26485       Transplant palm tendon                         29.7686             2050.34
26489       Transplant/graft palm tendon                   29.7686             2050.34
26490       Revise thumb tendon                            29.7686             2050.34
26492       Tendon transfer with graft                     29.7686             2050.34
26494       Hand tendon/muscle transfer                    29.7686             2050.34
26496       Revise thumb tendon                            29.7686             2050.34
26497       Finger tendon transfer                         29.7686             2050.34
26498       Finger tendon transfer                         29.7686             2050.34
26499       Revision of finger                             29.7686             2050.34
26500       Hand tendon reconstruction                     17.1642             1182.20
26502       Hand tendon reconstruction                     29.7686             2050.34
26508       Release thumb contracture                      17.1642             1182.20
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



26479       Shortening of hand tendon                       835.04            1,812.88            2,217.96                                    X
26480       Transplant hand tendon                         1,448.24           3,144.16            3,846.70                                    X
26483       Transplant/graft hand tendon                   1,448.24           3,144.16            3,846.70                                    X
26485       Transplant palm tendon                         1,448.24           3,144.16            3,846.70                                    X
26489       Transplant/graft palm tendon                   1,448.24           3,144.16            3,846.70                                    X
26490       Revise thumb tendon                            1,448.24           3,144.16            3,846.70                                    X
26492       Tendon transfer with graft                     1,448.24           3,144.16            3,846.70                                    X
26494       Hand tendon/muscle transfer                    1,448.24           3,144.16            3,846.70                                    X
26496       Revise thumb tendon                            1,448.24           3,144.16            3,846.70                                    X
26497       Finger tendon transfer                         1,448.24           3,144.16            3,846.70                                    X
26498       Finger tendon transfer                         1,448.24           3,144.16            3,846.70                                    X
26499       Revision of finger                             1,448.24           3,144.16            3,846.70                                    X
26500       Hand tendon reconstruction                      835.04            1,812.88            2,217.96                                    X
26502       Hand tendon reconstruction                     1,448.24           3,144.16            3,846.70                                    X
26508       Release thumb contracture                       835.04            1,812.88            2,217.96                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                           Medicare APC




   CPT/                           Description          January 2011   January 2011   January 2011              January 2011 Description
  HCPCS                             (short)



26510       Thumb tendon transfer                           T              T            0054           Level II Hand Musculoskeletal Procedures
26516       Fusion of knuckle joint                         T              T            0054           Level II Hand Musculoskeletal Procedures
26517       Fusion of knuckle joints                        T              T            0054           Level II Hand Musculoskeletal Procedures
26518       Fusion of knuckle joints                        T              T            0054           Level II Hand Musculoskeletal Procedures
26520       Release knuckle contracture                     T              T            0053            Level I Hand Musculoskeletal Procedures
26525       Release finger contracture                      T              T            0053            Level I Hand Musculoskeletal Procedures
26530       Revise knuckle joint                            T              T            0047                   Arthroplasty without Prosthesis
26531       Revise knuckle with implant                     T              T            0048        Level I Arthroplasty or Implantation with Prosthesis
26535       Revise finger joint                             T              T            0047                   Arthroplasty without Prosthesis
26536       Revise/implant finger joint                     T              T            0048        Level I Arthroplasty or Implantation with Prosthesis
26540       Repair hand joint                               T              T            0053            Level I Hand Musculoskeletal Procedures
26541       Repair hand joint with graft                    T              T            0054           Level II Hand Musculoskeletal Procedures
26542       Repair hand joint with graft                    T              T            0053            Level I Hand Musculoskeletal Procedures
26545       Reconstruct finger joint                        T              T            0054           Level II Hand Musculoskeletal Procedures
26546       Repair nonunion hand                            T              T            0054           Level II Hand Musculoskeletal Procedures
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                           Description           January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                             (short)            Relative Weights



26510       Thumb tendon transfer                          29.7686             2050.34
26516       Fusion of knuckle joint                        29.7686             2050.34
26517       Fusion of knuckle joints                       29.7686             2050.34
26518       Fusion of knuckle joints                       29.7686             2050.34
26520       Release knuckle contracture                    17.1642             1182.20
26525       Release finger contracture                     17.1642             1182.20
26530       Revise knuckle joint                           39.2855             2705.83
26531       Revise knuckle with implant                    59.9568             4129.58
26535       Revise finger joint                            39.2855             2705.83
26536       Revise/implant finger joint                    59.9568             4129.58
26540       Repair hand joint                              17.1642             1182.20
26541       Repair hand joint with graft                   29.7686             2050.34
26542       Repair hand joint with graft                   17.1642             1182.20
26545       Reconstruct finger joint                       29.7686             2050.34
26546       Repair nonunion hand                           29.7686             2050.34
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                           Description           January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                             (short)



26510       Thumb tendon transfer                          1,448.24           3,144.16            3,846.70                                    X
26516       Fusion of knuckle joint                        1,448.24           3,144.16            3,846.70                                    X
26517       Fusion of knuckle joints                       1,448.24           3,144.16            3,846.70                                    X
26518       Fusion of knuckle joints                       1,448.24           3,144.16            3,846.70                                    X
26520       Release knuckle contracture                     835.04            1,812.88            2,217.96                                    X
26525       Release finger contracture                      835.04            1,812.88            2,217.96                                    X
26530       Revise knuckle joint                           1,911.24           4,149.33            5,076.47                                    X
26531       Revise knuckle with implant                    2,916.90           6,332.64            7,747.62                                    X
26535       Revise finger joint                            1,911.24           4,149.33            5,076.47                                    X
26536       Revise/implant finger joint                    2,916.90           6,332.64            7,747.62                                    X
26540       Repair hand joint                               835.04            1,812.88            2,217.96                                    X
26541       Repair hand joint with graft                   1,448.24           3,144.16            3,846.70                                    X
26542       Repair hand joint with graft                    835.04            1,812.88            2,217.96                                    X
26545       Reconstruct finger joint                       1,448.24           3,144.16            3,846.70                                    X
26546       Repair nonunion hand                           1,448.24           3,144.16            3,846.70                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                      Medicare APC




   CPT/                          Description           January 2011   January 2011   January 2011          January 2011 Description
  HCPCS                            (short)



26548       Reconstruct finger joint                        T              T            0054        Level II Hand Musculoskeletal Procedures
26550       Construct thumb replacement                     T              T            0054        Level II Hand Musculoskeletal Procedures
26551       Great toe-hand transfer                         C              C
26553       Single transfer, toe-hand                       C              C
26554       Double transfer, toe-hand                       C              C
26555       Positional change of finger                     T              T            0054        Level II Hand Musculoskeletal Procedures
26556       Toe joint transfer                              C              C
26560       Repair of web finger                            T              T            0053        Level I Hand Musculoskeletal Procedures
26561       Repair of web finger                            T              T            0054        Level II Hand Musculoskeletal Procedures
26562       Repair of web finger                            T              T            0054        Level II Hand Musculoskeletal Procedures
26565       Correct metacarpal flaw                         T              T            0054        Level II Hand Musculoskeletal Procedures
26567       Correct finger deformity                        T              T            0054        Level II Hand Musculoskeletal Procedures
26568       Lengthen metacarpal/finger                      T              T            0054        Level II Hand Musculoskeletal Procedures
26580       Repair hand deformity                           T              T            0053        Level I Hand Musculoskeletal Procedures
26587       Reconstruct extra finger                        T              T            0053        Level I Hand Musculoskeletal Procedures
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                          Description            January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                            (short)             Relative Weights



26548       Reconstruct finger joint                       29.7686             2050.34
26550       Construct thumb replacement                    29.7686             2050.34
26551       Great toe-hand transfer                         0.0000               0.00
26553       Single transfer, toe-hand                       0.0000               0.00
26554       Double transfer, toe-hand                       0.0000               0.00
26555       Positional change of finger                    29.7686             2050.34
26556       Toe joint transfer                              0.0000               0.00
26560       Repair of web finger                           17.1642             1182.20
26561       Repair of web finger                           29.7686             2050.34
26562       Repair of web finger                           29.7686             2050.34
26565       Correct metacarpal flaw                        29.7686             2050.34
26567       Correct finger deformity                       29.7686             2050.34
26568       Lengthen metacarpal/finger                     29.7686             2050.34
26580       Repair hand deformity                          17.1642             1182.20
26587       Reconstruct extra finger                       17.1642             1182.20
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                          Description            January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                            (short)



26548       Reconstruct finger joint                       1,448.24           3,144.16            3,846.70                                    X
26550       Construct thumb replacement                    1,448.24           3,144.16            3,846.70                                    X
26551       Great toe-hand transfer                          0.00               0.00                0.00
26553       Single transfer, toe-hand                        0.00               0.00                0.00
26554       Double transfer, toe-hand                        0.00               0.00                0.00
26555       Positional change of finger                    1,448.24           3,144.16            3,846.70                                    X
26556       Toe joint transfer                               0.00               0.00                0.00
26560       Repair of web finger                            835.04            1,812.88            2,217.96                                    X
26561       Repair of web finger                           1,448.24           3,144.16            3,846.70                                    X
26562       Repair of web finger                           1,448.24           3,144.16            3,846.70                                    X
26565       Correct metacarpal flaw                        1,448.24           3,144.16            3,846.70                                    X
26567       Correct finger deformity                       1,448.24           3,144.16            3,846.70                                    X
26568       Lengthen metacarpal/finger                     1,448.24           3,144.16            3,846.70                                    X
26580       Repair hand deformity                           835.04            1,812.88            2,217.96                                    X
26587       Reconstruct extra finger                        835.04            1,812.88            2,217.96                                    X
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                         Medicare       Wyoming
                                                          Status         Status
                                                        Indicators     Indicators                            Medicare APC




   CPT/                            Description         January 2011   January 2011   January 2011               January 2011 Description
  HCPCS                              (short)



26590       Repair finger deformity                         T              T            0053              Level I Hand Musculoskeletal Procedures
26591       Repair muscles of hand                          T              T            0054              Level II Hand Musculoskeletal Procedures
26593       Release muscles of hand                         T              T            0053              Level I Hand Musculoskeletal Procedures
26596       Excision constricting tissue                    T              T            0053              Level I Hand Musculoskeletal Procedures
26600       Treat metacarpal fracture                       T              T            0129        Level I Closed Treatment Fracture Finger/Toe/Trunk
26605       Treat metacarpal fracture                       T              T            0129        Level I Closed Treatment Fracture Finger/Toe/Trunk
26607       Treat metacarpal fracture                       T              T            0139        Level III Closed Treatment Fracture Finger/Toe/Trunk
26608       Treat metacarpal fracture                       T              T            0062                 Level I Treatment Fracture/Dislocation
26615       Treat metacarpal fracture                       T              T            0063                Level II Treatment Fracture/Dislocation
26641       Treat thumb dislocation                         T              T            0129        Level I Closed Treatment Fracture Finger/Toe/Trunk
26645       Treat thumb fracture                            T              T            0138        Level II Closed Treatment Fracture Finger/Toe/Trunk
26650       Treat thumb fracture                            T              T            0062                 Level I Treatment Fracture/Dislocation
26665       Treat thumb fracture                            T              T            0063                Level II Treatment Fracture/Dislocation
26670       Treat hand dislocation                          T              T            0129        Level I Closed Treatment Fracture Finger/Toe/Trunk
26675       Treat hand dislocation                          T              T            0129        Level I Closed Treatment Fracture Finger/Toe/Trunk
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876


                                                       Medicare Relative
                                                           Weights
                                                                             January 2011    Procedure Codes Offset Percentage     Offset Percentage
                                                                           Medicare National with a "calculated" for Full Credit   for Partial Credit
                                                                            Payment Rates    January 2011 APC         Case                Case
   CPT/                            Description          January 2011
                                                                                              Relative Weight      Modifier FB        Modifier FC
  HCPCS                              (short)           Relative Weights



26590       Repair finger deformity                        17.1642             1182.20
26591       Repair muscles of hand                         29.7686             2050.34
26593       Release muscles of hand                        17.1642             1182.20
26596       Excision constricting tissue                   17.1642             1182.20
26600       Treat metacarpal fracture                       1.5787              108.73
26605       Treat metacarpal fracture                       1.5787              108.73
26607       Treat metacarpal fracture                      20.8356             1435.07
26608       Treat metacarpal fracture                      26.5543             1828.95
26615       Treat metacarpal fracture                      48.1318             3315.13
26641       Treat thumb dislocation                         1.5787              108.73
26645       Treat thumb fracture                            5.5050              379.16
26650       Treat thumb fracture                           26.5543             1828.95
26665       Treat thumb fracture                           48.1318             3315.13
26670       Treat hand dislocation                          1.5787              108.73
26675       Treat hand dislocation                          1.5787              108.73
Procedure Code List
Medicare Effective Date: January 1, 2011
Wyoming Medicaid Implementation Date: April 1, 2011
Effective Date January 1, 2011


2011 Wyoming Conversion Factors:
      48.65 General Acute Care Hospitals
     105.62 Children's Hospitals
     129.22 Critical Access Hospitals

Medicare's CY 2010 National Conversion Factor 67.406
Medicare's CY 2011 National Conversion Factor 68.876

                                                                                              Wyoming Critical
                                                       Wyoming General   Wyoming Children's   Access Hospital
                                                         Hospital Fee       Hospital Fee           Fee
                                                                                                                 Medicare Changes    Change in Medicare
                                                                                                                 from October 2010   Relative Weight from
                                                                                                                      Schedule           October 2010
   CPT/                            Description          January 2011        January 2011       January 2011
                                                                                                                    (New Column)        (New Column)
  HCPCS                              (short)



26590       Repair finger deformity                         835.04            1,812.88            2,217.96                                    X
26591       Repair muscles of hand                         1,448.24           3,144.16            3,846.70