Effective Date:
Title: Section 533.6 - Radiology.



533.6 Radiology. (a) Maximum payment for radiology services. The department will pay providers of radiology services according to the radiology fees listed in the Radiology Fee Schedule in subdivision (f) of this section. Unless otherwise indicated, these fees are full payment for the radiology service provided.

(b) Radiology fee components. The fees listed in the Radiology Fee Schedule include payment for the professional component and for the technical and administrative component of radiology services.

(1) Professional component. (i) The professional component of radiology services refers to the various professional services performed by physicians, including:

(a) determining the patient's problem, including interviewing the patient, obtaining the patient's medical history, and physically examining the patient to decide how to perform radiology procedures;

(b) studying the results of diagnostic or therapeutic procedures, interpreting X-rays or radioisotope data and estimating treatment results;

(c) dictating examination or treatment reports; and

(d) consulting with and furnishing written reports to referring physicians regarding the results of diagnostic or therapeutic procedures.

(ii) Physicians who render these services in hospitals are paid 40 percent of the appropriate fee listed in the Radiology Fee Schedule. The remaining 60 percent is applied to the technical and administrative component described in paragraph (2) of this subdivision.

(iii) Payments may be made only to physicians meeting the requirements of section 505.17 of this Title. Only physicians who are not paid by a hospital for patient care and who bill separately from a hospital may be paid under this section.

(2) Technical and administrative component of radiology services. (i) The technical and administrative component of radiology services refers to the various services provided to the physician by the hospital, including the following:

(a) use of hospital personnel, such as technologists and clerical staff;

(b) use of hospital supplies such as film, opaques, radioactive substances, chemicals and drugs; and

(c) purchase, rental or maintenance of space, equipment, telephones or other facilities or supplies.

(ii) Sixty percent of the fee listed in the Radiology Fee Schedule is applicable to these technical and administrative services provided by the hospital.

(3) Procedures not separable into professional and technical and administrative components. Injections of radiopaque media, fluoroscopy and consultations must be performed by the physician. Consequently, these procedures are not separated for billing into professional and technical and administrative components, and the total fee listed in the Radiology Fee Schedule for such services is paid to the physician.

(c) General rules. These rules apply to all procedure codes found in the Radiology Fee Schedule.

(1) What is included in radiology fees. Fees listed in the Radiology Fee Schedule include the following:

(i) the usual contrast media, equipment and materials. When the physician supplies special surgical trays or materials, an additional charge may be claimed from the department;

(ii) consultation with and written reports provided to the referring physician; and

(iii) payment for injection procedures, such as local anesthesia, needle or catheter placement or injection of contrast media as provided in the Radiology Fee Schedule, except for injection procedures which are identified by an asterisk before the MMIS code in the Radiology Fee Schedule.

(2) Payment for multiple or repeat radiology procedures. (i) When more than one radiology procedure is performed on different parts of the body during the same visit, the total payment is the sum of the fee for the more costly procedure plus 60 percent of the fee for the less costly procedure.

(ii) When a single radiology procedure is performed which shows more than one part of the body, payment will be made for only one procedure.

(iii) When repeat radiology procedures are performed on the same part of the body and for the same illness, payment for the repeat procedures will be made according to the fee listed in the Radiology Fee Schedule. However, no payment will be made for repeat procedures on the same part of the body and for the same illness when the reason for the repeat procedure is technical or professional error in the original procedure.

(d) Outpatient and clinic services. No additional payment will be made for outpatient emergency and clinic services if the cost of providing radiology or radiotherapy services is included in the maximum reimbursement rate promulgated for the hospital by the Director of the Budget pursuant to section 2807 of the Public Health Law. When physicians refer patients for outpatient radiology or radiotherapy services, payment will be made according to the Radiology Fee Schedule except when radiology or radiotherapy services are provided in a facility that includes the cost of these services in its clinic rate calculation. In these cases, the recipient shall be registered as a clinic patient and the clinic rate shall be billed.

(e) Medicaid management information system (MMIS) modifiers. Each radiology procedure listed in the Radiology Fee Schedule is preceded by a five-digit number identifying the specific procedure for which payment is claimed. Known as the MMIS procedure code, this number sometimes must be expanded by two additional digits, or modifiers, to describe more completely the particular procedure involved. The modifiers used in radiology are described below:

(1) '-60' Professional component. When physicians provide radiology services in hospitals but are not paid for these services by the hospitals, the physicians' services are identified for billing purposes by adding the modifier '-60' to the MMIS procedure code.

(2) '-61' Technical and administrative component. When physicians provide radiology services in hospitals but are not paid for these services by the hospitals, the services, facilities and supplies furnished to the physicians by the hospitals are identified for billing purposes by adding the modifier '-61' to the MMIS procedure code.

(3) '-62' Multiple radiology procedures. When more than one radiology procedure is performed on different parts of the body during the same visit, the more costly procedure is identified for billing purposes by its MMIS procedure code and the less costly procedure is identified by adding the modifier '-62' to its MMIS procedure code.

(4) '-65' Multiple vascular radiology procedures. Wnen more than one vascular radiology procedure is performed at the same time, the more costly procedure is identified for billing purposes by its MMIS procedure code and the less costly procedure is identified by adding the modifier '-65' to its MMIS procedure code.

(5) '-66' Repeal radiology procedures. When radiology procedures are repeated for reasons other than technical or professional error in the original procedure, the repeat procedure is identified for billing purposes by adding the modifier, '-66' to the MMIS procedure code.

(6) '-19' Multiple modifiers. More than one modifier often may be needed to identify radiology procedures for which payment is sought. Add the modifier '-19' to the MMIS procedure code and list the applicable modifiers in the procedure description.

(f) Radiology Fee Schedule. Listed below are the maximum medical assistance reimbursement fees for radiology procedures. A fee includes payment for injection procedures only if the MMIS code is not preceded by an asterisk. To be reimbursed for a procedure whose fee is to be determined "By Report" (BR), providers must submit information to MMIS on the nature and extent of the radiology procedure performed, the need for the procedure, and the time, skill and equipment necessary to perform the procedure. Reports, procedure descriptions or itemized invoices should accompany "BR" claims for reimbursement. Interim MMIS procedure codes are denoted by parentheses enclosing the fees. These
procedure codes may be used pending final approval and promulgation by the Director of the Budget.

(1) X-ray, diagnostic. MMIS Code Maximum

Fee 70001 Unlisted radiology procedure BR

HEAD AND NECK *70002 Pneumoencephalography or positive contrast

encephalography $ 75.00* 70003 including injection procedure 110.00 *70020 Ventriculography 50.00* 70030 Eye, for foreign body 20.00 70040 for localization of foreign body (70030 not included) 30.00 70050 Combined 70030 and 70040 40.00 70100 Mandible, partial, less than four views 15.00 70110 complete, minimum of four views 25.00 70120 Mastoids, less than three views per side 15.00 70130 complete study, minimum three views per side 25.00 70140 Facial bones, less than three views 15.00 70150 complete, minimum three views 25.00 70160 Nasal bones 15.00 *70172 Nasolacrimal duct (dacryocystography) 20.00* 70171 including injection procedure 30.00 70190 Optic foramina 15.00 70200 Orbits, complete, minimum four views 25.00 70210 Paranasal sinuses, less than three views 12.50 70231 complete study, minimum of three views 20.00 70240 Sella turcica 12.50 70250 Skull, less than four views with or without stereo 15.00 70260 complete study, minimum of four views, with or without

stereo 25.00 70300 Teeth, single view 5.00 70310 partial examination, less than full mouth 10.00 70320 complete examination, full mouth 15.00 70328 Temporomandibular joint, open and closed, unilateral 12.50 70330 bilateral 20.00 70350 Cephalogram (orthodontic) 7.50 70360 Neck for soft tissues 10.00 70370 Pharynx or larynx, including fluoroscopy 25.00 70380 Salivary gland for calculus 15.00 *70390 Sialography 20.00* 70391 including injection procedure 25.00 70374 Laryngogram 25.00 70134 Internal auditory meati (25.00)

CHEST 71000 Chest,"minifilm" $ 4.00 71010 Chest, single view 10.00 71020 two views 15.00 71023 three views (17.50) 71034 complete, minimum of four views, including

fluoroscopy where indicated 20.00 76001 Fluoroscopy, (independent procedure) 10.00 *71040 Bronchography, unilateral 35.00* 71041 including injection procedure 50.00 *71060 bilateral 40.00* 71061 including injection procedure 55.00 71100 Ribs, unilateral 15.00 71110 bilateral 25.00 71120 Sternum 15.00 71130 Sternoclavicular joints, minimum of three views 20.00

SPINE AND PELVIS 72010 Spine, entire, survey study (A-P and lateral) 40.00 72040 cervical, A-P and lateral 15.00 72050 cervical, minimum of four views 20.00 72052 cervical, complete, including flexion

and extension studies 30.00 72070 thoracic, minimum of two views 15.00 72080 thoraco-lumbar, A-P and lateral 15.00 72100 lumbo-sacral, A-P and lateral 15.00 72110 complete lumbo-sacral, minimum five views 30.00 72120 lumbo-sacral, bending views 20.00 72170 Pelvis, A-P only 12.50 72180 stereo 15.00 72190 complete, minimum of three views 20.00

(for Pelvimetry, see 74710) 72200 sacroiliac studies, A-P only 12.50

(For complete, see 72190) 72220 sacrume and coccyx 15.00 *72265 Myelography, lumbar or any other single level 40.00* 72266 including injection procedure 80.00 *72270 Myelography, complete spinal canal 60.00* 72271 including injection procedure 100.00 *72295 Discography, lumbar or cervical 50.00* 72296 including injection procedure 90.00

UPPER EXTREMITIES 73000 Clavicle 10.00 73010 Scapula 15.00 73020 Shoulder, one projection 10.00 73030 complete study 15.00 73050 Acromio-clavicular joints, bilateral, with or without

weighted distraction 17.50 73060 Humerus, including one joint 10.00 73070 Elbow, A-P and lateral 10.00 73080 complete, minimum three views 12.50 73090 Forearm, including one joint 10.00 73100 Wrist, A-P and lateral 10.00 73110 complete study, minimum three views 12.50 73120 Hand 10.00 73140 Fingers 7.50

LOWER EXTREMITIES 73500 Hip, one view 12.50 73510 complete study 20.00 73530 during operative procedure, up to four studies 30.00 73531 each additional study over four 7.50 73540 Hips and pelvis, infant and child, two views 15.00 73550 Femur, (thigh) including one joint 15.00 73560 Knee, two views 10.00 73570 complete study, minimum three views 15.00 73590 Tibia and fibula (leg) including one joint 10.00 73600 Ankle, two views 10.00 73610 complete study, minimum three views 12.50 73620 Foot, two views 10.00 73640 complete routine study, minimum three views 12.50 73631 complete including special os calcis views 20.00 73650 Os calcis (heel), minimum two views 10.00 73660 Toes 7.50

ABDOMEN 74000 Abdomen, single A-P 10.00 74020 complete study, minimum of three views 20.00

GASTRO-INTESTINAL TRACT

All X-ray studies included in fee codes 74220 to 74280 that include examinations of upper or lower gastrointestinal tract shall include fluoroscopic examination as an integral part of the study. All gallbladder series require erect and/or decubitus views necessary to determine the presence or absence of pathology. MMIS Code Maximum

Fee
74220 Esophagus, must include fluoroscopy $20.00 74240 Upper gastro-intestinal tract, with or without delayed

films, must include fluoroscopy 30.00 74241 with K.U.B., must include fluoroscopy 35.00 74245 with small bowel, includes multiple serial films,

must include fluoroscopy 40.00 74250 Small bowel, includes multiple serial films, with or

without K.U.B., must include fluoroscopy 30.00 74270 Colon, barium enema, must include fluoroscopy 25.00 74275 barium enema and air contrast, must include fluoroscopy 40.00 74280 air contrast only, minimum six views, must include

fluoroscopy 30.00 74290 Cholecystography, oral dye 20.00 74300 Cholangiography, operative 30.00 74305 Post-operative 22.50 74310 intravenous 37.50 74315 oral dye 30.00 *74320 percutaneous, transhepatic 25.00* 74321 including injection procedure 70.00 74322 Transduodenal cholangiography 30.00

UROLOGICAL 74401 Kidney, ureter and bladder (K.U.B.) single view 10.00 74402 multiple views 15.00 74400 Urography, intravenous, including K.U.B. 35.00 74405 including special hypertensive dye concentration

and clearance studies ("renal washout") 50.00 *74420 retrograde, including K.U.B. 25.00* *74430 Cystography, minimum three views 20.00* 74431 including injection procedure 25.00 74451 Urethrocystography, retrograde 20.00 74456 voiding 35.00 74415 Aorto-nephrotomography,intravenous 75.00 *74460 Retroperitoneal pneumography 25.00* 74461 including injection procedure 45.00 *74470 Translumbar renal cyst study (contrast visualization)

or antegrade urography 20.00* 74471 including injection procedure 40.00 74425 Loopagram, minimum three views 20.00 74426 Loopagram, including injection procedure 25.00

GYNECOLOGICAL AND OBSTETRICAL

For abdomen and pelvis, see 72170-72190, 74000, 74020) 74710 Pelvimetry, with or without cephalometry or placental

localization 25.00 74720 Placental localization 20.00 *74740 Hysterosal pingography 25.00* 74741 including injection procedure 35.00 *74760 Pelvic pneumography 25.00* 74761 including injection procedure 40.00

MISCELLANEOUS STUDIES 76000 Fluoroscopy (independent procedure) 10.00 76125 Cline Radiology, as part of other radiological

procedures except when otherwise included 20.00 74427 Pyelogram intravenous drip infusion (includes injection) 45.00 76020 Bone age studies 15.00 76040 Bone length studies (orthoroentgenogram) 25.00 76061 one survey (long bone or for metastasis) 35.00 *73527 Arthrography, contrast, three views or less 15.00* 73524 including injection procedure by same physician 25.00 *73528 minimum of four views 25.00* 73529 including injection procedure by same physician 35.00 76350 Kymography 25.00 76080 Fistula or sinus tract study 15.00* 76081 including injection procedure 20.00 76090 Mammography, unilateral 20.00 76091 bilateral 30.00 76100 Body section radiography (tomography, planigraphy, etc.)

(For more complex studies, an additional value may be warranted.) 30.00 75525 Cardiacoesophagogram 25.00 76300 Thermography (Breast), unilateral 20.00 76351 Thermography (Breast), bilateral 30.00 76140 Consultation on X-ray examination made elsewhere

(This value does not necessarily include consultation involving litigation.) 15.00 76141 Examination in home, additional charge (20.00)

VASCULAR SYSTEM *75505 Angiocardiography, single projection 100.00* *75507 additional projection 25.00* 75510 by CO(2) injection for auricular wall measurement 50.00 *75600 Aortography, thoracic or lumbar 50.00* *75610 including lower extremities 75.00* *75660 Angiography, cerebral, unilateral 90.00* *75662 bilateral 125.00* 75656 Angiography, 4 Vessel Cerebral (carotid and vertebral) 200.00 *75710 extremity, unilateral 35.00* *75729 arch, renal or splanchnic vessels 50.00* *75752 coronary (Sonne's or comparable technique) 100.00* *75746 pulmonary (intravenous) 50.00* *75809 Lymphangiography, unilateral or bilateral 50.00* *75810 Splenoportography 40.00* 74331 Pancreatography 40.00 *75824 Venography, extremity or caval 40.00* *75850 intraosseus 40.00*

(2) Radiotherapy. Radiotherapy fees include one year follow-up care for treatment of malignancies and 60-day follow-up care for treatment of nonmalignancies. Fees also include office visits during which radiotherapy is provided. However, radiotherapy fees do not include payment for surgical, radiology or laboratory procedures performed with the radiotherapy service.

CONSULTATIONS MMIS Maximum Code Fee 90611 Initial consultation, Office 24.00 90601 Subsequent consultation (when required to complete

diagnosis), office 18.00 90612 Initial consultation, other than office 20.00 90602 Subsequent consultation (when required to complete

diagnosis), other than office 15.00

PER TREATMENT SCHEDULE

SUPERFICIAL GRENZ OR LOW VOLTAGE

X-RAY THERAPY: 74401 Dermatoses (3 fields or less), per treatment 7.50 77402 more than 3 fields 10.00 77403 Benign tumors, per treatment 10.00 77404 Malignant lesions, per treatment 15.00 ORTHOVOLTAGE (150-500 KVP): 77466 Benign lesions, per treatment 10.00 77467 Malignant lesions, per treatment 15.00 SUPERVOLTAGES, 1 MILLION VOLTS AND HIGHER: (BETATRON, LINEAR ACCELERATOR, COBALT, ETC.) 77411 Per treatment 20.00

(3) Radium and radioisotopes (Nuclear medicine). (For consultation, dosage calculation and preparation, see 90611, 90601, 90612.) MMIS Code Maxium

Fee 77276 Basic value for placement of radioactive material

(add cost of radioactive material - see 99070) 75.00 77770 Interstitial application of radium or radioisotope BR 77760 Application of radium or radioisotope plaque or mold

for malignant lesion BR 77786 Application of Thorium X or similar liquid radioactive

material, includes office visit (add cost of radioactive material - see 99070) 7.50 77787 Surface application of sealed radioactive sources to

benign lesions, including radioactive source, single application 15.00

THERAPEUTIC

(Radioactive drugs not included, preliminary and follow-up diagnostic tests not included.) 79000 Hyperthyroidism, initial 100.00 79001 subsequent, each 50.00 79025 Thyroid suppression, initial 100.00 79026 subsequent, each 50.00 78030 Thyroid carcinoma BR 79100 Polycythemia vera, chronic leukemia, etc., per treatment 30.00 79400 Metastatic bone or other carcinoma, per treatment 30.00 79200 Inter-cavitary radioactive colloid therapy 45.00 79300 Interstitial radioactive colloid therapy 150.00 90792 Perfusion for malignant disease 3.00

DIAGNOSTIC

(Radioactive drugs not included) 78000 Radio-iodine uptake, single determination 15.00 78001 multiple determination (as 6 and 24 hours etc.) 20.00 78006 with scan 40.00 78010 Thyroid scanning only 25.00 78003 Thyroid stimulation or suppression test (including 2

uptakes) (THS or other drugs not included) 25.00 78005 Radioactive study, thyroid washout (thiocyanate,

perchlorate or other drugs not included) (20.00) 78072 Thyroid carcinoma metastases, imaging, neck

and chest only (45.00) 76360 Protein bound radio-iodine plasma, or conversion ratio 15.00 76370 Protein bound radlo-iodine plasma, or conversion ratio

(with uptake) 25.00 76352 Radio-tri-iodo-thyronine (in vitro) uptake 10.00

CIRCULATION AND BLOOD STUDIES 78271 Vitamin B-12 absorption study (e.g., Schilling Test); with

intrinsic factor 30.00 78270 without intrinsic factor 25.00 78272 combined, with and without intrinsic factor 50.00 78110 Blood or plasma volume (e.g., radio-iodinated HSA) 20.00 78120 Red cell mass determination 30.00 78130 Red cell survival (e.g., radio-chromate) 50.00 78135 Red cell survival plus splenic (and/or hepatic)

function study 75.00 78280 Gastrointestinal blood loss study 40.00 78160 Plasma radio-iron turnover rate 30.00 78170 Radio-iron red cell utilization and body distribution 50.00 78470 Cardiac output (e.g., radio-iodinated HSA) 30.00 78408 Circulation time (e.g., radio-iodinated HSA) 30.00 78034 Cardiac dynamic flow study (30.00) 78490 Tissue clearance studies 25.00 78491 Carotid/cerebral flow study (40.00)

MISCELLANEOUS 78222 Liver function (e.g., radio-iodinated rose bengal) 30.00 78226 Cholescintingraphy (60.00) 78724 Renal function (e.g., radio-iodinated hippurate sodium) 30.00 78721 Renogram (Isotope Study/Renal Image Flow) 85.00 78288 Gastrointestinal absorption study with radioactive

fat, first phase 30.00 78289 second phase 20.00 78282 Gastrointestinal protein loss (e.g., I-131, P.V.P.) 30.00 78081 Xenon washout (80.00) 78195 Lymphatics and lymph glands imaging (40.00) 78405 Myocardium, imaging (60.00)

LOCALIZATION AND SCANNING 78080 Bone marrow scan (45.00) 78803 Bone tumor 60.00 78804 positron method or complex instrumentation BR 78054 Joint scan (40.00) 78620 Brain tumor 60.00 78606 positron method or complex instrumentation BR 78201 Liver scintiscan 40.00 78223 Liver function with scanning 60.00 78850 Total body or multiple area scanning for metastatic

carcinoma 60.00 78655 Ocular tumor 35.00 78079 Lacrimal scan (20.00) 78404 Cardiac scan 60.00 78240 Pancreas (e.g., Selenium-75) 40.00 78070 Parathyroid scan 60.00 78775 Placental (e.g., RISA) 25.00 78185 Spleen scan 60.00 78707 Renal uptake and scintiscan (e.g., Mercury 203 or 197) 40.00 78582 Lung scan 60.00 78607 Brain scan 60.00 70017 Gamma Cisternogram 75.00 78805 Gallium scan 60.00 78290 Intestinal scan 40.00 78230 Salivary gland(s) scan 35.00 78403 MUGA Scan, cardiac blood pool imaging, with

determination of regional ventricular function including ejection fraction and wall motion

(e.g., gated blood pool images) 150.00 78407 Cardiac blood pool scan 40.00 76155 Scrotal scan (40.00)

(4) Diagnostic ultrasound. Note: A-Mode: Implies a one-dimensional ultrasonic measurement procedure.

M-Mode: Implies a one-dimensional ultrasonic measurement procedure with movements of the trace to record amplitude and velocity of moving echo producing structures.

B-Scan: Implies a two-dimensional ultrasonic scanning procedure with a two-dimensional display.

HEAD AND NECK MMIS Code Maximum

Fee 76500 Echoencephalography, Diencephalic Midine (A-Mode) 20.00 76505 Echoencephalography, Complete (Diencephalic Midline

and Ventricular Size) (A-Mode) 30.00 76516 Ophthalmic Echography(A-Mode) 40.00 76517 Ophthalmic Sonography (contact B-Scan) 60.00 76529 Parotid gland Sonography (B-Mode) (20.00) 76531 Soft tissue/neck mass Sonography (B-Scan) (30.00) 76530 Thyroid Echography (B-Scan) 20.00 76536 Thyroid Sonography (B-Scan) 30.00 76550 Non-invasive studies carotid artery, B-scan, Doppler (67.50)

HEART 76630 Echocardiagraphy, Pericardial Effusion (M-Mode) 25.00 76635 Echocardiography, Cardiac Valve(s) (M-Mode) 30.00 76620 Echocardiography, Complete (76630 and 76635 combined

and chamber dimensions) (M-Mode) 40.00 76628 Echocardiography, limited (e.g., follow-up or

limited study) (M-mode) 20.00 76621 Echocardiography, Two-dimensional (60.00) 76622 Echocardiography, Two-dimensional and M-Mode (90.00) 76931 Pericardiocentesis, by Ultrasonic Guidance (B-Mode,

real time) (BR) 76636 Doppler Echocardiography, Including 2-D

Echocardiography (87.00)

THORAX 76935 Thoracentesis, by Ultrasonic Guidance (BR) 76631 Pleural Effusion Echography (B-scan or real time) 25.00 76633 Diaphragm Sonography (B-Scan) (20.00) 76640 Breast Echography (B-Scan, real time) 25.00 76645 Breast Sonography (B-Scan) 50.00 76632 Mediastinum Mass Sonography (B-Scan, real time) (30.00)

ABDOMEN AND RETROPERITONEUM 76700 Abdominal Sonography, Complete Survey Study (B-Scan) 60.00 76705 Abdominal Sonography, Limited (e.g., follow-up or

limited study) (B-Scan) 40.00 76706 Hepatic Sonography (B-Scan) 60.00 76707 Gallbladder Sonography (B-Scan) 60.00 76775 Adrenal Gland Sonography (B-Scan) (70.00) 76776 Renal Sonography (B-Scan) 60.00 76940 Renal cyst aspiration, by Ultrasonic Guidance

(B-Scan, real time) (BR) 76944 Renal biopsy, by Ultrasonic Guidance (B-Scan real time) (BR) 76710 Pancreas Sonography (B-Scan) 60.00 76720 Spleen Sonography (B-Scan) 60.00 76730 Abdominal Aorta Echography (B-Mode, real time) 25.00 76735 Abdominal Aorta Sonography (B-Scan) 55.00 76780 Retroperitoneal Sonography (B-Scan) 60.00 76801 Urinary bladder Sonography (B-Scan) 40.00 76803 Prostate Sonography (B-Scan) (30.00) 76150 Scrotal Sonography (B-Scan) (30.00)

OBSTETRICS, GYNECOLOGY AND PELVIS 76816 Pregnancy Diagnosis Sonography (B Scan) 30.00 76817 Fetal Age Determination (Biparietal Diameter) Sonography

(B-Scan) and/or femur length, total intrauterine volume-TIUV and abdominal measurements 35.00 76815 Fetal Growth Rate (series of 76817) Sonography (B-Scan) 25.00 76818 Placental Localization Sonography (B-Scan) 40.00 76820 Pregnancy Sonography, Complete (76816; 76817; 76818

combined) (B-Scan) 55.00 76830 Molar Pregnancy Diagnosis Sonography (B-Scan) 40.00 76840 Ectopic Pregnancy Diagnosis Sonography (B-Scan) 60.00 76947 Amniocentesis, by Ultrasonic guidance (B-Scan, real time) (BR) 76841 Intrauterine Contraceptive Device Sonography (B-Scan) 40.00 76856 Pelvic Mass Diagnosis Sonography (B-Scan) 55.00

PERIPHERAL VASCULAR SYSTEM 76900 Arterial Flow Study, peripheral (Doppler) 45.00 76922 Venous Flow Study, peripheral (Doppler) (45.00)

MISCELLANEOUS 76901 Knee Sonography (B-Scan) (30.00) 76499 Ultrasonic planning of radiation field (B-Scan) (35.00)

(5) Computerized tomography scans. The fees for CT Scans with enhancement include the cost of all tomograph scans of the same anatomical site performed at the same session prior to the administration of contrast material.

CT SCANS HEAD MMIS Code Maximum

Fee 76101 CT Scan, head only, multiple views, without

enhancement; professional, administrative and technical components (120.00) 76102 CT Scan, head only, multiple views, with

enhancement; professional, administrative and technical components (145.00) 76103 CT Scan, head only, multiple views, without

enhancement; administrative and technical components (90.00) 76104 CT Scan, head only, multiple views, without

enhancement; professional component (30.00) 76105 CT Scan, head only, multiple views, with

enhancement; administrative and technical components (110.00) 76106 CT Scan, head only, multiple views, with

enhancement; professional component (35.00)

CT SCANS BODY 76107 Body CT Scan, multiple views performed to

investigate a specific anatomical region at the direction of an approved prescriber, without enhancement; includes administrative, technical and professional components (140.00) 76108 Body CT Scan, multiple views performed to

investigate a specific anatomical region at the direction of an approved prescriber, without enhancement; includes administrative and technical components (105.00) 76109 Body CT Scan, multiple views performed to

investigate a specific anatomical region at the direction of an approved prescriber, without enhancement; professional component (35.00) 76110 Body CT Scan, multiple views performed to

investigate a specific anatomical region at the direction of an approved prescriber, with enhancement; professional, administrative and technical components (170.00) 76111 Body CT Scan, multiple views performed to investigate

a specific anatomical region at the direction of an approved prescriber, with enhancement; includes administrative and technical components (130.00) 76112 Body CT Scan, multiple views performed to investigate

a specific anatomical region at the direction of an approved prescriber, with enhancement; professional component (40.00)


Volume: C