APG - Procedure Based Weights History File
| Effective Date > | Jan 1, 2013 | |||
|---|---|---|---|---|
| HCPCS Code | HCPCS Code Description | APG (ref only) |
Px-Based Weights |
Units Limit |
| 55450 | Ligation of sperm duct | 180 | 9.9081 | 1 |
| 58300 | Insert intrauterine device | 417 | 0.9902 | 1 |
| 58301 | Remove intrauterine device | 417 | 0.9902 | 1 |
| 58615 | Occlude fallopian tube(s) | 197 | 10.8930 | 1 |
| 90805 | Psytx, off, 20-30 min w/e&m | 315 | 1.0344 | 1 |
| 90807 | Psytx, off, 45-50 min w/e&m | 316 | 1.2413 | 1 |
| 90809 | Psytx, off, 75-80, w/e&m | 316 | 1.2413 | 1 |
| 90811 | Intact psytx, 20-30, w/e&m | 315 | 1.0344 | 1 |
| 90813 | Intact psytx, 45-50 min w/e&m | 316 | 1.2413 | 1 |
| 90815 | Intact psytx, 75-80 w/e&m | 316 | 1.2413 | 1 |
| 90819 | Psytx, hosp, 45-50 min w/e&m | 316 | 1.2413 | 1 |
| 90833 | Psychotherapy, 30 minutes with e&m (code e&m separately) | 315 | 0.3322 | 1 |
| 90836 | Psychotherapy, 45 minutes with e&m (code e&m separately) | 316 | 0.5390 | 1 |
| 90838 | Psychotherapy, 60 minutes with e&m (code e&m separately) | 316 | 0.5390 | 1 |
| 90847 | Family psytx w/patient | 317 | 1.2413 | 1 |
| 90862 | Medication management | 426 | 0.6620 | 1 |
| 90863 | Pharmacologic management, when performed with psychotherapy. | 322 | 0.6620 | 1 |
| 90882 | Environmental manipulation | 490 | 0.2896 | 1 |
| 90993 | Dialysis training incompl | 428 | 0.1939 | 1 |
| 92065 | Orthoptic/pleoptic training | 427 | 0.3820 | 1 |
| 92340 | Fitting of spectacles | 490 | 0.2624 | 1 |
| 92341 | Fitting of spectacles | 490 | 0.2624 | 1 |
| 92342 | Fitting of spectacles | 490 | 0.2624 | 1 |
| 92506 | Speech/hearing evaluation | 272 | 0.8996 | 1 |
| 92597 | Oral speech device eval | 272 | 0.8996 | 1 |
| 92605 | Eval for nonspeech device rx | 272 | 0.8996 | 1 |
| 92607 | Ex for speech device rx, 1hr | 272 | 0.8996 | 1 |
| 92608 | Ex for speech device rx addl | 272 | 0.4498 | 2 |
| 92626 | Eval aud rehab status | 272 | 0.8996 | 1 |
| 92627 | Eval aud status rehab add-on | 272 | 0.2249 | 2 |
| 92640 | Aud brainstem implt programg | 272 | 0.8996 | 1 |
| 95951 | EEG monitoring/videorecord | 210 | 3.9000 | 1 |
| 96040 | Genetic counseling, 30 min | 490 | 0.1939 | 4 |
| 96101 | Psycho testing by psych/phys | 310 | 1.6551 | 1 |
| 96102 | Psycho testing by technician | 310 | 1.2413 | 1 |
| 96111 | Developmental test, extend | 310 | 1.2413 | 1 |
| 96116 | Neurobehavioral status exam | 310 | 1.6551 | 1 |
| 96118 | Neuropsych tst by psych/phys | 310 | 1.6551 | 1 |
| 96119 | Neuropsych testing by tec | 310 | 1.2413 | 1 |
| 96125 | Cognitive test by hc pro | 310 | 1.2413 | 1 |
| 96150 | Assess hlth/behave, init | 490 | 0.1517 | 3 |
| 96151 | Assess hlth/behave, subseq | 490 | 0.1448 | 3 |
| 96152 | Intervene hlth/behave, indiv | 490 | 0.1379 | 3 |
| 96153 | Intervene hlth/behave, group | 490 | 0.0690 | 4 |
| 96154 | Interv hlth/behav, fam w/pt | 490 | 0.1379 | 4 |
| 96155 | Interv hlth/behav, fam w/o pt | 490 | 0.1517 | 4 |
| 97001 | Pt evaluation | 271 | 0.9045 | 1 |
| 97002 | Pt re-evaluation | 271 | 0.9045 | 1 |
| 97003 | Ot evaluation | 270 | 0.8141 | 1 |
| 97004 | Ot re-evaluation | 270 | 0.8141 | 1 |
| 97010 | Hot or cold packs therapy | 271 | 0.1379 | 1 |
| 97012 | Mechanical traction therapy | 271 | 0.1379 | 1 |
| 97014 | Electric stimulation therapy | 271 | 0.1379 | 1 |
| 97016 | Vasopneumatic device therapy | 271 | 0.1379 | 1 |
| 97018 | Paraffin bath therapy | 271 | 0.1379 | 1 |
| 97022 | Whirlpool therapy | 271 | 0.1379 | 1 |
| 97024 | Diathermy eg, microwave | 271 | 0.1379 | 1 |
| 97026 | Infrared therapy | 271 | 0.1379 | 1 |
| 97028 | Ultraviolet therapy | 271 | 0.1379 | 1 |
| 97032 | Electrical stimulation, 15 min | 271 | 0.1379 | 2 |
| 97033 | Electric current therapy, 15 min | 271 | 0.1379 | 2 |
| 97034 | Contrast bath therapy, 15 min | 271 | 0.1379 | 2 |
| 97035 | Ultrasound therapy, 15 min | 271 | 0.1379 | 2 |
| 97036 | Hydrotherapy, 15 min | 271 | 0.1379 | 2 |
| 97039 | Physical therapy treatment | 271 | 0.1379 | 1 |
| 97110 | Therapeutic exercises, 15 min | 271 | 0.2276 | 3 |
| 97112 | Neuromuscular reeducation | 271 | 0.2276 | 3 |
| 97113 | Aquatic therapy/exercises | 271 | 0.2276 | 3 |
| 97116 | Gait training therapy | 271 | 0.2276 | 3 |
| 97124 | Massage therapy, 15 min | 271 | 0.2276 | 3 |
| 97139 | Physical medicine procedure | 271 | 0.1379 | 1 |
| 97140 | Manual therapy, 15 min | 271 | 0.2276 | 3 |
| 97530 | Therapeutic activities, 15 min | 271 | 0.2276 | 3 |
| 97532 | Cognitive skills development, 15 min | 270 | 0.2414 | 3 |
| 97533 | Sensory integration, 15 min | 270 | 0.2414 | 3 |
| 97535 | Self care mngment training, 15 min | 270 | 0.2414 | 3 |
| 97537 | Community/work reintegration, 15 min | 270 | 0.2414 | 3 |
| 97542 | Wheelchair mngment training, 15 min | 270 | 0.2603 | 8 |
| 97545 | Work hardening | 271 | 0.9045 | 1 |
| 97750 | Physical performance test, 15 min | 271 | 0.2276 | 3 |
| 97755 | Assistive technology assess, 15 min | 271 | 0.2276 | 6 |
| 97760 | Orthotic mgmt and training, 15 min | 271 | 0.2276 | 4 |
| 97761 | Prosthetic training, 15 min | 271 | 0.2276 | 4 |
| 97762 | C/o for orthotic/prosth use, 15 min | 271 | 0.2276 | 3 |
| 97799 | Physical medicine procedure | 271 | 0.1379 | 1 |
| 97802 | Medical nutrition, indiv, each 15 min | 118 | 0.1847 | 2 |
| 97803 | Med nutrition, indiv, subseq, each 15 min | 118 | 0.1847 | 2 |
| 97804 | Medical nutrition, group, each 30 min | 118 | 0.1638 | 1 |
| 97810 | Acupunct w/o stimul 15 min | 271 | - | 0 |
| 98941 | Chiropractic manipulation | 271 | - | 0 |
| 98960 | Self-mgmt educ & train, 1 pt, 30 min | 428 | 0.1939 | 4 |
| 98961 | Self-mgmt educ/train, 2-4 pt | 429 | 0.0970 | 4 |
| 98962 | Self-mgmt educ/train, 5-8 pt | 429 | 0.0970 | 4 |
| 99002 | Device Handling | 490 | - | 1 |
| 99401 | Preventive counseling, indiv | 490 | 0.2500 | 1 |
| 99402 | Preventive counseling, indiv | 490 | 0.3103 | 1 |
| 99403 | Preventive counseling, indiv | 490 | 0.4482 | 1 |
| 99404 | Preventive counseling, indiv | 490 | 0.5862 | 1 |
| 99411 | Preventive counseling, group | 490 | 0.1379 | 1 |
| 99412 | Preventive counseling, group | 490 | 0.2414 | 1 |
| D1320 | Tobacco counseling | 999 | - | 0 |
| D9230 | Analgesia | 490 | 0.4688 | 1 |
| D9248 | Sedation (non-iv) | 490 | 0.4688 | 1 |
| D9310 | Dental consultation | 350 | 0.1875 | 1 |
| D9920 | Behavior management | 350 | 0.3125 | 1 |
| G0108 | Diab manage trn per indiv | 428 | 0.1939 | 4 |
| G0109 | Diab manage trn ind/group | 429 | 0.0970 | 4 |
| G0270 | MNT subs tx for change dx, each 15 min | 118 | 0.1847 | 2 |
| G0271 | Group MNT 2 or more 30 mins | 118 | 0.1517 | 1 |
| G0283 | Elec stim other than wound | 271 | 0.1379 | 1 |
| H0001 | Alcohol and/or drug assessment | 323 | 0.8965 | 1 |
| H0004 | Alcohol and/or drug services | 315 | 0.2803 | 1 |
| H0006 | Alcohol and/or drug services | 320 | 0.4138 | 1 |
| H0014 | Alcohol and/or drug services | 426 | 0.8275 | 1 |
| H0023 | Behavioral health outreach service | 490 | - | 0 |
| H0031 | MH health assess by non-md | 323 | 0.8965 | 1 |
| H0038 | Self-help/peer services per 15 min | 490 | 0.0313 | 4 |
| H1000 | Prenatal care atrisk assessm | 490 | 0.2069 | 1 |
| H1005 | Prenatal care enhanced srv pk | 490 | 0.0690 | 1 |
| H2010 | Comprehensive med svc 15 min | 490 | 0.4138 | 1 |
| H2011 | Crisis interven svc, per 15 min | 321 | 0.4000 | 6 |
| Q3014 | Telehealth facility fee | 490 | 0.2813 | 1 |
| S9152 | Speech therapy, re-eval | 272 | 0.8996 | 1 |
| S9445 | Patient education noc individ | 999 | 0.2813 | 1 |
| S9446 | Patient education noc group | 999 | 0.0938 | 1 |
| S9484 | Crisis intervention per hour | 321 | 2.4136 | 1 |
| S9485 | Crisis intervention mental h | 312 | 5.7927 | 1 |
| T1007 | Treatment Plan Development | 320 | 0.4138 | 1 |
| T1013 | Sign Lang/Oral Interpreter | 490 | 0.0688 | 2 |
| V2020 | Vision svcs frames purchases | 490 | 0.3567 | 1 |
| V2103 | Spherocylindr 4.00d/12-2.00d | 490 | 0.3567 | 1 |
| V2200 | Lens spher bifoc plano 4.00d | 490 | 0.3567 | 1 |
| V2203 | Lens sphcyl bifocal 4.00d/.1 | 490 | 0.3567 | 1 |
| V2300 | Lens sphere trifocal 4.00d | 490 | 0.3567 | 1 |
| V2303 | Lens sphcy trifocal 4.0/.12- | 490 | 0.3567 | 1 |
| V5010 | Assessment for hearing aid | 257 | - | 0 |
| V5014 | Hearing aid repair/modifying | 257 | - | 0 |
| V5020 | Conformity evaluation | 257 | - | 0 |
| V5160 | Dispensing fee binaural | 490 | 1.3792 | 1 |
| V5200 | Cros hearing aid dispens fee | 490 | 1.3792 | 1 |
| V5240 | Dispensing fee bicros | 490 | 1.3792 | 1 |
| V5241 | Dispensing fee, monaural | 490 | 0.9310 | 1 |
| V5362 | Speech screening | 272 | - | 0 |
| V5364 | Dysphagia screening | 272 | - | 0 |
For periods not specifically shown, the weight used is the weight displayed on the prior effective date. For example, the rates effective December 1, 2008 will be used for visits prior to January 1, 2010.
