APG - Procedure Based Weights History File
Revised for October 1, 2012 Updates:
| Effective Date > | Jan 1, 2010 | Apr 1, 2010 | Jul 1, 2010 | Oct 1, 2010 | Jan 1, 2011 | Apr 1, 2011 | Jul 1, 2011 | Oct 1, 2011 | Jan 1, 2012 | Apr 1, 2012 | Jul 1, 2012 | Oct 1, 2012 | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| HCPCS Code | HCPCS Code Description | APG (ref only) |
Px-Based Weights |
Units Limit | Px-Based Weights |
Units Limit | Px-Based Weights |
Units Limit | Px-Based Weights |
Units Limit | Px-Based Weights |
Units Limit | Px-Based Weights |
Units Limit | Px-Based Weights |
Units Limit | Px-Based Weights |
Units Limit | Px-Based Weights |
Units Limit | Px-Based Weights |
Units Limit | Px-Based Weights |
Units Limit | Px-Based Weights |
Units Limit |
| 55450 | Ligation of sperm duct | 180 | 9.9081 | 1 | 9.9081 | 1 | 9.9081 | 1 | 9.9081 | 1 | 9.9081 | 1 | 9.9081 | 1 | ||||||||||||
| 58300 | Insert intrauterine device | 417 | 0.9902 | 1 | 0.9902 | 1 | 0.9902 | 1 | 0.9902 | 1 | ||||||||||||||||
| 58301 | Remove intrauterine device | 417 | 0.9902 | 1 | 0.9902 | 1 | 0.9902 | 1 | 0.9902 | 1 | ||||||||||||||||
| 58615 | Occlude fallopian tube(s) | 197 | 10.8930 | 1 | 10.8930 | 1 | 10.8930 | 1 | 10.8930 | 1 | 10.8930 | 1 | 10.8930 | 1 | ||||||||||||
| 90805 | Psytx, off, 20-30 min w/e&m | 315 | 1.0344 | 1 | 1.0344 | 1 | 1.0344 | 1 | 1.0344 | 1 | 1.0344 | 1 | 1.0344 | 1 | 1.0344 | 1 | 1.0344 | 1 | 1.0344 | 1 | 1.0344 | 1 | 1.0344 | 1 | 1.0344 | 1 |
| 90807 | Psytx, off, 45-50 min w/e&m | 316 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 |
| 90809 | Psytx, off, 75-80, w/e&m | 316 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 |
| 90811 | Intact psytx, 20-30, w/e&m | 315 | 1.0344 | 1 | 1.0344 | 1 | 1.0344 | 1 | 1.0344 | 1 | 1.0344 | 1 | 1.0344 | 1 | 1.0344 | 1 | 1.0344 | 1 | 1.0344 | 1 | 1.0344 | 1 | 1.0344 | 1 | 1.0344 | 1 |
| 90813 | Intact psytx, 45-50 min w/e&m | 316 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 |
| 90815 | Intact psytx, 75-80 w/e&m | 316 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 |
| 90819 | Psytx, hosp, 45-50 min w/e&m | 316 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 |
| 90847 | Family psytx w/patient | 317 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 |
| 90862 | Medication management | 426 | 0.8275 | 1 | 0.8275 | 1 | 0.8275 | 1 | 0.6620 | 1 | 0.6620 | 1 | 0.6620 | 1 | 0.6620 | 1 | 0.6620 | 1 | 0.6620 | 1 | 0.6620 | 1 | 0.6620 | 1 | 0.6620 | 1 |
| 90882 | Environmental manipulation | 490 | 0.2896 | 1 | 0.2896 | 1 | 0.2896 | 1 | 0.2896 | 1 | 0.2896 | 1 | 0.2896 | 1 | 0.2896 | 1 | 0.2896 | 1 | 0.2896 | 1 | 0.2896 | 1 | 0.2896 | 1 | 0.2896 | 1 |
| 92065 | Orthoptic/pleoptic training | 427 | 0.3820 | 1 | 0.3820 | 1 | 0.3820 | 1 | 0.3820 | 1 | 0.3820 | 1 | 0.3820 | 1 | 0.3820 | 1 | 0.3820 | 1 | 0.3820 | 1 | 0.3820 | 1 | 0.3820 | 1 | 0.3820 | 1 |
| 92340 | Fitting of spectacles | 490 | 0.2624 | 1 | 0.2624 | 1 | 0.2624 | 1 | 0.2624 | 1 | 0.2624 | 1 | 0.2624 | 1 | 0.2624 | 1 | 0.2624 | 1 | 0.2624 | 1 | 0.2624 | 1 | 0.2624 | 1 | 0.2624 | 1 |
| 92341 | Fitting of spectacles | 490 | 0.2624 | 1 | 0.2624 | 1 | 0.2624 | 1 | 0.2624 | 1 | 0.2624 | 1 | 0.2624 | 1 | 0.2624 | 1 | 0.2624 | 1 | 0.2624 | 1 | 0.2624 | 1 | 0.2624 | 1 | 0.2624 | 1 |
| 92342 | Fitting of spectacles | 490 | 0.2624 | 1 | 0.2624 | 1 | 0.2624 | 1 | 0.2624 | 1 | 0.2624 | 1 | 0.2624 | 1 | 0.2624 | 1 | 0.2624 | 1 | 0.2624 | 1 | 0.2624 | 1 | 0.2624 | 1 | 0.2624 | 1 |
| 92506 | Speech/hearing evaluation | 272 | 0.8996 | 1 | 0.8996 | 1 | 0.8996 | 1 | 0.8996 | 1 | 0.8996 | 1 | 0.8996 | 1 | 0.8996 | 1 | 0.8996 | 1 | ||||||||
| 92597 | Oral speech device eval | 272 | 0.8996 | 1 | 0.8996 | 1 | 0.8996 | 1 | 0.8996 | 1 | 0.8996 | 1 | 0.8996 | 1 | 0.8996 | 1 | 0.8996 | 1 | ||||||||
| 92605 | Eval for nonspeech device rx | 272 | 0.8996 | 1 | 0.8996 | 1 | 0.8996 | 1 | 0.8996 | 1 | 0.8996 | 1 | 0.8996 | 1 | 0.8996 | 1 | 0.8996 | 1 | ||||||||
| 92607 | Ex for speech device rx, 1hr | 272 | 0.8827 | 1 | 0.8827 | 1 | 0.8827 | 1 | 0.8827 | 1 | 0.8996 | 1 | 0.8996 | 1 | 0.8996 | 1 | 0.8996 | 1 | 0.8996 | 1 | 0.8996 | 1 | 0.8996 | 1 | 0.8996 | 1 |
| 92608 | Ex for speech device rx addl | 272 | 0.8827 | 1 | 0.8827 | 1 | 0.8827 | 1 | 0.8827 | 1 | 0.4498 | 2 | 0.4498 | 2 | 0.4498 | 2 | 0.4498 | 2 | 0.4498 | 2 | 0.4498 | 2 | 0.4498 | 2 | 0.4498 | 2 |
| 92626 | Eval aud rehab status | 272 | 0.8996 | 1 | 0.8996 | 1 | 0.8996 | 1 | 0.8996 | 1 | 0.8996 | 1 | 0.8996 | 1 | 0.8996 | 1 | 0.8996 | 1 | ||||||||
| 92627 | Eval aud status rehab add-on | 272 | 0.2249 | 2 | 0.2249 | 2 | 0.2249 | 2 | 0.2249 | 2 | 0.2249 | 2 | 0.2249 | 2 | 0.2249 | 2 | 0.2249 | 2 | ||||||||
| 92640 | Aud brainstem implt programg | 272 | 0.8996 | 1 | 0.8996 | 1 | 0.8996 | 1 | 0.8996 | 1 | 0.8996 | 1 | 0.8996 | 1 | 0.8996 | 1 | 0.8996 | 1 | ||||||||
| 95951 | EEG monitoring/videorecord | 210 | 3.9000 | 1 | 3.9000 | 1 | 3.9000 | 1 | 3.9000 | 1 | ||||||||||||||||
| 96040 | Genetic counseling, 30 min | 490 | 0.1939 | 4 | 0.1939 | 4 | 0.1939 | 4 | 0.1939 | 4 | 0.1939 | 4 | 0.1939 | 4 | 0.1939 | 4 | 0.1939 | 4 | ||||||||
| 96101 | Psycho testing by psych/phys | 310 | 1.6551 | 1 | 1.6551 | 1 | 1.6551 | 1 | 1.6551 | 1 | 1.6551 | 1 | 1.6551 | 1 | 1.6551 | 1 | 1.6551 | 1 | 1.6551 | 1 | 1.6551 | 1 | 1.6551 | 1 | 1.6551 | 1 |
| 96102 | Psycho testing by technician | 310 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 |
| 96111 | Developmental test, extend | 310 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 |
| 96116 | Neurobehavioral status exam | 310 | 1.6551 | 1 | 1.6551 | 1 | 1.6551 | 1 | 1.6551 | 1 | 1.6551 | 1 | 1.6551 | 1 | 1.6551 | 1 | 1.6551 | 1 | 1.6551 | 1 | 1.6551 | 1 | 1.6551 | 1 | 1.6551 | 1 |
| 96118 | Neuropsych tst by psych/phys | 310 | 1.6551 | 1 | 1.6551 | 1 | 1.6551 | 1 | 1.6551 | 1 | 1.6551 | 1 | 1.6551 | 1 | 1.6551 | 1 | 1.6551 | 1 | 1.6551 | 1 | 1.6551 | 1 | 1.6551 | 1 | 1.6551 | 1 |
| 96119 | Neuropsych testing by tec | 310 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 |
| 96125 | Cognitive test by hc pro | 310 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 | 1.2413 | 1 |
| 96150 | Assess hlth/behave, init | 490 | 0.1517 | 3 | 0.1517 | 3 | 0.1517 | 3 | 0.1517 | 3 | 0.1517 | 3 | 0.1517 | 3 | 0.1517 | 3 | 0.1517 | 3 | 0.1517 | 3 | 0.1517 | 3 | 0.1517 | 3 | 0.1517 | 3 |
| 96151 | Assess hlth/behave, subseq | 490 | 0.1448 | 3 | 0.1448 | 3 | 0.1448 | 3 | 0.1448 | 3 | 0.1448 | 3 | 0.1448 | 3 | 0.1448 | 3 | 0.1448 | 3 | 0.1448 | 3 | 0.1448 | 3 | 0.1448 | 3 | 0.1448 | 3 |
| 96152 | Intervene hlth/behave, indiv | 490 | 0.1379 | 3 | 0.1379 | 3 | 0.1379 | 3 | 0.1379 | 3 | 0.1379 | 3 | 0.1379 | 3 | 0.1379 | 3 | 0.1379 | 3 | 0.1379 | 3 | 0.1379 | 3 | 0.1379 | 3 | 0.1379 | 3 |
| 96153 | Intervene hlth/behave, group | 490 | 0.0690 | 4 | 0.0690 | 4 | 0.0690 | 4 | 0.0690 | 4 | 0.0690 | 4 | 0.0690 | 4 | 0.0690 | 4 | 0.0690 | 4 | 0.0690 | 4 | 0.0690 | 4 | 0.0690 | 4 | 0.0690 | 4 |
| 96154 | Interv hlth/behav, fam w/pt | 490 | 0.1379 | 4 | 0.1379 | 4 | 0.1379 | 4 | 0.1379 | 4 | 0.1379 | 4 | 0.1379 | 4 | 0.1379 | 4 | 0.1379 | 4 | 0.1379 | 4 | 0.1379 | 4 | 0.1379 | 4 | 0.1379 | 4 |
| 96155 | Interv hlth/behav, fam w/o pt | 490 | 0.1517 | 4 | 0.1517 | 4 | 0.1517 | 4 | 0.1517 | 4 | 0.1517 | 4 | 0.1517 | 4 | 0.1517 | 4 | 0.1517 | 4 | 0.1517 | 4 | 0.1517 | 4 | 0.1517 | 4 | 0.1517 | 4 |
| 97001 | Pt evaluation | 271 | 0.9045 | 1 | 0.9045 | 1 | 0.9045 | 1 | 0.9045 | 1 | 0.9045 | 1 | 0.9045 | 1 | 0.9045 | 1 | 0.9045 | 1 | ||||||||
| 97002 | Pt re-evaluation | 271 | 0.9045 | 1 | 0.9045 | 1 | 0.9045 | 1 | 0.9045 | 1 | 0.9045 | 1 | 0.9045 | 1 | 0.9045 | 1 | 0.9045 | 1 | ||||||||
| 97003 | Ot evaluation | 270 | 0.8141 | 1 | 0.8141 | 1 | 0.8141 | 1 | 0.8141 | 1 | 0.8141 | 1 | 0.8141 | 1 | 0.8141 | 1 | 0.8141 | 1 | ||||||||
| 97004 | Ot re-evaluation | 270 | 0.8141 | 1 | 0.8141 | 1 | 0.8141 | 1 | 0.8141 | 1 | 0.8141 | 1 | 0.8141 | 1 | 0.8141 | 1 | 0.8141 | 1 | ||||||||
| 97010 | Hot or cold packs therapy | 271 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | ||||||||
| 97012 | Mechanical traction therapy | 271 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | ||||||||
| 97014 | Electric stimulation therapy | 271 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | ||||||||
| 97016 | Vasopneumatic device therapy | 271 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | ||||||||
| 97018 | Paraffin bath therapy | 271 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | ||||||||
| 97022 | Whirlpool therapy | 271 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | ||||||||
| 97024 | Diathermy eg, microwave | 271 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | ||||||||
| 97026 | Infrared therapy | 271 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | ||||||||
| 97028 | Ultraviolet therapy | 271 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | ||||||||
| 97032 | Electrical stimulation, 15 min | 271 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.1379 | 1 | 0.1379 | 2 | 0.1379 | 2 | 0.1379 | 2 | 0.1379 | 2 | 0.1379 | 2 | 0.1379 | 2 | 0.1379 | 2 |
| 97033 | Electric current therapy, 15 min | 271 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.1379 | 1 | 0.1379 | 2 | 0.1379 | 2 | 0.1379 | 2 | 0.1379 | 2 | 0.1379 | 2 | 0.1379 | 2 | 0.1379 | 2 |
| 97034 | Contrast bath therapy, 15 min | 271 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.1379 | 1 | 0.1379 | 2 | 0.1379 | 2 | 0.1379 | 2 | 0.1379 | 2 | 0.1379 | 2 | 0.1379 | 2 | 0.1379 | 2 |
| 97035 | Ultrasound therapy, 15 min | 271 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.1379 | 1 | 0.1379 | 2 | 0.1379 | 2 | 0.1379 | 2 | 0.1379 | 2 | 0.1379 | 2 | 0.1379 | 2 | 0.1379 | 2 |
| 97036 | Hydrotherapy, 15 min | 271 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.1379 | 1 | 0.1379 | 2 | 0.1379 | 2 | 0.1379 | 2 | 0.1379 | 2 | 0.1379 | 2 | 0.1379 | 2 | 0.1379 | 2 |
| 97039 | Physical therapy treatment | 271 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | ||||||||
| 97110 | Therapeutic exercises, 15 min | 271 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 |
| 97112 | Neuromuscular reeducation | 271 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 |
| 97113 | Aquatic therapy/exercises | 271 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 |
| 97116 | Gait training therapy | 271 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 |
| 97124 | Massage therapy, 15 min | 271 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 |
| 97139 | Physical medicine procedure | 271 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | ||||||||
| 97140 | Manual therapy, 15 min | 271 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 |
| 97530 | Therapeutic activities, 15 min | 271 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 |
| 97532 | Cognitive skills development, 15 min | 270 | 0.2414 | 3 | 0.2414 | 3 | 0.2414 | 3 | 0.2414 | 3 | 0.2414 | 3 | 0.2414 | 3 | 0.2414 | 3 | 0.2414 | 3 | 0.2414 | 3 | 0.2414 | 3 | 0.2414 | 3 | 0.2414 | 3 |
| 97533 | Sensory integration, 15 min | 270 | 0.2414 | 3 | 0.2414 | 3 | 0.2414 | 3 | 0.2414 | 3 | 0.2414 | 3 | 0.2414 | 3 | 0.2414 | 3 | 0.2414 | 3 | 0.2414 | 3 | 0.2414 | 3 | 0.2414 | 3 | 0.2414 | 3 |
| 97535 | Self care mngment training, 15 min | 270 | 0.2414 | 3 | 0.2414 | 3 | 0.2414 | 3 | 0.2414 | 3 | 0.2414 | 3 | 0.2414 | 3 | 0.2414 | 3 | 0.2414 | 3 | 0.2414 | 3 | 0.2414 | 3 | 0.2414 | 3 | 0.2414 | 3 |
| 97537 | Community/work reintegration, 15 min | 270 | 0.2414 | 3 | 0.2414 | 3 | 0.2414 | 3 | 0.2414 | 3 | 0.2414 | 3 | 0.2414 | 3 | 0.2414 | 3 | 0.2414 | 3 | 0.2414 | 3 | 0.2414 | 3 | 0.2414 | 3 | 0.2414 | 3 |
| 97542 | Wheelchair mngment training, 15 min | 270 | 0.2414 | 3 | 0.2414 | 3 | 0.2414 | 3 | 0.2414 | 3 | 0.2603 | 8 | 0.2603 | 8 | 0.2603 | 8 | 0.2603 | 8 | 0.2603 | 8 | 0.2603 | 8 | 0.2603 | 8 | 0.2603 | 8 |
| 97545 | Work hardening | 271 | 0.9045 | 1 | 0.9045 | 1 | 0.9045 | 1 | 0.9045 | 1 | 0.9045 | 1 | 0.9045 | 1 | 0.9045 | 1 | 0.9045 | 1 | ||||||||
| 97750 | Physical performance test, 15 min | 271 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 |
| 97755 | Assistive technology assess, 15 min | 271 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 6 | 0.2276 | 6 | 0.2276 | 6 | 0.2276 | 6 | 0.2276 | 6 | 0.2276 | 6 | 0.2276 | 6 |
| 97760 | Orthotic mgmt and training, 15 min | 271 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.1939 | 4 | 0.2276 | 4 | 0.2276 | 4 | 0.2276 | 4 | 0.2276 | 4 | 0.2276 | 4 | 0.2276 | 4 |
| 97761 | Prosthetic training, 15 min | 271 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 4 | 0.2276 | 4 | 0.2276 | 4 | 0.2276 | 4 | 0.2276 | 4 | 0.2276 | 4 | 0.2276 | 4 |
| 97762 | C/o for orthotic/prosth use, 15 min | 271 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 | 0.2276 | 3 |
| 97799 | Physical medicine procedure | 271 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | ||||||||
| 97802 | Medical nutrition, indiv, each 15 min | 118 | 0.1793 | 2 | 0.1793 | 2 | 0.1793 | 2 | 0.1793 | 2 | 0.1847 | 2 | 0.1847 | 2 | 0.1847 | 2 | 0.1847 | 2 | 0.1847 | 2 | 0.1847 | 2 | 0.1847 | 2 | 0.1847 | 2 |
| 97803 | Med nutrition, indiv, subseq, each 15 min | 118 | 0.1793 | 2 | 0.1793 | 2 | 0.1793 | 2 | 0.1793 | 2 | 0.1847 | 2 | 0.1847 | 2 | 0.1847 | 2 | 0.1847 | 2 | 0.1847 | 2 | 0.1847 | 2 | 0.1847 | 2 | 0.1847 | 2 |
| 97804 | Medical nutrition, group, each 30 min | 118 | 0.3448 | 1 | 0.3448 | 1 | 0.3448 | 1 | 0.3448 | 1 | 0.1638 | 1 | 0.1638 | 1 | 0.1638 | 1 | 0.1638 | 1 | 0.1638 | 1 | 0.1638 | 1 | 0.1638 | 1 | 0.1638 | 1 |
| 97810 | Acupunct w/o stimul 15 min | 271 | 0.2276 | 3 | 0.2276 | 3 | - | 0 | - | 0 | - | 0 | - | 0 | - | 0 | - | 0 | - | 0 | - | 0 | - | 0 | - | 0 |
| 98941 | Chiropractic manipulation | 271 | - | 0 | - | 0 | - | 0 | - | 0 | - | 0 | - | 0 | - | 0 | ||||||||||
| 98960 | Self-mgmt educ & train, 1 pt, 30 min | 428 | 0.1379 | 4 | 0.1379 | 4 | 0.1379 | 4 | 0.1379 | 4 | 0.1939 | 4 | 0.1939 | 4 | 0.1939 | 4 | 0.1939 | 4 | 0.1939 | 4 | 0.1939 | 4 | 0.1939 | 4 | 0.1939 | 4 |
| 98961 | Self-mgmt educ/train, 2-4 pt | 429 | 0.0690 | 4 | 0.0690 | 4 | 0.0690 | 4 | 0.0690 | 4 | 0.0970 | 4 | 0.0970 | 4 | 0.0970 | 4 | 0.0970 | 4 | 0.0970 | 4 | 0.0970 | 4 | 0.0970 | 4 | 0.0970 | 4 |
| 98962 | Self-mgmt educ/train, 5-8 pt | 429 | 0.0690 | 4 | 0.0690 | 4 | 0.0690 | 4 | 0.0690 | 4 | 0.0970 | 4 | 0.0970 | 4 | 0.0970 | 4 | 0.0970 | 4 | 0.0970 | 4 | 0.0970 | 4 | 0.0970 | 4 | 0.0970 | 4 |
| 99002 | Device Handling | 490 | 0.7586 | 1 | 0.7586 | 1 | 0.7586 | 1 | 0.7586 | 1 | - | 1 | - | 1 | - | 1 | - | 1 | - | 1 | - | 1 | - | 1 | - | 1 |
| 99401 | Preventive counseling, indiv | 490 | 0.1724 | 1 | 0.1724 | 1 | 0.1724 | 1 | 0.1724 | 1 | 0.1724 | 1 | 0.1724 | 1 | 0.2500 | 1 | 0.2500 | 1 | 0.2500 | 1 | 0.2500 | 1 | 0.2500 | 1 | 0.2500 | 1 |
| 99402 | Preventive counseling, indiv | 490 | 0.3103 | 1 | 0.3103 | 1 | 0.3103 | 1 | 0.3103 | 1 | 0.3103 | 1 | 0.3103 | 1 | 0.3103 | 1 | 0.3103 | 1 | 0.3103 | 1 | 0.3103 | 1 | 0.3103 | 1 | 0.3103 | 1 |
| 99403 | Preventive counseling, indiv | 490 | 0.4482 | 1 | 0.4482 | 1 | 0.4482 | 1 | 0.4482 | 1 | 0.4482 | 1 | 0.4482 | 1 | 0.4482 | 1 | 0.4482 | 1 | 0.4482 | 1 | 0.4482 | 1 | 0.4482 | 1 | 0.4482 | 1 |
| 99404 | Preventive counseling, indiv | 490 | 0.5862 | 1 | 0.5862 | 1 | 0.5862 | 1 | 0.5862 | 1 | 0.5862 | 1 | 0.5862 | 1 | 0.5862 | 1 | 0.5862 | 1 | 0.5862 | 1 | 0.5862 | 1 | 0.5862 | 1 | 0.5862 | 1 |
| 99411 | Preventive counseling, group | 490 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 |
| 99412 | Preventive counseling, group | 490 | 0.2414 | 1 | 0.2414 | 1 | 0.2414 | 1 | 0.2414 | 1 | 0.2414 | 1 | 0.2414 | 1 | 0.2414 | 1 | 0.2414 | 1 | 0.2414 | 1 | 0.2414 | 1 | 0.2414 | 1 | 0.2414 | 1 |
| D1320 | Tobacco counseling | 999 | 0.1267 | 1 | - | 0 | - | 0 | ||||||||||||||||||
| D9230 | Analgesia | 490 | 0.1515 | 1 | 0.3030 | 1 | 0.3030 | 1 | 0.4688 | 1 | 0.4688 | 1 | 0.4688 | 1 | 0.4688 | 1 | 0.4688 | 1 | ||||||||
| D9248 | Sedation (non-iv) | 490 | 0.4545 | 1 | 0.4545 | 1 | 0.4545 | 1 | 0.1515 | 1 | 0.3030 | 1 | 0.3030 | 1 | 0.4688 | 1 | 0.4688 | 1 | 0.4688 | 1 | 0.4688 | 1 | 0.4688 | 1 | ||
| D9310 | Dental consultation | 350 | 0.2976 | 1 | 0.2976 | 1 | 0.1875 | 1 | 0.1875 | 1 | 0.1875 | 1 | 0.1875 | 1 | 0.1875 | 1 | 0.1875 | 1 | ||||||||
| D9920 | Behavior management | 350 | 0.1563 | 1 | 0.3125 | 1 | 0.3125 | 1 | 0.3125 | 1 | 0.3125 | 1 | 0.3125 | 1 | ||||||||||||
| G0108 | Diab manage trn per indiv | 428 | 0.1379 | 4 | 0.1379 | 4 | 0.1379 | 4 | 0.1379 | 4 | 0.1939 | 4 | 0.1939 | 4 | 0.1939 | 4 | 0.1939 | 4 | 0.1939 | 4 | 0.1939 | 4 | 0.1939 | 4 | 0.1939 | 4 |
| G0109 | Diab manage trn ind/group | 429 | 0.0690 | 4 | 0.0690 | 4 | 0.0690 | 4 | 0.0690 | 4 | 0.0970 | 4 | 0.0970 | 4 | 0.0970 | 4 | 0.0970 | 4 | 0.0970 | 4 | 0.0970 | 4 | 0.0970 | 4 | 0.0970 | 4 |
| G0270 | MNT subs tx for change dx, each 15 min | 118 | 0.1793 | 2 | 0.1793 | 2 | 0.1793 | 2 | 0.1793 | 2 | 0.1847 | 2 | 0.1847 | 2 | 0.1847 | 2 | 0.1847 | 2 | 0.1847 | 2 | 0.1847 | 2 | 0.1847 | 2 | 0.1847 | 2 |
| G0271 | Group MNT 2 or more 30 mins | 118 | 0.1517 | 1 | 0.1517 | 1 | 0.1517 | 1 | 0.1517 | 1 | 0.1517 | 1 | 0.1517 | 1 | 0.1517 | 1 | 0.1517 | 1 | 0.1517 | 1 | 0.1517 | 1 | 0.1517 | 1 | 0.1517 | 1 |
| G0283 | Elec stim other than wound | 271 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | 0.1379 | 1 | ||||||||
| H0001 | Alcohol and/or drug assessment | 323 | 0.8965 | 1 | 0.8965 | 1 | 0.8965 | 1 | 0.8965 | 1 | 0.8965 | 1 | 0.8965 | 1 | 0.8965 | 1 | 0.8965 | 1 | 0.8965 | 1 | 0.8965 | 1 | 0.8965 | 1 | 0.8965 | 1 |
| H0004 | Alcohol and/or drug services | 315 | 0.2803 | 1 | ||||||||||||||||||||||
| H0006 | Alcohol and/or drug services | 320 | 0.4138 | 1 | 0.4138 | 1 | 0.4138 | 1 | 0.4138 | 1 | 0.4138 | 1 | 0.4138 | 1 | 0.4138 | 1 | 0.4138 | 1 | 0.4138 | 1 | 0.4138 | 1 | 0.4138 | 1 | 0.4138 | 1 |
| H0014 | Alcohol and/or drug services | 426 | 0.8275 | 1 | 0.8275 | 1 | 0.8275 | 1 | 0.8275 | 1 | 0.8275 | 1 | 0.8275 | 1 | 0.8275 | 1 | 0.8275 | 1 | ||||||||
| H0023 | Behavioral health outreach service | 490 | 0.7034 | 1 | 0.7034 | 1 | 0.7034 | 1 | - | 1 | - | 1 | - | 1 | - | 1 | - | 1 | - | 1 | - | 1 | - | 0 | - | 0 |
| H0031 | MH health assess by non-md | 323 | 0.8965 | 1 | 0.8965 | 1 | 0.8965 | 1 | 0.8965 | 1 | 0.8965 | 1 | 0.8965 | 1 | 0.8965 | 1 | 0.8965 | 1 | 0.8965 | 1 | 0.8965 | 1 | 0.8965 | 1 | 0.8965 | 1 |
| H0038 | Self-help/peer services per 15 min | 490 | 0.0172 | 4 | 0.0172 | 4 | 0.0172 | 4 | 0.0172 | 4 | 0.0172 | 4 | 0.0313 | 4 | 0.0313 | 4 | 0.0313 | 4 | ||||||||
| H1000 | Prenatal care atrisk assessm | 490 | 0.2069 | 1 | 0.2069 | 1 | 0.2069 | 1 | 0.2069 | 1 | 0.2069 | 1 | 0.2069 | 1 | 0.2069 | 1 | 0.2069 | 1 | 0.2069 | 1 | 0.2069 | 1 | 0.2069 | 1 | 0.2069 | 1 |
| H1005 | Prenatal care enhanced srv pk | 490 | 0.0690 | 1 | 0.0690 | 1 | 0.0690 | 1 | 0.0690 | 1 | 0.0690 | 1 | 0.0690 | 1 | 0.0690 | 1 | 0.0690 | 1 | 0.0690 | 1 | 0.0690 | 1 | 0.0690 | 1 | 0.0690 | 1 |
| H2010 | Comprehensive med svc 15 min | 490 | 0.4138 | 1 | 0.4138 | 1 | 0.4138 | 1 | 0.4138 | 1 | 0.4138 | 1 | 0.4138 | 1 | 0.4138 | 1 | 0.4138 | 1 | 0.4138 | 1 | 0.4138 | 1 | 0.4138 | 1 | 0.4138 | 1 |
| H2011 | Crisis interven svc, per 15 min | 321 | 0.2069 | 8 | 0.4000 | 6 | 0.4000 | 6 | 0.4000 | 6 | 0.4000 | 6 | 0.4000 | 6 | 0.4000 | 6 | 0.4000 | 6 | 0.4000 | 6 | 0.4000 | 6 | 0.4000 | 6 | 0.4000 | 6 |
| Q3014 | Telehealth facility fee | 490 | 0.2813 | 1 | 0.2813 | 1 | 0.2813 | 1 | 0.2813 | 1 | ||||||||||||||||
| S9152 | Speech therapy, re-eval | 272 | 0.8996 | 1 | 0.8996 | 1 | 0.8996 | 1 | 0.8996 | 1 | 0.8996 | 1 | 0.8996 | 1 | ||||||||||||
| S9445 | Patient education noc individ | 999 | 0.2813 | 1 | 0.2813 | 1 | ||||||||||||||||||||
| S9446 | Patient education noc group | 999 | 0.0938 | 1 | 0.0938 | 1 | ||||||||||||||||||||
| S9484 | Crisis intervention per hour | 321 | 2.4136 | 1 | 2.4136 | 1 | 2.4136 | 1 | 2.4136 | 1 | 2.4136 | 1 | 2.4136 | 1 | 2.4136 | 1 | 2.4136 | 1 | 2.4136 | 1 | 2.4136 | 1 | 2.4136 | 1 | 2.4136 | 1 |
| S9485 | Crisis intervention mental h | 312 | 5.7927 | 1 | 5.7927 | 1 | 5.7927 | 1 | 5.7927 | 1 | 5.7927 | 1 | 5.7927 | 1 | 5.7927 | 1 | 5.7927 | 1 | 5.7927 | 1 | 5.7927 | 1 | 5.7927 | 1 | 5.7927 | 1 |
| T1007 | Treatment Plan Development | 320 | 0.4138 | 1 | 0.4138 | 1 | 0.4138 | 1 | 0.4138 | 1 | 0.4138 | 1 | 0.4138 | 1 | 0.4138 | 1 | 0.4138 | 1 | 0.4138 | 1 | 0.4138 | 1 | 0.4138 | 1 | 0.4138 | 1 |
| T1013 | Sign Lang/Oral Interpreter | 490 | - | 0 | 0.0295 | 3 | 0.0295 | 3 | 0.0295 | 3 | 0.0295 | 3 | 0.0295 | 3 | 0.0295 | 3 | 0.0295 | 3 | 0.0295 | 3 | 0.0295 | 3 | 0.0688 | 2 | 0.0688 | 2 |
| V2020 | Vision svcs frames purchases | 490 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 |
| V2103 | Spherocylindr 4.00d/12-2.00d | 490 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 |
| V2200 | Lens spher bifoc plano 4.00d | 490 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 |
| V2203 | Lens sphcyl bifocal 4.00d/.1 | 490 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 |
| V2300 | Lens sphere trifocal 4.00d | 490 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 | ||||||||||||||||
| V2303 | Lens sphcy trifocal 4.0/.12- | 490 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 | 0.3567 | 1 | ||||||||||||||||
| V5010 | Assessment for hearing aid | 257 | 0.0844 | 1 | 0.0844 | 1 | 0.0844 | 1 | 0.0844 | 1 | 0.0844 | 1 | 0.1688 | 1 | 0.4211 | 1 | - | 0 | - | 0 | - | 0 | - | 0 | ||
| V5014 | Hearing aid repair/modifying | 257 | 0.1563 | 1 | 0.1563 | 1 | - | 0 | - | 0 | ||||||||||||||||
| V5020 | Conformity evaluation | 257 | 0.0422 | 1 | 0.0422 | 1 | 0.0422 | 1 | 0.0422 | 1 | 0.0422 | 1 | 0.0844 | 1 | 0.4211 | 1 | - | 0 | - | 0 | - | 0 | - | 0 | ||
| V5160 | Dispensing fee binaural | 490 | 1.3792 | 1 | 1.3792 | 1 | 1.3792 | 1 | 1.3792 | 1 | 1.3792 | 1 | 1.3792 | 1 | 1.3792 | 1 | 1.3792 | 1 | 1.3792 | 1 | 1.3792 | 1 | 1.3792 | 1 | 1.3792 | 1 |
| V5200 | Cros hearing aid dispens fee | 490 | 1.3792 | 1 | 1.3792 | 1 | 1.3792 | 1 | 1.3792 | 1 | 1.3792 | 1 | 1.3792 | 1 | 1.3792 | 1 | 1.3792 | 1 | 1.3792 | 1 | 1.3792 | 1 | 1.3792 | 1 | 1.3792 | 1 |
| V5240 | Dispensing fee bicros | 490 | 1.3792 | 1 | 1.3792 | 1 | 1.3792 | 1 | 1.3792 | 1 | 1.3792 | 1 | 1.3792 | 1 | 1.3792 | 1 | 1.3792 | 1 | 1.3792 | 1 | 1.3792 | 1 | 1.3792 | 1 | 1.3792 | 1 |
| V5241 | Dispensing fee, monaural | 490 | 0.9310 | 1 | 0.9310 | 1 | 0.9310 | 1 | 0.9310 | 1 | 0.9310 | 1 | 0.9310 | 1 | 0.9310 | 1 | 0.9310 | 1 | 0.9310 | 1 | 0.9310 | 1 | 0.9310 | 1 | 0.9310 | 1 |
| V5362 | Speech screening | 272 | - | 0 | - | 0 | - | 0 | - | 0 | - | 0 | - | 0 | - | 0 | ||||||||||
| V5364 | Dysphagia screening | 272 | - | 0 | - | 0 | - | 0 | - | 0 | - | 0 | - | 0 | - | 0 | ||||||||||
