Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule, DME Face-to-Face Encounters, Elimination of the Requirement for Termination of Non-Random Prepayment Complex Medical Review and Other Revisions to Part B for CY 2013, 48995-49059 [2013-19378]

Agencies

• Centers for Medicare & Medicaid Services
• DEPARTMENT OF HEALTH AND HUMAN SERVICES

[Federal Register Volume 78, Number 155 (Monday, August 12, 2013)]
[Rules and Regulations]
[Pages 48995-49059]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2013-19378]



[[Page 48995]]

Vol. 78

Monday,

No. 155

August 12, 2013

Part III





Department of Health and Human Services





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Center for Medicare & Medicaid Services





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42 CFR Parts 410, 414, 415, et al.





Medicare Program; Revisions to Payment Policies Under the Physician Fee 
Schedule, DME Face-to-Face Encounters, Elimination of the Requirement 
for Termination of Non-Random Prepayment Complex Medical Review and 
Other Revisions to Part B for CY 2013; Final Rule

Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules 
and Regulations

[[Page 48996]]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 410, 414, 415, 421, 423, 425, 486, and 495

[CMS-1590-CN]
RIN 0938-AR11


Medicare Program; Revisions to Payment Policies Under the 
Physician Fee Schedule, DME Face-to-Face Encounters, Elimination of the 
Requirement for Termination of Non-Random Prepayment Complex Medical 
Review and Other Revisions to Part B for CY 2013

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Correction of final rule with comment period.

-----------------------------------------------------------------------

SUMMARY: This document corrects technical errors that appeared in the 
final rule with comment period published in the Federal Register on 
November 16, 2012, entitled ``Medicare Program; Revisions to Payment 
Policies Under the Physician Fee Schedule, DME Face-to-Face Encounters, 
Elimination of the Requirement for Termination of Non-Random Prepayment 
Complex Medical Review and Other Revisions to Part B for CY 2013.''

DATES: The correcting document is effective August 12, 2013 and is 
applicable beginning January 1, 2013.

FOR FURTHER INFORMATION CONTACT: Elliott Isaac, (410) 786-4735.

SUPPLEMENTARY INFORMATION: 

I. Background

    In FR Doc. 2012-26900 of November 16, 2012 (77 FR 68892 through 
69373), there were a number of technical errors that are identified and 
corrected in the Correction of Errors section below. These corrections 
are effective January 1, 2013. We note that the Addenda A through H for 
the CY 2013 PFS final rule with comment period as corrected in this 
correction notice are available on the CMS Web site at www.cms.gov//PhysicianFeeSched/.

II. Summary of Errors

A. Summary of Errors in the Preamble

    On pages 68904 through 68906, in Table 3: Calculation of PE RVUs 
under Methodology for Selected Codes, the PE RVUs listed in the table 
are incorrect.
    On page 68907, in our discussion of the changes to direct PE inputs 
for specific services, we made a typographical error in identifying the 
calendar years.
    On page 68957, in our discussion of Medicare telehealth services, 
we inadvertently omitted a discussion of psychotherapy services.
    On page 68958, in our discussion of therapy services, we 
inadvertently omitted language regarding the claims-based data 
collection strategy for therapy services.
    On page 68965, we inadvertently omitted language in our discussion 
on non-payable G-codes on beneficiary functional status.
    On page 68966, we inadvertently included language.
    On pages 68967 and 68968, we inadvertently made errors in the 
descriptors for G-codes in Table 21: G-Codes for Claims-Based 
Functional Reporting for CY 2013.
    On page 69033, we inadvertently omitted a code-specific direct PE 
input.
    On pages 69042 and 69043, in our discussion of the global period 
for CPT code 22586, we made a typographical error in the code 
descriptor.
    On page 69051,
    a. We inadvertently used the wrong descriptor for CPT 36221.
    b. We inadvertently omitted two paragraphs regarding our treatment 
of CPT codes 37197 and 37214.
    On pages 69071 through 69073, we made clerical errors in table 
references.
    On page 69074, in our discussion of pricing supply and equipment 
items, we inadvertently omitted a paragraph detailing the items for 
which we did not receive adequate information and therefore could not 
price them for the interim final values in the CY 2013 rule.
    On pages 69077 through 69128, we made numerous typographical errors 
and technical errors in Table 74: CPT Codes with Refined direct PE 
Recommendations for CY 2013 Interim Codes and therefore are correcting 
the table.
    On page 69138, we made typographical errors in the CY 2013 PFS 
conversion factor (CF).
    On page 69138, we made typographical errors in the CY 2013 PFS CF 
in Table 87: Calculation of the CY 2013 PFS CF.
    On page 69139, in Table 88: Calculation of the CY 2013 Anesthesia 
CF, we inadvertently listed the incorrect anesthesia CF.
    On page 69145, we inadvertently referred to ``physician's order'' 
instead of ``valid prescription.''
    On page 69212, due to a typographical error, the title of PQRS 
Measure 190 referred to in the comment bullet was not correct.
    On pages 69215 through 69267, the notes after Table 95: Individual 
Quality Measures for the Physician Quality Reporting System Proposed to 
be Available for Reporting via Claims, Registry, EHR, or GRPO Web 
Interface Beginning in 2013 or 2014* were inadvertently omitted.
    On page 69237, in Table 95: Individual Quality Measures for the 
Physician Quality Reporting System Proposed to be Available for 
Reporting via Claims, Registry, EHR, or GRPO Web Interface Beginning in 
2013 or 2014*, due to a typographical error, Measures 189 and 
190 were incorrectly listed as available for reporting under PQRS.
    On page 69269, in Table 96: PQRS Quality Measures Available for 
Reporting for Group Practices Using the GPRO Web Interface for 2013 and 
Beyond, due to a typographical error, the description of the measure 
``Medication Reconciliation'' is incorrect.
    On page 69277, in Table 108: HIV/AIDS Measures Group, due to a 
clerical error, there are measures listed that have lost their NQF 
endorsement and are therefore no longer being maintained by the 
respective measure owner.
    On page 69300, due to a clerical error, we stated the deadlines for 
requesting an informal review for the 2012 and 2013 eRx incentives 
incorrectly. The regulation at Sec.  414.92(g) correctly states that 
eligible professionals and group practices must submit an informal 
review request for the 2012 and 2013 incentives within 90 days of the 
release of the feedback reports. The preamble does not reflect this 
same regulation text. Therefore, we are revising the preamble to 
reflect the regulation text at Sec.  414.92(g).
    On pages 69344 through 69345, in Table 134: CY 2013 PFS Final Rule 
with Comment Period Estimated Impact on Total Allowed Charges by 
Specialty, due to technical errors in the calculations of the impacts, 
there were errors in the total estimated impacts and the estimated 
impacts for the following specialties: 01--ALLERGY/IMMUNOLOGY, 02--
ANESTHESIOLOGY, 10--FAMILY PRACTICE, 13--GENERAL SURGERY, 18--INTERNAL 
MEDICINE, 19--INTERVENTIONAL PAIN MANAGEMENT, 21--MULTISPECIALTY 
CLINIC/OTHER PHY, 34--PLASTIC SURGERY, 41--UROLOGY, 49--NURSE ANES/ANES 
ASST.
    On page 69345, at the end of Table 134: CY 2013 PFS Final Rule with 
Comment Period Estimated Impact on Total Allowed Charges by Specialty, 
we made clerical errors in the first footnote.
    On pages 69347 through 69348, in Table 135: CY 2013 PFS Final Rule 
with

[[Page 48997]]

Comment Period Estimated Impact on Total Allowed Charges by Specialty 
by Selected Policy, due to technical errors in calculations of the 
impacts, there were errors in the estimates of the total impact and on 
the impact for the following specialties: 01--ALLERGY/IMMUNOLOGY, 02--
ANESTHESIOLOGY, 13--GENERAL SURGERY, 18--INTERNAL MEDICINE, 19--
INTERVENTIONAL PAIN MANAGEMENT, 21--MULTISPECIALTY CLINIC/OTHER PHY, 
41--UROLOGY, 49--NURSE ANES/ANES ASST.
    On page 69348, at the end of Table 135: CY 2013 PFS Final Rule with 
Comment Period Estimated Impact on Total Allowed Charges by Specialty 
by Selected Policy, we made a clerical error in the first footnote.
    On page 69350 through 69351, in Table 136: Impact of Final Rule 
with Comment Period on CY 2013 Payment for Selected Procedures, we made 
technical errors in the calculation of the impacts.
    On page 69351, in footnotes 3 and 4 at the end of Table 136: Impact 
of Final Rule with Comment Period on CY 2013 Payment for Selected 
Procedures, we inadvertently listed the incorrect 2012 conversion 
factor.

B. Summary and Correction of Errors in the Addenda on the CMS Web site

    Technical errors in the creation of the direct practice expense 
database resulted in incorrect direct PE inputs for CPT codes: 11307, 
11313, 13100, 13101, 13102, 13120, 13121, 13122, 13131, 13132, 13133, 
13150, 13151, 13152, 31231, 32554, 32555, 32556, 32557, 35475, 35476, 
36221, 36222, 36223, 36224, 36225, 36226, 37197, 52224, 64612, 65800, 
72040, 72050, 72052, 72069, 72193, 72194, 74160, 74170, 74177, 74178, 
76872, 77301, 92081, 92082, 92083, 92235, 92286, 93925, 93970, 95010, 
95015, 95017, 95018, 95782, 95783, and 97150. As a result of these 
errors, the budget neutrality adjustment used in calculating PE RVUs 
was incorrect, resulting in incorrect values for other PE RVUs in 
Addenda B and C. These errors are corrected in the revised Direct PE 
Input Database available on the CMS Web site at www.cms.gov//PhysicianFeeSched/. Resulting changes to PE RVUs are reflected in the 
corrected Addenda B and C posted on the CMS Web site at www.cms.gov//PhysicianFeeSched/.
    Due to a technical error, although the physician time records for 
CPT codes 22841, 51798, 95990, 96913, and 97602 were properly removed 
from the physician time file per final policy discussed in the CY 2013 
final rule with comment period (77 FR 68926), these time records were 
inadvertently used in the creation of the PE RVUs. This technical error 
is corrected in the revised CY 2013 Addendum B posted to the CMS Web 
site at www.cms.gov//PhysicianFeeSched/.
    Due a technical error in applying a change made in the final rule 
in calculating the impact of the ophthalmology MPPR used in the PE 
methodology, as described on page 68901, the ``CY 2012 Utilization data 
Crosswalk to CY 2013'' file posted on the CMS Web site contained 
errors. This also resulted in errors in Addenda B and C files posted on 
the CMS Web site. These addenda have been corrected as a result of the 
changes made in this correction notice and the corrected Addenda B and 
C files are posted on the CMS Web site. www.cms.gov//PhysicianFeeSched/
.
    Due to a technical error in calculating the anesthesia inputs, the 
PE RVUs for all services reflected in Addenda B and C posted on the CMS 
Web site were inaccurate. Resulting changes to the PE RVUs are 
reflected in the corrected Addenda B and C.
    Due to a technical error, in Addendum B, row 8744 containing CPT/
HCPC 92287 did not list RVUs for use with both the TC and 26 modifiers. 
The corrected Addendum B, which is posted on the CMS Web site at 
www.cms.gov//PhysicianFeeSched/, includes these services and related 
information.
    Due to a technical error in Addendum B, row 9180 containing CPT/
HCPC 93657 did not list a PE RVU. The corrected Addendum B, which is 
posted on the CMS Web site at www.cms.gov//PhysicianFeeSched/ reflects 
this change.
    Due to a technical error in the posting of Addendum C, the ``NA'' 
flags did not display for services when either the facility or 
nonfacility setting did not contain a value. The corrected Addendum C, 
which is posted on the CMS Web site at www.cms.gov//PhysicianFeeSched/, 
reflects the ``NA'' flags for services that are not valued in the 
indicated setting.

III. Waiver of Proposed Rulemaking

    We ordinarily publish a notice of proposed rulemaking in the 
Federal Register to provide a period for public comment before the 
provisions of a rule take effect in accordance with section 553(b) of 
the Administrative Procedure Act (APA) (5 U.S.C. 553(b)). However, we 
can waive this notice and comment procedure if the Secretary finds, for 
good cause, that the notice and comment process is impracticable, 
unnecessary, or contrary to the public interest, and incorporates a 
statement of the finding and the reasons therefore in the notice.
    Section 553(d) of the APA ordinarily requires a 30-day delay in the 
effective date of final rules after the date of their publication in 
the Federal Register. This 30-day delay in effective date can be 
waived, however, if an agency finds for good cause that the delay is 
impracticable, unnecessary, or contrary to the public interest, and the 
agency incorporates a statement of the findings and its reasons in the 
rule issued.
    This document merely corrects typographical and technical errors in 
the preamble and addenda of the CY 2013 Physician Fee Schedule final 
rule with comment period. The provisions of that final rule with 
comment period have been subjected to notice and comment procedures. 
The corrections contained in this document are consistent with, and do 
not make substantive changes to, the policies and payment methodologies 
that were adopted in the CY 2013 PFS final rule with comment period. As 
a result, the corrections made through this correcting document are 
intended to ensure that the CY 2013 PFS final rule with comment period 
accurately reflects the policies adopted in that rule. Therefore, we 
find for good cause that it is unnecessary and would be contrary to the 
public interest to undertake further notice and comment procedures to 
incorporate the corrections in this document into the CY 2013 PFS final 
rule with comment period. For the same reasons, we find that there is 
good cause to waive the 30-day delay in the effective date for these 
corrections.
    Further, we believe that it is in the public interest to ensure 
that the CY 2013 PFS final rule with comment period accurately reflects 
our policies as of the date they take effect. Therefore, we find that 
delaying the effective date of these corrections beyond the effective 
date of the final rule with comment period would be contrary to the 
public interest. In so doing, we find good cause to waive the 30-day 
delay in effective date.

IV. Correction of Errors

    In FR Doc. 2012-26900 of November 16, 2012 (77 FR 68892), make the 
following corrections:

A. Correction of Errors in the Preamble

    1. On pages 68904 through 68906, in Table 3: Calculation of PE RVUs 
Under Methodology for Selected Codes, the table is corrected to read as 
follows:

[[Page 48998]]



                                                                                  Table 3--Calculation of PE RVUS Under Methodology for Selected Codes
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                     33533 CABG,
                                                                                                    99213 Office      arterial,      71020 Chest x-  71020-TC  Chest   71020-26 Chest     93000 ECG,       93005 ECG,       93010 ECG,
                                             Step                 Source             Formula         visit, est         single            ray             x-ray            x-ray           complete         tracing           report
                                                                                                    nonfacility        facility       nonfacility      nonfacility      nonfacility      nonfacility      nonfacility      nonfacility
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
(1) Labor cost (Lab)..............  Step 1...............  AMA.................  ...............            13.32            77.52             5.74             5.74             0.00             6.12             6.12             0.00
(2) Supply cost (Sup).............  Step 1...............  AMA.................  ...............             2.98             0.00             3.39             3.39             0.00             1.19             1.19             0.00
(3) Equipment cost (Eqp)..........  Step 1...............  AMA.................  ...............             0.17             0.58             7.24             7.24             0.00             0.11             0.11             0.00
(4) Direct cost (Dir).............  Step 1...............  ....................     =(1)+(2)+(3)            16.48            78.10            16.38            16.38             0.00             7.42             7.42             0.00
(5) Direct adjustment (Dir. Adj.).  Steps 2-4............  See footnote*.......  ...............           0.5973           0.5973           0.5973           0.5973           0.5973           0.5973           0.5973           0.5973
(6) Adjusted Labor................  Steps 2-4............  =Labor * Dir Adj....         =(1)*(5)             7.96            46.30             3.43             3.43             0.00             3.66             3.66             0.00
(7) Adjusted Supplies.............  Steps 2-4............  =Eqp * Dir Adj......         =(2)*(5)             1.78             0.00             2.03             2.03             0.00             0.71             0.71             0.00
(8) Adjusted Equipment............  Steps 2-4............  =Sup * Dir Adj......         =(3)*(5)             0.10             0.35             4.33             4.33             0.00             0.06             0.06             0.00
(9) Adjusted Direct...............  Steps 2-4............  ....................     =(6)+(7)+(8)             9.84            46.65             9.78             9.78             0.00             4.43             4.43             0.00
(10) Conversion Factor (CF).......  Step 5...............  PFS.................  ...............          34.0376          34.0376          34.0376          34.0376          34.0376          34.0376          34.0376          34.0376
(11) Adj. labor cost converted....  Step 5...............  =(Lab * Dir Adj)/CF.        =(6)/(10)             0.23             1.36             0.10             0.10             0.00             0.11             0.11             0.00
(12) Adj. supply cost converted...  Step 5...............  =(Sup * Dir Adj)/CF.        =(7)/(10)             0.05             0.00             0.06             0.06             0.00             0.02             0.02             0.00
(13) Adj. equipment cost converted  Step 5...............  =(Eqp * Dir Adj)/CF.        =(8)/(10)             0.00             0.01             0.13             0.13             0.00             0.00             0.00             0.00
(14) Adj. direct cost converted...  Step 5...............  ....................  =(11)+(12)+(13)             0.29             1.37             0.29             0.29             0.00             0.13             0.13             0.00
(15) Work RVU.....................  Setup File...........  PFS.................  ...............             0.97            33.75             0.22             0.00             0.22             0.17             0.00             0.17
(16) Dir--pct.....................  Steps 6,7............  Surveys.............  ...............             0.31             0.18             0.31             0.31             0.31             0.31             0.31             0.31
(17) Ind--pct.....................  Steps 6,7............  Surveys.............  ...............             0.69             0.82             0.69             0.69             0.69             0.69             0.69             0.69
(18) Ind. Alloc. Formula (1st       Step 8...............  See Step 8..........  ...............  ((14)/(16)*(17)  ((14)/(16)*(17)  ((14)/(16)*(17)  ((14)/(16)*(17)  ((14)/(16)*(17)  ((14)/(16)*(17)  ((14)/(16)*(17)  ((14)/(16)*(17)
 part).
(19) Ind. Alloc.(1st part)........  Step 8...............  ....................           See 18             0.87             6.41              0.7              0.7                0             0.32             0.32                0
(20) Ind. Alloc. Formula (2nd       Step 8...............  See Step 8..........  ...............             (15)             (15)          (15+11)             (11)             (15)          (15+11)             (11)             (15)
 part).
(21) Ind. Alloc.(2nd part)........  Step 8...............  ....................           See 20             0.97            33.75             0.32             0.10             0.22             0.28             0.11             0.17
(22) Indirect Allocator (1st +      Step 8...............  ....................       =(19)+(21)             1.84            40.16             1.03             0.81             0.22             0.60             0.43             0.17
 2nd).
(23) Indirect Adjustment (Ind.      Steps 9-11...........  See Footnote**......  ...............             0.40             0.40             0.40             0.40             0.40             0.40             0.40             0.40
 Adj.).

[[Page 48999]]

 
(24) Adjusted Indirect Allocator..  Steps 9-11...........  =Ind Alloc * Ind Adj  ...............             0.75            16.25             0.42             0.33             0.09             0.24             0.17             0.07
(25) Ind. Practice Cost Index       Steps 12-16..........  ....................  ...............             1.08             0.79             0.92             0.92             0.92             0.92             0.92             0.92
 (IPCI).
(26) Adjusted Indirect............  Step 17..............  = Adj.Ind Alloc *          =(24)*(25)             0.81            12.76             0.38             0.30             0.08             0.22             0.16             0.06
                                                            PCI.
(27) PE RVU.......................  Step 18..............  =(Adj Dir + Adj Ind)   =((14)+(26)) *             1.10            14.15             0.67             0.59             0.08             0.35             0.29             0.06
                                                            * budn.                         budn
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------


[[Page 49000]]

    2. On page 68907, first column, first paragraph,
    a. Line 6, the phrase ``CY 2012'' is corrected to read ``CY 2013.''
    b. Line 8, the phrase ``CY 2012'' is corrected to read ``CY 2013.''
    3. On page 68957, second column, following Table 18 is corrected by 
adding the following:
    ``6. Psychiatry Services
    For CY 2013, the CPT Editorial Panel replaced the current 
psychiatry/psychotherapy CPT codes with a new structure that allows for 
the separate reporting of E/M codes, eliminates codes based upon the 
site-of-service, establishes CPT codes for crisis, and creates a series 
of psychotherapy add-on CPT codes to describe interactive complexity 
and medication management. Many of these services are included in the 
list of Medicare telehealth services. For CY 2013, we did not propose 
any changes in Medicare telehealth payment policies related to the 
existing services described by these new codes. Therefore, the new 
codes describing services currently included on the CY 2012 list of 
Medicare telehealth services will be included on the CY 2013 list of 
Medicare telehealth services.
    In the case of pharmacologic management services, currently on the 
CY 2012 list of Medicare telehealth services, we note that the CPT 
Editorial Panel deleted CPT code 90862 (Pharmacologic management, 
including prescription, use, and review of medication with no more than 
minimal medical psychotherapy), and that for CY 2013, psychiatrists 
will bill the appropriate E/M code when furnishing pharmacologic 
management services. In order to maintain current telehealth policy for 
these services when furnished to inpatients, we are establishing a new 
HCPCS G-code, G0459 (Inpatient telehealth, pharmacologic management, 
including prescription use and review of medication with no more than 
minimal medical psychotherapy), on an interim basis for CY 2013 that 
will describe the pharmacologic management service when furnished via 
telehealth to inpatients.
    We will address any other change in telehealth policy regarding 
psychiatry services in future rulemaking.''.
    4. On page 68959, first column, partial line 5, before the phrase 
``Between 1998-2008,'' is corrected to read as follows: ``We note that 
this number does not represent a discrete number of beneficiaries; 
rather, it represents the total number of beneficiaries receiving 
therapy services under plans of care from different disciplines and 
different providers.''.
    5. On page 68965, third column, third paragraph, lines 4 and 5, the 
phrase ``a composite score'' is corrected to read ``an overall 
composite score.''
    6. On page 68966, third column, second full paragraph, lines 19 
through 21, the phrase ``[hellip]functional measures, such as is done 
with the FOTO Patient tool, for example.'' is corrected to read 
``functional measures.''
    7. On page 68967 and 68968, in Table 21: G-Codes for Claims-Based 
Functional Reporting for CY 2013, the listed entries are corrected to 
read as follows:

------------------------------------------------------------------------
 
------------------------------------------------------------------------
                Other PT/OT Primary Functional Limitation
------------------------------------------------------------------------
G8990....................  Other physical or occupational therapy
                            primary functional limitation, current
                            status, at therapy episode outset and at
                            reporting intervals.
G8991....................  Other physical or occupational therapy
                            primary functional limitation, projected
                            goal status, at therapy episode outset, at
                            reporting intervals, and at discharge or to
                            end reporting.
G8992....................  Other physical or occupational therapy
                            primary functional limitation, discharge
                            status, at discharge from therapy or to end
                            reporting.
------------------------------------------------------------------------
                Other PT/OT Primary Functional Limitation
------------------------------------------------------------------------
G8993....................  Other physical or occupational therapy
                            subsequent functional limitation, current
                            status, at therapy episode outset and at
                            reporting intervals.
G8994....................  Other physical or occupational therapy
                            subsequent functional limitation, projected
                            goal status, at therapy episode outset, at
                            reporting intervals, and at discharge or to
                            end reporting.
G8995....................  Other physical or occupational therapy
                            subsequent functional limitation, discharge
                            status, at discharge from therapy or to end
                            reporting.
------------------------------------------------------------------------
                               Swallowing
------------------------------------------------------------------------
G8996....................  Swallowing functional limitation, current
                            status at therapy episode outset and at
                            reporting intervals.
G8997....................  Swallowing functional limitation, projected
                            goal status, at therapy episode outset, at
                            reporting intervals, and at discharge or to
                            end reporting.
G8998....................  Swallowing functional limitation, discharge
                            status, at discharge from therapy or to end
                            reporting.
------------------------------------------------------------------------
                              Motor Speech
------------------------------------------------------------------------
G8999....................  Motor speech functional limitation, current
                            status at therapy episode outset and at
                            reporting intervals.
G9186....................  Motor speech functional limitation, projected
                            goal status at therapy episode outset, at
                            reporting intervals, and at discharge from
                            or to end reporting.
------------------------------------------------------------------------
                      Spoken Language Comprehension
------------------------------------------------------------------------
G9159....................  Spoken language comprehension functional
                            limitation, current status at therapy
                            episode outset and at reporting intervals.
G9160....................  Spoken language comprehension functional
                            limitation, projected goal status at therapy
                            episode outset, at reporting intervals, and
                            at discharge from or to end reporting.
G9161....................  Spoken language comprehension functional
                            limitation, discharge status at discharge
                            from therapy or to end reporting.
------------------------------------------------------------------------
                       Spoken Language Expression
------------------------------------------------------------------------
G9162....................  Spoken language expression functional
                            limitation, current status at therapy
                            episode outset and at reporting intervals.
G9163....................  Spoken language expression functional
                            limitation, projected goal status at therapy
                            episode outset, at reporting intervals, and
                            at discharge from or to end reporting.

[[Page 49001]]

 
G9164....................  Spoken language expression functional
                            limitation, discharge status at discharge
                            from therapy or to end reporting.
------------------------------------------------------------------------
                                Attention
------------------------------------------------------------------------
G9165....................  Attention functional limitation, current
                            status at therapy episode outset and at
                            reporting intervals.
G9166....................  Attention functional limitation, projected
                            goal status at therapy episode outset, at
                            reporting intervals, and at discharge from
                            or to end reporting.
G9167....................  Attention functional limitation, discharge
                            status at discharge from therapy or to end
                            reporting.
------------------------------------------------------------------------
                                 Memory
------------------------------------------------------------------------
G9168....................  Memory functional limitation, current status
                            at therapy episode outset and at reporting
                            intervals.
G9169....................  Memory functional limitation, projected goal
                            status at therapy episode outset, at
                            reporting intervals, and at discharge from
                            or to end reporting.
G9170....................  Memory functional limitation, discharge
                            status at discharge from therapy or to end
                            reporting.
------------------------------------------------------------------------
                                  Voice
------------------------------------------------------------------------
G9171....................  Voice functional limitation, current status
                            at therapy episode outset and at reporting
                            intervals.
G9172....................  Voice functional limitation, projected goal
                            status at therapy episode outset, at
                            reporting intervals, and at discharge from
                            or to end reporting.
G9173....................  Voice functional limitation, discharge status
                            at discharge from therapy or to end
                            reporting.
------------------------------------------------------------------------
                     Other SLP Functional Limitation
------------------------------------------------------------------------
G9174....................  Other speech language pathology functional
                            limitation, current status at therapy
                            episode outset and at reporting intervals.
G9175....................  Other speech language pathology functional
                            limitation, projected goal status at therapy
                            episode outset, at reporting intervals, and
                            at discharge from or to end reporting.
G9176....................  Other speech language pathology functional
                            limitation, discharge status at discharge
                            from therapy or to end reporting.
------------------------------------------------------------------------

    8. On page 69033, in the third column, after second full paragraph, 
is corrected by adding the following:
    ``(14) Needle EMG: Electromyography (CPT Codes 95886, 95887)
    In establishing interim final direct PE inputs for 2012, CMS 
refined the AMA RUC's recommendation for CPT codes 95886 (Needle 
electromyography, each extremity, with related paraspinal areas, when 
performed, done with nerve conduction, amplitude and latency/velocity 
study; complete, five or more muscles studied, innervated by three or 
more nerves or four or more spinal levels (list separately in addition 
to code for primary procedure)) and 95887 (Needle electromyography, 
non-extremity (cranial nerve supplied or axial) muscle(s) done with 
nerve conduction, amplitude and latency/velocity study (list separately 
in addition to code for primary procedure)) by reducing the number of 
service period clinical labor minutes to account for preparatory 
clinical labor tasks associated with both the base and add-on codes. 
CMS also refined the corresponding equipment minutes.
    Comment: Several commenters explained that clinical labor typically 
requires additional time to prepare the distinct equipment used in 
furnishing the services described by the add-on codes.
    Response: After reviewing the information provided by the 
commenters, we agree that it would be appropriate to incorporate 
additional minutes for these codes. Therefore, we are finalizing the 
direct PE inputs for CPT codes 95886 and 95887 with the additional 
refinement of adding two minutes to both the service period clinical 
labor time and the corresponding equipment time. The direct PE inputs 
are displayed in the final CY 2013 direct PE input database, available 
on the CMS Web site under downloads for the CY 2013 PFS final rule at 
www.cms.gov/PhysicianFeeSched/.''.
    9. On page 69042, bottom half of the page, last paragraph, last 
line, the phrase CPT code 99231 visits is corrected to read ``99231 
(subsequent hospital care, per day, for the evaluation and management 
of a patient, which requires at least 2 of these 3 key components: A 
problem focused interval history; a problem focused examination; 
medical decision making that is straightforward or of low complexity) 
visits,''.
    10. On page 69043, top of page, first column, first partial 
paragraph, lines 1 and 2, the phrase 99323 visit is corrected to read 
``99232 (subsequent hospital care, per day, for the evaluation and 
management of a patient, which requires at least 2 of these 3 key 
components: An expanded problem focused interval history; an expanded 
problem focused examination; medical decision making of moderate 
complexity) visit, 1 CPT code 99238 (hospital discharge day management; 
30 minutes or less) visit, and 4 CPT code 99213 (office or other 
outpatient visit for the evaluation and management of an established 
patient, which requires at least 2 of these 3 key components: an 
expanded problem focused history; an expanded problem focused 
examination; medical decision making of low complexity) visits.''.
    11. On page 69051,
    a. First column, first full paragraph, lines 2 through 10, the 
parenthetical ((Non-selective catheter placement, thoracic aorta, with 
angiography of the extracranial carotid, vertebral, and/or intracranial 
vessels, unilateral or bilateral, and all associated radiological 
supervision and interpretation, includes angiography of the 
cervicocerebral arch, when performed).), is corrected to read: 
``((Selective catheter placement, common carotid or innominate artery, 
unilateral, any approach, with angiography of the ipsilateral 
extracranial carotid circulation and all associated radiological 
supervision and interpretation, includes angiography of the 
cervicocerebral arch, when performed).)''.
    b. Third column, after last full paragraph, is corrected by adding 
the following:
    ``CPT codes 37620, 75940, and 36010 were identified as potentially 
misvalued through the Codes Reported Together 75 percent or More 
screen. In response, the CPT Editorial Panel created CPT codes 37191 
through 37193 and 37197 to bundle the services together. After clinical 
review of CPT code 37197 (Transcatheter retrieval, percutaneous, of 
intravascular foreign body (for example, fractured venous or arterial

[[Page 49002]]

catheter), includes radiological supervision and interpretation, and 
imaging guidance (ultrasound or fluoroscopy), when performed), along 
with the other related bundled services, we believe a work RVU of 6.29 
accurately reflects the work involved in furnishing this service. We 
believe CPT code 37197 involves similar work as CPT code 36247 
(Selective catheter placement, arterial system; initial third order or 
more selective abdominal, pelvic, or lower extremity artery branch, 
within a vascular family) and should be valued the same. Furthermore, 
we believe a work RVU of 6.29 appropriately reflects the relative 
difference in work between this service and related CPT codes 37191, 
37192, and 37193. The AMA RUC recommended a work RVU of 6.72 for CPT 
code 37197, a direct crosswalk to CPT code 36475 (Endovenous ablation 
therapy of incompetent vein, extremity, inclusive of all imaging 
guidance and monitoring, percutaneous, radiofrequency; first vein 
treated). On an interim final basis for CY 2013, we are assigning a 
work RVU of 6.29 to CPT code 37197.''.
    12. On page 69071, lower half of the page, third column,
    a. Lines 3 and 4, the phrase ``Table KK6 is corrected to read 
``Table 73.''.
    b. Line 10, the phrase ``Table KK7'' is corrected to read ``Table 
74.''.
    13. On page 69072,
    a. First column, first full paragraph, line 1, the phrase ``Table 
KK7'' is corrected to read ``Table 74.''
    b. Second column,
    (1) First full paragraph, last line, the phrase ``Table 73'' is 
corrected to read ``Table 74.''.
    (2) Second full paragraph, last line, the phrase ``Table 73'' is 
corrected to read ``Table 74.''.
    c. Third column,
    (1) First paragraph, last line, the phrase ``Table 73'' is 
corrected to read ``Table 74.''.
    (2) Second paragraph, lines 23 and 24, the phrase ``Table 73'' is 
corrected to read ``Table 74.''
    14. On page 69073, second column, second full paragraph, last line, 
the phrase ``Table 73'' is corrected to read, ``Table 74.''
    15. On page 69074, first column, following first partial paragraph, 
is corrected to read as follows:
    ``We note that we did not receive adequate information for pricing 
the following new supply and equipment items included in the AMA RUC's 
CY 2013 direct PE input recommendations: SD276 (Indicator powder), 
SK115 (Reproduced patient worksheet), SL464 (Atomizer tips, 
disposable), and ER088 (Infrared illuminator). Therefore, for CY 2013, 
these supply and equipment items have no price inputs associated with 
them in the direct PE database. We will consider any newly submitted 
information regarding appropriate pricing for these supply items as 
part of our annual supply and equipment price update process.''
    16. On pages 69077 through 69128, in Table 74: CPT Codes with 
Refined Direct PE Recommendations for CY 2013 Interim Codes is 
corrected to read as follows:

                                  TABLE 74--CPT Codes With Refined Direct PE Recommendations for CY 2013 Interim Codes
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                               RUC
                                                                                                          recommendation      CMS
       CPT Code              CPT Code       CMS Code       CMS Code       NonFac/Fac    Labor activity      or current     refinement       Comment
                           description                   description                   (if applicable)    value  (min or    (min or
                                                                                                               qty)           qty)
--------------------------------------------------------------------------------------------------------------------------------------------------------
11300.................  Shave skin lesion      ED004  camera, digital             NF  .................               29           14  Refined equipment
                         0.5 cm/<                      (6 mexapixel).                                                                   time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF014  light, surgical..           NF  .................               29           14  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF015  mayo stand.......           NF  .................               29           14  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF031  table, power.....           NF  .................               29           14  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ110  electrocautery-             NF  .................               29            0  CMS clinical
                                                       hyfrecator, up                                                                   review; not
                                                       to 45 watts.                                                                     described as
                                                                                                                                        typical in work
                                                                                                                                        vignette.
                                               EQ137  instrument pack,            NF  .................               29           24  Refined equipment
                                                       basic ($500-                                                                     time to reflect
                                                       $1499).                                                                          typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ351  Smoke                       NF  .................               29           14  Refined equipment
                                                       Evacuator(tubing                                                                 time to reflect
                                                       , covering,                                                                      typical use
                                                       etc.) with stand.                                                                exclusive to
                                                                                                                                        patient.
                                               L037D  RN/LPN/MTA.......           NF  Clean Surgical                   1           10  Standardized time
                                                                                       Instrument                                       input.
                                                                                       Package.
                                               SB003  cover, probe                NF  .................                1            0  CMS clinical
                                                       (cryosurgery).                                                                   review.
                                               SB027  gown, staff,                NF  .................                2            1  Duplicative.
                                                       impervious.
                                               SB033  mask, surgical...           NF  .................                2            1  Duplicative.

[[Page 49003]]

 
                                               SC029  needle, 18-27g...           NF  .................                1            0  CMS clinical
                                                                                                                                        review.
11301.................  Shave skin lesion      ED004  camera, digital             NF  .................               32           17  Refined equipment
                         0.6-1.0 cm.                   (6 mexapixel).                                                                   time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF014  light, surgical..           NF  .................               32           17  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF015  mayo stand.......           NF  .................               32           17  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF031  table, power.....           NF  .................               32           17  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ110  electrocautery-             NF  .................               32            0  CMS clinical
                                                       hyfrecator, up                                                                   review; not
                                                       to 45 watts.                                                                     described as
                                                                                                                                        typical in work
                                                                                                                                        vignette.
                                               EQ137  instrument pack,            NF  .................               32           27  Refined equipment
                                                       basic ($500-                                                                     time to reflect
                                                       $1499).                                                                          typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ351  Smoke Evacuator             NF  .................               32           17  Refined equipment
                                                       (tubing,                                                                         time to reflect
                                                       covering, etc.)                                                                  typical use
                                                       with stand.                                                                      exclusive to
                                                                                                                                        patient.
                                               L037D  RN/LPN/MTA.......           NF  Clean Surgical                   1           10  Standardized time
                                                                                       Instrument                                       input.
                                                                                       Package.
                                               SB003  cover, probe                NF  .................                1            0  CMS clinical
                                                       (cryosurgery).                                                                   review.
                                               SB027  gown, staff,                NF  .................                2            1  Duplicative.
                                                       impervious.
                                               SB033  mask, surgical...           NF  .................                2            1  Duplicative.
                                               SC029  needle, 18-27g...           NF  .................                1            0  CMS clinical
                                                                                                                                        review.
11302.................  Shave skin lesion      ED004  camera, digital             NF  .................               37           20  Refined equipment
                         1.1-2.0 cm.                   (6 mexapixel).                                                                   time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF014  light, surgical..           NF  .................               37           20  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF015  mayo stand.......           NF  .................               37           20  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF031  table, power.....           NF  .................               37           20  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ110  electrocautery-             NF  .................               37            0  CMS clinical
                                                       hyfrecator, up                                                                   review; not
                                                       to 45 watts.                                                                     described as
                                                                                                                                        typical in work
                                                                                                                                        vignette.
                                               EQ137  instrument pack,            NF  .................               37           30  Refined equipment
                                                       basic ($500-                                                                     time to reflect
                                                       $1499).                                                                          typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.

[[Page 49004]]

 
                                               EQ351  Smoke Evacuator             NF  .................               37           20  Refined equipment
                                                       (tubing,                                                                         time to reflect
                                                       covering, etc.)                                                                  typical use
                                                       with stand.                                                                      exclusive to
                                                                                                                                        patient.
                                               L037D  RN/LPN/MTA.......           NF  Clean Surgical                   1           10  Standardized time
                                                                                       Instrument                                       input.
                                                                                       Package.
                                               SB003  cover, probe                NF  .................                1            0  CMS clinical
                                                       (cryosurgery).                                                                   review.
                                               SB027  gown, staff,                NF  .................                2            1  Duplicative.
                                                       impervious.
                                               SB033  mask, surgical...           NF  .................                2            1  Duplicative.
                                               SC029  needle, 18-27g...           NF  .................                1            0  CMS clinical
                                                                                                                                        review.
11303.................  Shave skin lesion      ED004  camera, digital             NF  .................               41           22  Refined equipment
                         >2.0 cm.                      (6 mexapixel).                                                                   time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF014  light, surgical..           NF  .................               41           22  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF015  mayo stand.......           NF  .................               41           22  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF031  table, power.....           NF  .................               41           22  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ110  electrocautery-             NF  .................               41            0  CMS clinical
                                                       hyfrecator, up                                                                   review; not
                                                       to 45 watts.                                                                     described as
                                                                                                                                        typical in work
                                                                                                                                        vignette.
                                               EQ137  instrument pack,            NF  .................               41           32  Refined equipment
                                                       basic ($500-                                                                     time to reflect
                                                       $1499).                                                                          typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ351  Smoke Evacuator             NF  .................               41           22  Refined equipment
                                                       (tubing,                                                                         time to reflect
                                                       covering, etc.)                                                                  typical use
                                                       with stand.                                                                      exclusive to
                                                                                                                                        patient.
                                               L037D  RN/LPN/MTA.......           NF  Clean Surgical                   1           10  Standardized time
                                                                                       Instrument                                       input.
                                                                                       Package.
                                               SB003  cover, probe                NF  .................                1            0  CMS clinical
                                                       (cryosurgery).                                                                   review.
                                               SB027  gown, staff,                NF  .................                2            1  Duplicative.
                                                       impervious.
                                               SB033  mask, surgical...           NF  .................                2            1  Duplicative.
                                               SC029  needle, 18-27g...           NF  .................                1            0  CMS clinical
                                                                                                                                        review.
11305.................  Shave skin lesion      ED004  camera, digital             NF  .................               29           17  Refined equipment
                         0.5 cm/<                      (6 mexapixel).                                                                   time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF014  light, surgical..           NF  .................               29           17  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF015  mayo stand.......           NF  .................               29           17  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.

[[Page 49005]]

 
                                               EF031  table, power.....           NF  .................               29           17  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ110  electrocautery-             NF  .................               29            0  CMS clinical
                                                       hyfrecator, up                                                                   review; not
                                                       to 45 watts.                                                                     described as
                                                                                                                                        typical in work
                                                                                                                                        vignette.
                                               EQ137  instrument pack,            NF  .................               29           27  Refined equipment
                                                       basic ($500-                                                                     time to reflect
                                                       $1499).                                                                          typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ351  Smoke Evacuator             NF  .................               29           17  Refined equipment
                                                       (tubing,                                                                         time to reflect
                                                       covering, etc.)                                                                  typical use
                                                       with stand.                                                                      exclusive to
                                                                                                                                        patient.
                                               L037D  RN/LPN/MTA.......           NF  Clean Surgical                   1           10  Standardized time
                                                                                       Instrument                                       input.
                                                                                       Package.
                                               SB003  cover, probe                NF  .................                1            0  CMS clinical
                                                       (cryosurgery).                                                                   review.
                                               SB027  gown, staff,                NF  .................                2            1  Duplicative.
                                                       impervious.
                                               SB033  mask, surgical...           NF  .................                2            1  Duplicative.
                                               SC029  needle, 18-27g...           NF  .................                1            0  CMS clinical
                                                                                                                                        review.
11306.................  Shave skin lesion      ED004  camera, digital             NF  .................               31           25  Refined equipment
                         0.6-1.0 cm.                   (6 mexapixel).                                                                   time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF014  light, surgical..           NF  .................               31           25  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF015  mayo stand.......           NF  .................               31           25  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF031  table, power.....           NF  .................               31           25  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ110  electrocautery-             NF  .................               31            0  CMS clinical
                                                       hyfrecator, up                                                                   review; not
                                                       to 45 watts.                                                                     described as
                                                                                                                                        typical in work
                                                                                                                                        vignette.
                                               EQ137  instrument pack,            NF  .................               31           35  Refined equipment
                                                       basic ($500-                                                                     time to reflect
                                                       $1499).                                                                          typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ351  Smoke Evacuator             NF  .................               31           25  Refined equipment
                                                       (tubing,                                                                         time to reflect
                                                       covering, etc.)                                                                  typical use
                                                       with stand.                                                                      exclusive to
                                                                                                                                        patient.
                                               L037D  RN/LPN/MTA.......           NF  Assist physician                10           18  Conforming to
                                                                                       in performing                                    physician time.
                                                                                       procedure.
                                               L037D  RN/LPN/MTA.......           NF  Clean Surgical                   1           10  Standardized time
                                                                                       Instrument                                       input.
                                                                                       Package.
                                               SB003  cover, probe                NF  .................                1            0  CMS clinical
                                                       (cryosurgery).                                                                   review.
                                               SB027  gown, staff,                NF  .................                2            1  Duplicative.
                                                       impervious.
                                               SB033  mask, surgical...           NF  .................                2            1  Duplicative.
                                               SC029  needle, 18-27g...           NF  .................                1            0  CMS clinical
                                                                                                                                        review.

[[Page 49006]]

 
11307.................  Shave skin lesion      ED004  camera, digital             NF  .................               37           21  Refined equipment
                         1.1-2.0 cm.                   (6 mexapixel).                                                                   time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF014  light, surgical..           NF  .................               37           21  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF015  mayo stand.......           NF  .................               37           21  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF031  table, power.....           NF  .................               37           21  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ110  electrocautery-             NF  .................               37            0  CMS clinical
                                                       hyfrecator, up                                                                   review; not
                                                       to 45 watts.                                                                     described as
                                                                                                                                        typical in work
                                                                                                                                        vignette.
                                               EQ137  instrument pack,            NF  .................               37           31  Refined equipment
                                                       basic ($500-                                                                     time to reflect
                                                       $1499).                                                                          typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ351  Smoke Evacuator             NF  .................               37           21  Refined equipment
                                                       (tubing,                                                                         time to reflect
                                                       covering, etc.)                                                                  typical use
                                                       with stand.                                                                      exclusive to
                                                                                                                                        patient.
                                               L037D  RN/LPN/MTA.......           NF  Clean Surgical                   1           10  Standardized time
                                                                                       Instrument                                       input.
                                                                                       Package.
                                               SB003  cover, probe                NF  .................                1            0  CMS clinical
                                                       (cryosurgery).                                                                   review.
                                               SB027  gown, staff,                NF  .................                2            1  Duplicative.
                                                       impervious.
                                               SB033  mask, surgical...           NF  .................                2            1  Duplicative.
                                               SC029  needle, 18-27g...           NF  .................                1            0  CMS clinical
                                                                                                                                        review.
11308.................  Shave skin lesion      ED004  camera, digital             NF  .................               42           24  Refined equipment
                         >2.0 cm.                      (6 mexapixel).                                                                   time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF014  light, surgical..           NF  .................               42           24  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF015  mayo stand.......           NF  .................               42           24  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF031  table, power.....           NF  .................               42           24  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ110  electrocautery-             NF  .................               42            0  CMS clinical
                                                       hyfrecator, up                                                                   review; not
                                                       to 45 watts.                                                                     described as
                                                                                                                                        typical in work
                                                                                                                                        vignette.
                                               EQ137  instrument pack,            NF  .................               42           34  Refined equipment
                                                       basic ($500-                                                                     time to reflect
                                                       $1499).                                                                          typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.

[[Page 49007]]

 
                                               EQ351  Smoke Evacuator             NF  .................               42           24  Refined equipment
                                                       (tubing,                                                                         time to reflect
                                                       covering, etc.)                                                                  typical use
                                                       with stand.                                                                      exclusive to
                                                                                                                                        patient.
                                               L037D  RN/LPN/MTA.......           NF  Clean Surgical                   1           10  Standardized time
                                                                                       Instrument                                       input.
                                                                                       Package.
                                               SB003  cover, probe                NF  .................                1            0  CMS clinical
                                                       (cryosurgery).                                                                   review.
                                               SB027  gown, staff,                NF  .................                2            1  Duplicative.
                                                       impervious.
                                               SB033  mask, surgical...           NF  .................                2            1  Duplicative.
                                               SC029  needle, 18-27g...           NF  .................                1            0  CMS clinical
                                                                                                                                        review.
11310.................  Shave skin lesion      ED004  camera, digital             NF  .................               34           20  Refined equipment
                         0.5 cm/<                      (6 mexapixel).                                                                   time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF014  light, surgical..           NF  .................               34           20  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF015  mayo stand.......           NF  .................               34           20  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF031  table, power.....           NF  .................               34           20  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ110  electrocautery-             NF  .................               34            0  CMS clinical
                                                       hyfrecator, up                                                                   review; not
                                                       to 45 watts.                                                                     described as
                                                                                                                                        typical in work
                                                                                                                                        vignette.
                                               EQ137  instrument pack,            NF  .................               34           30  Refined equipment
                                                       basic ($500-                                                                     time to reflect
                                                       $1499).                                                                          typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ351  Smoke Evacuator             NF  .................               34           20  Refined equipment
                                                       (tubing,                                                                         time to reflect
                                                       covering, etc.)                                                                  typical use
                                                       with stand.                                                                      exclusive to
                                                                                                                                        patient.
                                               L037D  RN/LPN/MTA.......           NF  Clean Surgical                   1           10  Standardized time
                                                                                       Instrument                                       input.
                                                                                       Package.
                                               SB003  cover, probe                NF  .................                1            0  CMS clinical
                                                       (cryosurgery).                                                                   review.
                                               SB027  gown, staff,                NF  .................                2            1  Duplicative.
                                                       impervious.
                                               SB033  mask, surgical...           NF  .................                2            1  Duplicative.
                                               SC029  needle, 18-27g...           NF  .................                1            0  CMS clinical
                                                                                                                                        review.
11311.................  Shave skin lesion      ED004  camera, digital             NF  .................               34           24  Refined equipment
                         0.6-1.0 cm.                   (6 mexapixel).                                                                   time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF014  light, surgical..           NF  .................               34           24  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF015  mayo stand.......           NF  .................               34           24  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.

[[Page 49008]]

 
                                               EF031  table, power.....           NF  .................               34           24  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ110  electrocautery-             NF  .................               34            0  CMS clinical
                                                       hyfrecator, up                                                                   review; not
                                                       to 45 watts.                                                                     described as
                                                                                                                                        typical in work
                                                                                                                                        vignette.
                                               EQ137  instrument pack,            NF  .................               34           34  Refined equipment
                                                       basic ($500-                                                                     time to reflect
                                                       $1499).                                                                          typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ351  Smoke Evacuator             NF  .................               34           24  Refined equipment
                                                       (tubing,                                                                         time to reflect
                                                       covering, etc.)                                                                  typical use
                                                       with stand.                                                                      exclusive to
                                                                                                                                        patient.
                                               L037D  RN/LPN/MTA.......           NF  Assist physician                11           17  Conforming to
                                                                                       in performing                                    physician time.
                                                                                       procedure.
                                               L037D  RN/LPN/MTA.......           NF  Clean Surgical                   1           10  Standardized time
                                                                                       Instrument                                       input.
                                                                                       Package.
                                               SB003  cover, probe                NF  .................                1            0  CMS clinical
                                                       (cryosurgery).                                                                   review.
                                               SB027  gown, staff,                NF  .................                2            1  Duplicative.
                                                       impervious.
                                               SB033  mask, surgical...           NF  .................                2            1  Duplicative.
                                               SC029  needle, 18-27g...           NF  .................                1            0  CMS clinical
                                                                                                                                        review.
11312.................  Shave skin lesion      ED004  camera, digital             NF  .................               43           17  Refined equipment
                         1.1-2.0 cm.                   (6 mexapixel).                                                                   time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF014  light, surgical..           NF  .................               43           17  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF015  mayo stand.......           NF  .................               43           17  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF031  table, power.....           NF  .................               43           17  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ110  electrocautery-             NF  .................               43            0  CMS clinical
                                                       hyfrecator, up                                                                   review; not
                                                       to 45 watts.                                                                     described as
                                                                                                                                        typical in work
                                                                                                                                        vignette.
                                               EQ137  instrument pack,            NF  .................               43           37  Refined equipment
                                                       basic ($500-                                                                     time to reflect
                                                       $1499).                                                                          typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ351  Smoke Evacuator             NF  .................               43           17  Refined equipment
                                                       (tubing,                                                                         time to reflect
                                                       covering, etc.)                                                                  typical use
                                                       with stand.                                                                      exclusive to
                                                                                                                                        patient.
                                               L037D  RN/LPN/MTA.......           NF  Clean Surgical                   1           10  Standardized time
                                                                                       Instrument                                       input.
                                                                                       Package.
                                               SB003  cover, probe                NF  .................                1            0  CMS clinical
                                                       (cryosurgery).                                                                   review.
                                               SB027  gown, staff,                NF  .................                2            1  Duplicative.
                                                       impervious.
                                               SB033  mask, surgical...           NF  .................                2            1  Duplicative.
                                               SC029  needle, 18-27g...           NF  .................                1            0  CMS clinical
                                                                                                                                        review.

[[Page 49009]]

 
11313.................  Shave skin lesion      ED004  camera, digital             NF  .................               48           30  Refined equipment
                         >2.0 cm.                      (6 mexapixel).                                                                   time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF014  light, surgical..           NF  .................               48           30  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF015  mayo stand.......           NF  .................               48           30  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF031  table, power.....           NF  .................               48           30  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ110  electrocautery-             NF  .................               48            0  CMS clinical
                                                       hyfrecator, up                                                                   review; not
                                                       to 45 watts.                                                                     described as
                                                                                                                                        typical in work
                                                                                                                                        vignette.
                                               EQ137  instrument pack,            NF  .................               48           40  Refined equipment
                                                       basic ($500-                                                                     time to reflect
                                                       $1499).                                                                          typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ351  Smoke Evacuator             NF  .................               48           30  Refined equipment
                                                       (tubing,                                                                         time to reflect
                                                       covering, etc.)                                                                  typical use
                                                       with stand.                                                                      exclusive to
                                                                                                                                        patient.
                                               L037D  RN/LPN/MTA.......           NF  Clean Surgical                   1           10  Standardized time
                                                                                       Instrument                                       input.
                                                                                       Package.
                                               SB003  cover, probe                NF  .................                1            0  CMS clinical
                                                       (cryosurgery).                                                                   review.
                                               SB027  gown, staff,                NF  .................                2            1  Duplicative.
                                                       impervious.
                                               SB033  mask, surgical...           NF  .................                2            1  Duplicative.
                                               SC029  needle, 18-27g...           NF  .................                1            0  CMS clinical
                                                                                                                                        review.
11719.................  Trim nail(s) any       L037D  RN/LPN/MTA.......           NF  Greet patient,                   3            1  CMS clinical
                         number.                                                       provide gowning,                                 review.
                                                                                       assure
                                                                                       appropriate
                                                                                       medical records
                                                                                       are available.
                                               L037D  RN/LPN/MTA.......           NF  Provide pre-                     2            1  CMS clinical
                                                                                       service                                          review.
                                                                                       education/obtain
                                                                                       consent.
                                               L037D  RN/LPN/MTA.......           NF  Prepare room,                    2            1  CMS clinical
                                                                                       equipment,                                       review.
                                                                                       supplies.
                                               L037D  RN/LPN/MTA.......           NF  Clean room/                      3            1  CMS clinical
                                                                                       equipment by                                     review.
                                                                                       physician staff.
                                               SJ028  hydrogen peroxide           NF  .................               10            0  CMS clinical
                                                                                                                                        review.
                                               SJ053  swab-pad, alcohol           NF  .................               10            0  CMS clinical
                                                                                                                                        review.
13100.................  Cmplx rpr trunk        EF014  light, surgical..           NF  .................               32           27  Refined equipment
                         1.1-2.5 cm.                                                                                                    time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF015  mayo stand.......           NF  .................               32           39  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.

[[Page 49010]]

 
                                               EF023  table, exam......           NF  .................               32           27  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF031  table, power.....           NF  .................               32           39  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ114  electrosurgical             NF  .................               32           39  Refined equipment
                                                       generator, up to                                                                 time to reflect
                                                       120 watts.                                                                       typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ137  instrument pack,            NF  .................               32           46  Refined equipment
                                                       basic ($500-                                                                     time to reflect
                                                       $1499).                                                                          typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ351  Smoke Evacuator             NF  .................               32           39  Refined equipment
                                                       (tubing,                                                                         time to reflect
                                                       covering, etc.)                                                                  typical use
                                                       with stand.                                                                      exclusive to
                                                                                                                                        patient.
                                               SB016  drape-cover,                NF  .................                2            1  CMS clinical
                                                       sterile, OR                                                                      review.
                                                       light handle.
                                               SB027  gown, staff,                NF  .................                2            0  Duplicative.
                                                       impervious.
                                               SB034  mask, surgical,             NF  .................                2            1  Duplicative.
                                                       with face shield.
                                               SC029  needle, 18-27g...           NF  .................                1            0  CMS clinical
                                                                                                                                        review.
                                                      Electrocautery              NF  .................                1            0  Non-standard
                                                       Supply Pack.                                                                     direct practice
                                                                                                                                        expense input.
                                               SJ041  povidone soln               NF  .................                5            0  Duplicative.
                                                       (Betadine).
13101.................  Cmplx rpr trunk        EF014  light, surgical..           NF  .................               45           27  Refined equipment
                         2.6-7.5 cm.                                                                                                    time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF015  mayo stand.......           NF  .................               45           47  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF023  table, exam......           NF  .................               45           27  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF031  table, power.....           NF  .................               45           47  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ114  electrosurgical             NF  .................               45           47  Refined equipment
                                                       generator, up to                                                                 time to reflect
                                                       120 watts.                                                                       typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ137  instrument pack,            NF  .................               45           54  Refined equipment
                                                       basic ($500-                                                                     time to reflect
                                                       $1499).                                                                          typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ351  Smoke Evacuator             NF  .................               45           47  CMS clinical
                                                       (tubing,                                                                         review.
                                                       covering, etc.)
                                                       with stand.
                                               SB016  drape-cover,                NF  .................                2            1  CMS clinical
                                                       sterile, OR                                                                      review.
                                                       light handle.
                                               SB027  gown, staff,                NF  .................                2            0  Duplicative.
                                                       impervious.

[[Page 49011]]

 
                                               SB027  gown, staff,                 F  .................                2            0  CMS clinical
                                                       impervious.                                                                      review.
                                               SB034  mask, surgical,             NF  .................                2            1  Duplicative.
                                                       with face shield.
                                               SB034  mask, surgical,              F  .................                2            1  CMS clinical
                                                       with face shield.                                                                review.
                                               SC029  needle, 18-27g...           NF  .................                1            0  CMS clinical
                                                                                                                                        review.
                                                      Electrocautery              NF  .................                1            0  Non-standard
                                                       Supply Pack.                                                                     direct practice
                                                                                                                                        expense input.
                                               SJ041  povidone soln               NF  .................               10            0  Duplicative.
                                                       (Betadine).
13102.................  Cmplx rpr trunk        EF015  mayo stand.......           NF  .................               30           20  Refined equipment
                         addl 5cm/<                                                                                                     time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF031  table, power.....           NF  .................               30           20  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ114  electrosurgical             NF  .................               30           20  Refined equipment
                                                       generator, up to                                                                 time to reflect
                                                       120 watts.                                                                       typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ137  instrument pack,            NF  .................               30           20  Refined equipment
                                                       basic ($500-                                                                     time to reflect
                                                       $1499).                                                                          typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ351  Smoke Evacuator             NF  .................               30           20  Refined equipment
                                                       (tubing,                                                                         time to reflect
                                                       covering, etc.)                                                                  typical use
                                                       with stand.                                                                      exclusive to
                                                                                                                                        patient.
                                                      Electrocautery              NF  .................                1            0  Non-standard
                                                       Supply Pack.                                                                     direct practice
                                                                                                                                        expense input.
                                               SJ041  povidone soln               NF  .................                5            0  Duplicative.
                                                       (Betadine).
13120.................  Cmplx rpr s/a/l        EF014  light, surgical..           NF  .................               86           27  Refined equipment
                         1.1-2.5 cm.                                                                                                    time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF015  mayo stand.......           NF  .................               86           41  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF023  table, exam......           NF  .................               86           27  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF031  table, power.....           NF  .................               86           41  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ114  electrosurgical             NF  .................               86           41  Refined equipment
                                                       generator, up to                                                                 time to reflect
                                                       120 watts.                                                                       typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ137  instrument pack,            NF  .................               86           48  Refined equipment
                                                       basic ($500-                                                                     time to reflect
                                                       $1499).                                                                          typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ351  Smoke Evacuator             NF  .................               86           41  Refined equipment
                                                       (tubing,                                                                         time to reflect
                                                       covering, etc.)                                                                  typical use
                                                       with stand.                                                                      exclusive to
                                                                                                                                        patient.

[[Page 49012]]

 
                                               SB016  drape-cover,                NF  .................                2            1  CMS clinical
                                                       sterile, OR                                                                      review.
                                                       light handle.
                                               SB027  gown, staff,                NF  .................                2            0  Duplicative.
                                                       impervious.
                                               SB027  gown, staff,                 F  .................                2            0  CMS clinical
                                                       impervious.                                                                      review.
                                               SB034  mask, surgical,             NF  .................                2            1  Duplicative.
                                                       with face shield.
                                               SB034  mask, surgical,              F  .................                2            1  CMS clinical
                                                       with face shield.                                                                review.
                                               SC029  needle, 18-27g...           NF  .................                1            0  CMS clinical
                                                                                                                                        review.
                                                      Electrocautery              NF  .................                1            0  Non-standard
                                                       Supply Pack.                                                                     direct practice
                                                                                                                                        expense input.
                                               SJ041  povidone soln               NF  .................                5            0  Duplicative.
                                                       (Betadine).
13121.................  Cmplx rpr s/a/l        EF014  light, surgical..           NF  .................              129           27  Refined equipment
                         2.6-7.5 cm.                                                                                                    time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF015  mayo stand.......           NF  .................              129           48  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF023  table, exam......           NF  .................              129           27  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF031  table, power.....           NF  .................              129           48  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ114  electrosurgical             NF  .................              129           48  Refined equipment
                                                       generator, up to                                                                 time to reflect
                                                       120 watts.                                                                       typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ137  instrument pack,            NF  .................              129           55  Refined equipment
                                                       basic ($500-                                                                     time to reflect
                                                       $1499).                                                                          typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ351  Smoke Evacuator             NF  .................              129           48  Refined equipment
                                                       (tubing,                                                                         time to reflect
                                                       covering, etc.)                                                                  typical use
                                                       with stand.                                                                      exclusive to
                                                                                                                                        patient.
                                               L037D  RN/LPN/MTA.......           NF  Clean Surgical                  15           10  Standardized time
                                                                                       Instrument                                       input.
                                                                                       Package.
                                               SB016  drape-cover,                NF  .................                2            1  CMS clinical
                                                       sterile, OR                                                                      review.
                                                       light handle.
                                               SB027  gown, staff,                NF  .................                2            0  Duplicative.
                                                       impervious.
                                               SB034  mask, surgical,             NF  .................                2            1  Duplicative.
                                                       with face shield.
                                               SC029  needle, 18-27g...           NF  .................                1            0  CMS clinical
                                                                                                                                        review.
                                                      Electrocautery              NF  .................                1            0  Non-standard
                                                       Supply Pack.                                                                     direct practice
                                                                                                                                        expense input.
                                               SJ041  povidone soln               NF  .................               10            0  Duplicative.
                                                       (Betadine).
13122.................  Cmplx rpr s/a/l        EF015  mayo stand.......           NF  .................               30           20  Refined equipment
                         addl 5 cm/>                                                                                                    time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.

[[Page 49013]]

 
                                               EF031  table, power.....           NF  .................               30           20  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ114  electrosurgical             NF  .................               30           20  Refined equipment
                                                       generator, up to                                                                 time to reflect
                                                       120 watts.                                                                       typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ137  instrument pack,            NF  .................               30           20  Refined equipment
                                                       basic ($500-                                                                     time to reflect
                                                       $1499).                                                                          typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ351  Smoke Evacuator             NF  .................               30           20  Refined equipment
                                                       (tubing,                                                                         time to reflect
                                                       covering, etc.)                                                                  typical use
                                                       with stand.                                                                      exclusive to
                                                                                                                                        patient.
                                                      Electrocautery              NF  .................                1            0  Non-standard
                                                       Supply Pack.                                                                     direct practice
                                                                                                                                        expense input.
                                               SJ041  povidone soln               NF  .................                5            0  Duplicative.
                                                       (Betadine).
13131.................  Cmplx rpr f/c/c/m/     EF014  light, surgical..           NF  .................               45           27  Refined equipment
                         n/ax/g/h/f.                                                                                                    time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF015  mayo stand.......           NF  .................               45           48  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF023  table, exam......           NF  .................               45           27  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF031  table, power.....           NF  .................               45           48  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ114  electrosurgical             NF  .................               45           48  Refined equipment
                                                       generator, up to                                                                 time to reflect
                                                       120 watts.                                                                       typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ137  instrument pack,            NF  .................               45           55  Refined equipment
                                                       basic ($500-                                                                     time to reflect
                                                       $1499).                                                                          typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ351  Smoke Evacuator             NF  .................               45           48  Refined equipment
                                                       (tubing,                                                                         time to reflect
                                                       covering, etc.)                                                                  typical use
                                                       with stand.                                                                      exclusive to
                                                                                                                                        patient.
                                               SB016  drape-cover,                NF  .................                2            1  CMS clinical
                                                       sterile, OR                                                                      review.
                                                       light handle.
                                               SB027  gown, staff,                NF  .................                2            0  Duplicative.
                                                       impervious.
                                               SB034  mask, surgical,             NF  .................                2            1  Duplicative.
                                                       with face shield.
                                               SC029  needle, 18-27g...           NF  .................                1            0  CMS clinical
                                                                                                                                        review.
                                                      Electrocautery              NF  .................                1            0  Non-standard
                                                       Supply Pack.                                                                     direct practice
                                                                                                                                        expense input.
                                               SJ041  povidone soln               NF  .................                5            0  Duplicative.
                                                       (Betadine).

[[Page 49014]]

 
13132.................  Cmplx rpr f/c/c/m/     EF014  light, surgical..           NF  .................               50           27  Refined equipment
                         n/ax/g/h/f.                                                                                                    time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF015  mayo stand.......           NF  .................               50           51  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF023  table, exam......           NF  .................               50           27  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF031  table, power.....           NF  .................               50           51  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ114  electrosurgical             NF  .................               50           51  Refined equipment
                                                       generator, up to                                                                 time to reflect
                                                       120 watts.                                                                       typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ137  instrument pack,            NF  .................               50           58  Refined equipment
                                                       basic ($500-                                                                     time to reflect
                                                       $1499).                                                                          typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ351  Smoke Evacuator             NF  .................               50           51  Refined equipment
                                                       (tubing,                                                                         time to reflect
                                                       covering, etc.)                                                                  typical use
                                                       with stand.                                                                      exclusive to
                                                                                                                                        patient.
                                               SB016  drape-cover,                NF  .................                2            1  CMS clinical
                                                       sterile, OR                                                                      review.
                                                       light handle.
                                               SB027  gown, staff,                NF  .................                2            0  Duplicative.
                                                       impervious.
                                               SB034  mask, surgical,             NF  .................                2            1  Duplicative.
                                                       with face shield.
                                               SC029  needle, 18-27g...           NF  .................                1            0  CMS clinical
                                                                                                                                        review.
                                                      Electrocautery              NF  .................                1            0  Non-standard
                                                       Supply Pack.                                                                     direct practice
                                                                                                                                        expense input.
                                               SJ041  povidone soln               NF  .................               10            0  Duplicative.
                                                       (Betadine).
13133.................  Cmplx rpr f/c/c/m/     EF015  mayo stand.......           NF  .................               35           23  Refined equipment
                         n/ax/g/h/f.                                                                                                    time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF031  table, power.....           NF  .................               35           23  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ114  electrosurgical             NF  .................               35           23  Refined equipment
                                                       generator, up to                                                                 time to reflect
                                                       120 watts.                                                                       typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ137  instrument pack,            NF  .................               35           23  Refined equipment
                                                       basic ($500-                                                                     time to reflect
                                                       $1499).                                                                          typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ351  Smoke Evacuator             NF  .................               35           23  Refined equipment
                                                       (tubing,                                                                         time to reflect
                                                       covering, etc.)                                                                  typical use
                                                       with stand.                                                                      exclusive to
                                                                                                                                        patient.
                                                      Electrocautery              NF  .................                1            0  Non-standard
                                                       Supply Pack.                                                                     direct practice
                                                                                                                                        expense input.

[[Page 49015]]

 
                                               SJ041  povidone soln               NF  .................                5            0  Duplicative.
                                                       (Betadine).
13150.................  Cmplx rpr e/n/e/l      EF014  light, surgical..           NF  .................               30           27  Refined equipment
                         1.0 cm/<                                                                                                       time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF015  mayo stand.......           NF  .................               30           44  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF023  table, exam......           NF  .................               30           27  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF031  table, power.....           NF  .................               30           44  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ114  electrosurgical             NF  .................               30           44  Refined equipment
                                                       generator, up to                                                                 time to reflect
                                                       120 watts.                                                                       typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ137  instrument pack,            NF  .................               30           51  Refined equipment
                                                       basic ($500-                                                                     time to reflect
                                                       $1499).                                                                          typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ351  Smoke Evacuator             NF  .................               30           44  Refined equipment
                                                       (tubing,                                                                         time to reflect
                                                       covering, etc.)                                                                  typical use
                                                       with stand.                                                                      exclusive to
                                                                                                                                        patient.
                                               L037D  RN/LPN/MTA.......           NF  Assist physician                20           26  Conforming to
                                                                                       in performing                                    physician time.
                                                                                       procedure.
                                               SB016  drape-cover,                NF  .................                2            1  CMS clinical
                                                       sterile, OR                                                                      review.
                                                       light handle.
                                               SB027  gown, staff,                NF  .................                2            0  Duplicative.
                                                       impervious.
                                               SB034  mask, surgical,             NF  .................                2            1  Duplicative.
                                                       with face shield.
                                               SC029  needle, 18-27g...           NF  .................                1            0  CMS clinical
                                                                                                                                        review.
                                                      Electrocautery              NF  .................                1            0  Non-standard
                                                       Supply Pack.                                                                     direct practice
                                                                                                                                        expense input.
                                               SJ041  povidone soln               NF  .................                5            0  Duplicative.
                                                       (Betadine).
13151.................  Cmplx rpr e/n/e/l      EF014  light, surgical..           NF  .................               45           27  Refined equipment
                         1.1-2.5 cm.                                                                                                    time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF015  mayo stand.......           NF  .................               45           48  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF023  table, exam......           NF  .................               45           27  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF031  table, power.....           NF  .................               45           48  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.

[[Page 49016]]

 
                                               EQ114  electrosurgical             NF  .................               45           48  Refined equipment
                                                       generator, up to                                                                 time to reflect
                                                       120 watts.                                                                       typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ137  instrument pack,            NF  .................               45           55  Refined equipment
                                                       basic ($500-                                                                     time to reflect
                                                       $1499).                                                                          typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ351  Smoke Evacuator             NF  .................               45           48  Refined equipment
                                                       (tubing,                                                                         time to reflect
                                                       covering, etc.)                                                                  typical use
                                                       with stand.                                                                      exclusive to
                                                                                                                                        patient.
                                               SB016  drape-cover,                NF  .................                2            1  CMS clinical
                                                       sterile, OR                                                                      review.
                                                       light handle.
                                               SB027  gown, staff,                NF  .................                2            0  Duplicative.
                                                       impervious.
                                               SB034  mask, surgical,             NF  .................                2            1  Duplicative.
                                                       with face shield.
                                               SC029  needle, 18-27g...           NF  .................                1            0  CMS clinical
                                                                                                                                        review.
                                                      Electrocautery              NF  .................                1            0  Non-standard
                                                       Supply Pack.                                                                     direct practice
                                                                                                                                        expense input.
                                               SJ041  povidone soln               NF  .................                5            0  Duplicative.
                                                       (Betadine).
13152.................  Cmplx rpr e/n/e/l      EF014  light, surgical..           NF  .................               50           27  Refined equipment
                         2.6-7.5 cm.                                                                                                    time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF015  mayo stand.......           NF  .................               50           51  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF023  table, exam......           NF  .................               50           27  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF031  table, power.....           NF  .................               50           51  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ114  electrosurgical             NF  .................               50           51  Refined equipment
                                                       generator, up to                                                                 time to reflect
                                                       120 watts.                                                                       typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ137  instrument pack,            NF  .................               50           58  Refined equipment
                                                       basic ($500-                                                                     time to reflect
                                                       $1499).                                                                          typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ351  Smoke Evacuator             NF  .................               50           51  Refined equipment
                                                       (tubing,                                                                         time to reflect
                                                       covering, etc.)                                                                  typical use
                                                       with stand.                                                                      exclusive to
                                                                                                                                        patient.
                                               L037D  RN/LPN/MTA.......           NF  .................               15           10  Standardized time
                                                                                                                                        input.
                                               SB016  drape-cover,                NF  .................                2            1  CMS clinical
                                                       sterile, OR                                                                      review.
                                                       light handle.
                                               SB027  gown, staff,                NF  .................                2            0  Duplicative.
                                                       impervious.
                                               SB034  mask, surgical,             NF  .................                2            1  Duplicative.
                                                       with face shield.
                                                      Electrocautery              NF  .................                1            0  Non-standard
                                                       Supply Pack.                                                                     direct practice
                                                                                                                                        expense input.
                                               SJ041  povidone soln               NF  .................               10            0  Duplicative.
                                                       (Betadine).

[[Page 49017]]

 
13153.................  Cmplx rpr e/n/e/l      EF015  mayo stand.......           NF  .................               45           30  Refined equipment
                         addl 5cm/<                                                                                                     time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF031  table, power.....           NF  .................               45           30  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ114  electrosurgical             NF  .................               45           30  Refined equipment
                                                       generator, up to                                                                 time to reflect
                                                       120 watts.                                                                       typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ137  instrument pack,            NF  .................               45           30  Refined equipment
                                                       basic ($500-                                                                     time to reflect
                                                       $1499).                                                                          typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ351  Smoke Evacuator             NF  .................               45           30  Refined equipment
                                                       (tubing,                                                                         time to reflect
                                                       covering, etc.)                                                                  typical use
                                                       with stand.                                                                      exclusive to
                                                                                                                                        patient.
                                               SC029  needle, 18-27g...           NF  .................                2            0  CMS clinical
                                                                                                                                        review.
                                                      Electrocautery              NF  .................                1            0  Non-standard
                                                       Supply Pack.                                                                     direct practice
                                                                                                                                        expense input.
                                               SJ041  povidone soln               NF  .................                5            0  Duplicative.
                                                       (Betadine).
20600.................  Drain/inject           EF023  table, exam......           NF  .................               19           16  Refined equipment
                         joint/bursa.                                                                                                   time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ168  light, exam......           NF  .................               19           16  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               L037D  RN/LPN/MTA.......            F  Discharge day                    6            0  CMS clinical
                                                                                       management.                                      review.
                                               L037D  RN/LPN/MTA.......            F  Conduct phone                    0            3  CMS clinical
                                                                                       calls/call in                                    review.
                                                                                       prescriptions.
                                               SC029  needle, 18-27g...           NF  .................                4            2  CMS clinical
                                                                                                                                        review.
                                               SC055  syringe 3ml......           NF  .................                2            1  CMS clinical
                                                                                                                                        review.
20605.................  Drain/inject           EF023  table, exam......           NF  .................               19           16  Refined equipment
                         joint/bursa.                                                                                                   time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ168  light, exam......           NF  .................               19           16  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               L037D  RN/LPN/MTA.......            F  Discharge day                    6            0  CMS clinical
                                                                                       management.                                      review.
                                               L037D  RN/LPN/MTA.......            F  Conduct phone                    0            3  CMS clinical
                                                                                       calls/call in                                    review.
                                                                                       prescriptions.
                                               SC029  needle, 18-27g...           NF  .................                4            2  CMS clinical
                                                                                                                                        review.
                                               SC055  syringe 3ml......           NF  .................                2            1  CMS clinical
                                                                                                                                        review.
20610.................  Drain/inject           EF023  table, exam......           NF  .................               19           16  Refined equipment
                         joint/bursa.                                                                                                   time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.

[[Page 49018]]

 
                                               EQ168  light, exam......           NF  .................               19           16  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               L037D  RN/LPN/MTA.......            F  Discharge day                    6            0  CMS clinical
                                                                                       management.                                      review.
                                               L037D  RN/LPN/MTA.......            F  Conduct phone                    0            3  CMS clinical
                                                                                       calls/call in                                    review.
                                                                                       prescriptions.
                                               SC029  needle, 18-27g...           NF  .................                4            2  CMS clinical
                                                                                                                                        review.
                                               SC057  syringe 5-6ml....           NF  .................                2            1  CMS clinical
                                                                                                                                        review.
23472.................  Reconstruct            SA052  pack, post-op                F  .................                0            1  CMS clinical
                         shoulder joint.               incision care                                                                    review.
                                                       (staple).
                                               SA053  pack, post-op                F  .................                1            0  CMS clinical
                                                       incision care                                                                    review.
                                                       (suture &
                                                       staple).
23473.................  Revis reconst          SA052  pack, post-op                F  .................                0            1  CMS clinical
                         shoulder joint.               incision care                                                                    review.
                                                       (staple).
                                               SA053  pack, post-op                F  .................                1            0  CMS clinical
                                                       incision care                                                                    review.
                                                       (suture &
                                                       staple).
23474.................  Revis reconst          SA052  pack, post-op                F  .................                0            1  CMS clinical
                         shoulder joint.               incision care                                                                    review.
                                                       (staple).
                                               SA053  pack, post-op                F  .................                1            0  CMS clinical
                                                       incision care                                                                    review.
                                                       (suture &
                                                       staple).
24363.................  Replace elbow          SA052  pack, post-op                F  .................                0            1  CMS clinical
                         joint.                        incision care                                                                    review.
                                                       (staple).
                                               SA053  pack, post-op                F  .................                1            0  CMS clinical
                                                       incision care                                                                    review.
                                                       (suture &
                                                       staple).
24370.................  Revise reconst         SA052  pack, post-op                F  .................                0            1  CMS clinical
                         elbow joint.                  incision care                                                                    review.
                                                       (staple).
                                               SA053  pack, post-op                F  .................                1            0  CMS clinical
                                                       incision care                                                                    review.
                                                       (suture &
                                                       staple).
24371.................  Revise reconst         SA052  pack, post-op                F  .................                0            1  CMS clinical
                         elbow joint.                  incision care                                                                    review.
                                                       (staple).
                                               SA053  pack, post-op                F  .................                1            0  CMS clinical
                                                       incision care                                                                    review.
                                                       (suture &
                                                       staple).
31231.................  Nasal endoscopy        ED032  printer, laser,             NF  .................               43           35  Refined equipment
                         dx.                           paper.                                                                           time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF008  chair with                  NF  .................               43           35  Refined equipment
                                                       headrest, exam,                                                                  time to reflect
                                                       reclining.                                                                       typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ138  instrument pack,            NF  .................                0           47  Refined equipment
                                                       medium ($1500                                                                    time to reflect
                                                       and up).                                                                         typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ167  light source,               NF  .................               43           35  Refined equipment
                                                       xenon.                                                                           time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ170  light, fiberoptic           NF  .................               43           35  Refined equipment
                                                       headlight w-                                                                     time to reflect
                                                       source.                                                                          typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.

[[Page 49019]]

 
                                               EQ234  suction and                 NF  .................               43           35  Refined equipment
                                                       pressure                                                                         time to reflect
                                                       cabinet, ENT                                                                     typical use
                                                       (SMR).                                                                           exclusive to
                                                                                                                                        patient.
                                               ES013  endoscope, rigid,           NF  .................               63           42  Refined equipment
                                                       sinoscopy.                                                                       time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               ES013  endoscope, rigid,           NF  .................               63            0  CMS clinical
                                                       sinoscopy.                                                                       review.
                                               ES031  video system,               NF  .................               43           35  Refined equipment
                                                       endoscopy                                                                        time to reflect
                                                       (processor,                                                                      typical use
                                                       digital capture,                                                                 exclusive to
                                                       monitor,                                                                         patient.
                                                       printer, cart).
                                               ES036  Nasal Endoscopy             NF  .................               63            0  Non-standard
                                                       Instrument                                                                       direct practice
                                                       Package.                                                                         expense input.
                                               L037D  RN/LPN/MTA.......           NF  Greet patient,                   2            0  CMS clinical
                                                                                       provide gowning,                                 review.
                                                                                       assure
                                                                                       appropriate
                                                                                       medical records
                                                                                       are available.
                                               L037D  RN/LPN/MTA.......           NF  Obtain vital                     1            0  CMS clinical
                                                                                       signs.                                           review.
                                               L037D  RN/LPN/MTA.......           NF  Clean Surgical                  10           15  Standardized time
                                                                                       Instrument                                       input.
                                                                                       Package.
                                               L037D  RN/LPN/MTA.......           NF  Review/read X-                   5            0  CMS clinical
                                                                                       ray, lab, and                                    review.
                                                                                       pathology
                                                                                       reports.
                                               SB027  gown, staff,                NF  .................                2            1  Duplicative.
                                                       impervious.
                                               SB034  mask, surgical,             NF  .................                2            1  Duplicative.
                                                       with face shield.
31647.................  Bronchial valve        L047C  RN/Respiratory               F  Complete pre-                    3            5  CMS clinical
                         init insert.                  Therapist.                      service                                          review.
                                                                                       diagnostic &
                                                                                       referral forms.
                                               L047C  RN/Respiratory               F  Coordinate pre-                  5            3  CMS clinical
                                                       Therapist.                      surgery services.                                review.
32554.................  Aspirate pleura w/     EF023  table, exam......           NF  .................               56           52  Refined equipment
                         o imaging.                                                                                                     time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ168  light, exam......           NF  .................                0           52  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               L037D  RN/LPN/MTA.......           NF  Complete pre-                    5            0  CMS clinical
                                                                                       service                                          review.
                                                                                       diagnostic &
                                                                                       referral forms.
                                               L037D  RN/LPN/MTA.......           NF  Coordinate pre-                  3            1  CMS clinical
                                                                                       surgery services.                                review.
                                               L037D  RN/LPN/MTA.......           NF  Monitor pt.                      5           10  CMS clinical
                                                                                       following                                        review.
                                                                                       service/check
                                                                                       tubes, monitors,
                                                                                       drains.
                                               SA048  pack, minimum               NF  .................                0            1  CMS clinical
                                                       multi-specialty                                                                  review.
                                                       visit.
                                               SA067  tray, shave prep.           NF  .................                0            1  CMS clinical
                                                                                                                                        review.
                                           .........  kit,                        NF  .................                1            0  CMS clincial
                                                       thoracentesis.                                                                   review.
                                               SA070  tray,                       NF  .................                0            1  CMS clincial
                                                       thoracentesis.                                                                   review.
                                               SA077  kit, pleural                NF  .................                0            1  CMS clinical
                                                       catheter                                                                         review.
                                                       insertion.
                                               SB001  cap, surgical....           NF  .................                0            2  CMS clinical
                                                                                                                                        review.

[[Page 49020]]

 
                                               SB006  drape, non-                 NF  .................                1            0  CMS clinical
                                                       sterile, sheet                                                                   review.
                                                       40in x 60in.
                                               SB024  gloves, sterile..           NF  .................                1            2  CMS clinical
                                                                                                                                        review.
                                               SB034  mask, surgical,             NF  .................                0            2  CMS clinical
                                                       with face shield.                                                                review.
                                               SB039  shoe covers,                NF  .................                0            2  CMS clinical
                                                       surgical.                                                                        review.
                                               SB044  underpad 2ft x              NF  .................                0            1  CMS clinical
                                                       3ft (Chux).                                                                      review.
                                               SG056  gauze, sterile              NF  .................                1            0  CMS clinical
                                                       4in x 4in (10                                                                    review.
                                                       pack uou).
32555.................  Aspirate pleura w/     ED024  film processor,             NF  .................               58            7  Refined equipment
                         imaging.                      dry, laser.                                                                      time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF019  stretcher chair..           NF  .................               15           10  CMS clinical
                                                                                                                                        review.
                                               EL015  room, ultrasound,           NF  .................               33           30  Refined equipment
                                                       general.                                                                         time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               ER029  film alternator             NF  .................               58            7  Refined equipment
                                                       (motorized film                                                                  time to reflect
                                                       viewbox).                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               L041B  Radiologic                  NF  Complete pre-                    5            0  CMS clinical
                                                       Technologist.                   service                                          review.
                                                                                       diagnostic &
                                                                                       referral forms.
                                               L041B  Radiologic                  NF  Coordinate pre-                  3            1  CMS clinical
                                                       Technologist.                   surgery services.                                review.
                                               L041B  Radiologic                  NF  Monitor pt.                     15           10  CMS clinical
                                                       Technologist.                   following                                        review.
                                                                                       service/check
                                                                                       tubes, monitors,
                                                                                       drains.
                                               L041B  Radiologic                  NF  Process images,                  5            2  CMS clinical
                                                       Technologist.                   complete data                                    review.
                                                                                       sheet, present
                                                                                       images and data
                                                                                       to the
                                                                                       interpreting
                                                                                       physician.
                                                      kit,                        NF  .................                1            0  CMS clinical
                                                       thoracentesis.                                                                   review.
                                               SA070  tray,                       NF  .................                0            1  CMS clinical
                                                       thoracentesis.                                                                   review.
                                               SA077  kit, pleural                NF  .................                0            1  CMS clinical
                                                       catheter                                                                         review.
                                                       insertion.
                                               SB001  cap, surgical....           NF  .................                0            3  CMS clinical
                                                                                                                                        review.
                                               SB027  gown, staff,                NF  .................                0            1  CMS clinical
                                                       impervious.                                                                      review.
                                               SB039  shoe covers,                NF  .................                0            3  CMS clinical
                                                       surgical.                                                                        review.
                                               SB044  underpad 2ft x              NF  .................                0            1  CMS clinical
                                                       3ft (Chux).                                                                      review.
                                               SG078  tape, surgical              NF  .................                0           15  CMS clinical
                                                       occlusive 1in                                                                    review.
                                                       (Blenderm).
                                               SM012  disinfectant                NF  .................               10            0  CMS clinical
                                                       spray                                                                            review.
                                                       (Transeptic).
                                               SM021  sanitizing cloth-           NF  .................                2            0  CMS clinical
                                                       wipe (patient).                                                                  review.
32556.................  Insert cath            EQ168  light, exam......           NF  .................                0           76  Refined equipment
                         pleura w/o image.                                                                                              time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               L037D  RN/LPN/MTA.......           NF  Complete pre-                    5            0  CMS clinical
                                                                                       service                                          review.
                                                                                       diagnostic &
                                                                                       referral forms.

[[Page 49021]]

 
                                               L037D  RN/LPN/MTA.......           NF  Coordinate pre-                  3            1  CMS clinical
                                                                                       surgery services.                                review.
                                               SA044  pack, moderate              NF  .................                0            1  CMS clinical
                                                       sedation.                                                                        review.
                                               SA048  pack, minimum               NF  .................                0            1  CMS clinical
                                                       multi-specialty                                                                  review.
                                                       visit.
                                               SA067  tray, shave prep.           NF  .................                0            1  CMS clinical
                                                                                                                                        review.
                                               SB001  cap, surgical....           NF  .................                0            2  CMS clinical
                                                                                                                                        review.
                                               SB006  drape, non-                 NF  .................                1            0  CMS clinical
                                                       sterile, sheet                                                                   review.
                                                       40in x 60in.
                                               SB034  mask, surgical,             NF  .................                0            2  CMS clinical
                                                       with face shield.                                                                review.
                                               SB039  shoe covers,                NF  .................                0            2  CMS clinical
                                                       surgical.                                                                        review.
                                               SB044  underpad 2ft x              NF  .................                0            1  CMS clinical
                                                       3ft (Chux).                                                                      review.
                                               SC010  closed flush                NF  .................                0            1  CMS clinical
                                                       system,                                                                          review.
                                                       angiography.
                                               SG056  gauze, sterile              NF  .................                1            0  CMS clinical
                                                       4in x 4in (10                                                                    review.
                                                       pack uou).
                                               SH065  sodium chloride             NF  .................                0            1  CMS clinical
                                                       0.9% flush                                                                       review.
                                                       syringe.
                                               SH069  sodium chloride             NF  .................                0            1  CMS clinical
                                                       0.9% irrigation                                                                  review.
                                                       (500-1000ml uou).
                                               SL157  cup, sterile, 8             NF  .................                0            1  CMS clinical
                                                       oz.                                                                              review.
32557.................  Insert cath            ED024  film processor,             NF  .................               58            7  CMS clinical
                         pleura w/image.               dry, laser.                                                                      review.
                                               EF019  stretcher chair..           NF  .................               15           10  CMS clinical
                                                                                                                                        review.
                                               EL007  room, CT.........           NF  .................               43           40  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ168  light, exam......           NF  .................               60           40  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               ER029  film alternator             NF  .................               58            7  CMS clinical
                                                       (motorized film                                                                  review.
                                                       viewbox).
                                               L046A  CT Technologist..           NF  Complete pre-                    5            0  CMS clinical
                                                                                       service                                          review.
                                                                                       diagnostic &
                                                                                       referral forms.
                                               L046A  CT Technologist..           NF  Coordinate pre-                  3            1  CMS clinical
                                                                                       surgery services.                                review.
                                               L046A  CT Technologist..           NF  Check dressings &                3            5  CMS clinical
                                                                                       wound/home care                                  review.
                                                                                       instructions/
                                                                                       coordinate
                                                                                       office visits/
                                                                                       prescriptions.
                                               L046A  CT Technologist..           NF  Assist physician                28           30  Conforming to
                                                                                       in performing                                    physician time.
                                                                                       procedure.
                                               SA071  kit, AccuStick II           NF  .................                1            0  CMS clinical
                                                       Introducer                                                                       review.
                                                       System with RO
                                                       Marker.
                                               SA077  kit, pleural                NF  .................                0            1  CMS clinical
                                                       catheter                                                                         review.
                                                       insertion.
                                               SB001  cap, surgical....           NF  .................                2            3  CMS clinical
                                                                                                                                        review.
                                               SB011  drape, sterile,             NF  .................                1            0  CMS clinical
                                                       fenestrated 16in                                                                 review.
                                                       x 29in.

[[Page 49022]]

 
                                               SB014  drape, sterile,             NF  .................                1            0  CMS clinical
                                                       three-quarter                                                                    review.
                                                       sheet.
                                               SB019  drape-towel,                NF  .................                4            0  CMS clinical
                                                       sterile 18in x                                                                   review.
                                                       26in.
                                               SB024  gloves, sterile..           NF  .................                2            1  CMS clinical
                                                                                                                                        review.
                                               SB027  gown, staff,                NF  .................                0            1  CMS clinical
                                                       impervious.                                                                      review.
                                               SB039  shoe covers,                NF  .................                2            3  CMS clinical
                                                       surgical.                                                                        review.
                                               SC049  stop cock, 3-way.           NF  .................                1            0  CMS clinical
                                                                                                                                        review.
                                               SC056  syringe 50-60ml..           NF  .................                2            0  CMS clinical
                                                                                                                                        review.
                                               SC058  syringe w-needle,           NF  .................                1            0  CMS clinical
                                                       OSHA compliant                                                                   review.
                                                       (SafetyGlide).
                                               SD043  dilator, vessel,            NF  .................                1            0  CMS clinical
                                                       angiographic.                                                                    review.
                                               SD088  guidewire........           NF  .................                1            0  CMS clinical
                                                                                                                                        review.
                                               SD146  catheter                    NF  .................                1            0  CMS clinical
                                                       percutaneous                                                                     review.
                                                       fastener (Percu-
                                                       Stay).
                                               SD161  drainage                    NF  .................                1            0  CMS clinical
                                                       catheter, all                                                                    review.
                                                       purpose.
                                               SD163  drainage pouch,             NF  .................                1            0  CMS clinical
                                                       nephrostomy-                                                                     review.
                                                       biliary.
                                               SF007  blade, surgical             NF  .................                1            0  CMS clinical
                                                       (Bard-Parker).                                                                   review.
                                               SG009  applicator,                 NF  .................                4            0  CMS clinical
                                                       sponge-tipped.                                                                   review.
                                               SG078  tape, surgical              NF  .................                0           25  CMS clinical
                                                       occlusive 1in                                                                    review.
                                                       (Blenderm).
                                               SH047  lidocaine 1%-2%             NF  .................               10            0  CMS clinical
                                                       inj (Xylocaine).                                                                 review.
                                               SJ041  povidone soln               NF  .................               60            0  CMS clinical
                                                       (Betadine).                                                                      review.
                                               SL036  cup, biopsy-                NF  .................                1            0  CMS clinical
                                                       specimen sterile                                                                 review.
                                                       4oz.
                                               SL156  cup, sterile, 12-           NF  .................                1            0  CMS clinical
                                                       16 oz.                                                                           review.
33361.................  Replace aortic         L037D  RN/LPN/MTA.......            F  Coordinate pre-                 40           10  Standardized time
                         valve perq.                                                   surgery services.                                input.
                                               L037D  RN/LPN/MTA.......            F  Schedule space                   8            5  Standardized time
                                                                                       and equipment in                                 input.
                                                                                       facility.
                                               L037D  RN/LPN/MTA.......            F  Provide pre-                    20            7  Standardized time
                                                                                       service                                          input.
                                                                                       education/obtain
                                                                                       consent.
                                               L037D  RN/LPN/MTA.......            F  Follow-up phone                  7            3  Standardized time
                                                                                       calls &                                          input.
                                                                                       prescriptions.
33362.................  Replace aortic         L037D  RN/LPN/MTA.......            F  Coordinate pre-                 40           10  Standardized time
                         valve open.                                                   surgery services.                                input.
                                               L037D  RN/LPN/MTA.......            F  Schedule space                   8            5  Standardized time
                                                                                       and equipment in                                 input.
                                                                                       facility.
                                               L037D  RN/LPN/MTA.......            F  Provide pre-                    20            7  Standardized time
                                                                                       service                                          input.
                                                                                       education/obtain
                                                                                       consent.
                                               L037D  RN/LPN/MTA.......            F  Follow-up phone                  7            3  Standardized time
                                                                                       calls &                                          input.
                                                                                       prescriptions.
33363.................  Replace aortic         L037D  RN/LPN/MTA.......            F  Coordinate pre-                 40           10  Standardized time
                         valve open.                                                   surgery services.                                input.
                                               L037D  RN/LPN/MTA.......            F  Schedule space                   8            5  Standardized time
                                                                                       and equipment in                                 input.
                                                                                       facility.
                                               L037D  RN/LPN/MTA.......            F  Provide pre-                    20            7  Standardized time
                                                                                       service                                          input.
                                                                                       education/obtain
                                                                                       consent.
                                               L037D  RN/LPN/MTA.......            F  Follow-up phone                  7            3  Standardized time
                                                                                       calls &                                          input.
                                                                                       prescriptions.

[[Page 49023]]

 
33364.................  Replace aortic         L037D  RN/LPN/MTA.......            F  Coordinate pre-                 40           10  Standardized time
                         valve open.                                                   surgery services.                                input.
                                               L037D  RN/LPN/MTA.......            F  Schedule space                   8            5  Standardized time
                                                                                       and equipment in                                 input.
                                                                                       facility.
                                               L037D  RN/LPN/MTA.......            F  Provide pre-                    20            7  Standardized time
                                                                                       service                                          input.
                                                                                       education/obtain
                                                                                       consent.
                                               L037D  RN/LPN/MTA.......            F  Follow-up phone                  7            3  Standardized time
                                                                                       calls &                                          input.
                                                                                       prescriptions.
33365.................  Replace aortic         L037D  RN/LPN/MTA.......            F  Coordinate pre-                 40           10  Standardized time
                         valve open.                                                   surgery services.                                input.
                                               L037D  RN/LPN/MTA.......            F  Schedule space                   8            5  Standardized time
                                                                                       and equipment in                                 input.
                                                                                       facility.
                                               L037D  RN/LPN/MTA.......            F  Provide pre-                    20            7  Standardized time
                                                                                       service                                          input.
                                                                                       education/obtain
                                                                                       consent.
                                               L037D  RN/LPN/MTA.......            F  Follow-up phone                  7            3  Standardized time
                                                                                       calls &                                          input.
                                                                                       prescriptions.
33366.................  N/A.....      L037D  RN/LPN/MTA.......            F  Coordinate pre-                 40           10  Standardized time
                                                                                       surgery services.                                input.
                                               L037D  RN/LPN/MTA.......            F  Schedule space                   8            5  Standardized time
                                                                                       and equipment in                                 input.
                                                                                       facility.
                                               L037D  RN/LPN/MTA.......            F  Provide pre-                    20            7  Standardized time
                                                                                       service                                          input.
                                                                                       education/obtain
                                                                                       consent.
                                               L037D  RN/LPN/MTA.......            F  Follow-up phone                  7            3  Standardized time
                                                                                       calls &                                          input.
                                                                                       prescriptions.
33405.................  Replacement of         L051A  RN...............            F  Other Clinical                  15            0  CMS clinical
                         aortic valve.                                                 Activity--specif                                 review.
                                                                                       y: for reference
                                                                                       code 33406 and
                                                                                       codes 33405 and
                                                                                       33430:
                                                                                       Additional
                                                                                       coordination
                                                                                       between multiple
                                                                                       specialties for
                                                                                       complex
                                                                                       procedures
                                                                                       (tests, meds,
                                                                                       scheduling, etc)
                                                                                       prior to patient
                                                                                       arrival at site
                                                                                       of service..
                                               L051A  RN...............            F  Other Clinical                  15            0  CMS clinical
                                                                                       Activity--specif                                 review.
                                                                                       y: for reference
                                                                                       code 33406 and
                                                                                       codes 33405 and
                                                                                       33430:
                                                                                       Additional
                                                                                       coordination
                                                                                       between multiple
                                                                                       specialties for
                                                                                       complex
                                                                                       procedures
                                                                                       (tests, meds,
                                                                                       scheduling, etc)
                                                                                       prior to patient
                                                                                       arrival at site
                                                                                       of service..
35475.................  Repair arterial        EL011  room, angiography           NF  .................               51           52  Refined equipment
                         blockage.                                                                                                      time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ011  ECG, 3-channel              NF  .................              212          285  Moderate Sedation
                                                       (with SpO2,                                                                      equipment--Time
                                                       NIBP, temp,                                                                      includes
                                                       resp).                                                                           administering
                                                                                                                                        anesthesia,
                                                                                                                                        procedure time,
                                                                                                                                        and monitoring
                                                                                                                                        patient.

[[Page 49024]]

 
                                               EQ032  IV infusion pump.           NF  .................              212          285  Moderate Sedation
                                                                                                                                        equipment--Time
                                                                                                                                        includes
                                                                                                                                        administering
                                                                                                                                        anesthesia,
                                                                                                                                        procedure time,
                                                                                                                                        and monitoring
                                                                                                                                        patient.
                                               EQ168  light, exam......           NF  .................              120           52  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               L037D  RN/LPN/MTA.......            F  Complete pre-                    5            3  CMS clinical
                                                                                       service                                          review.
                                                                                       diagnostic &
                                                                                       referral forms.
                                               L037D  RN/LPN/MTA.......           NF  Obtain vital                     5            3  CMS clinical
                                                                                       signs.                                           review.
                                               L041B  Radiologic                  NF  Prepare room,                    4            2  Standardized time
                                                       Technologist.                   equipment,                                       input.
                                                                                       supplies.
                                               SB019  drape-towel,                NF  .................                4            2  CMS clinical
                                                       sterile 18in x                                                                   review.
                                                       26in.
35476.................  Repair venous          Ef027  table,                      NF  .................              302          277  Moderate Sedation
                         blockage.                     instrument,                                                                      equipment--Time
                                                       mobile.                                                                          includes
                                                                                                                                        administering
                                                                                                                                        anesthesia,
                                                                                                                                        procedure time,
                                                                                                                                        and monitoring
                                                                                                                                        patient.
                                               EL011  room, angiography           NF  .................               43           44  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ011  ECG, 3-channel              NF  .................              137          277  Moderate Sedation
                                                       (with SpO2,                                                                      equipment--Time
                                                       NIBP, temp,                                                                      includes
                                                       resp).                                                                           administering
                                                                                                                                        anesthesia,
                                                                                                                                        procedure time,
                                                                                                                                        and monitoring
                                                                                                                                        patient.
                                               EQ032  IV infusion pump.           NF  .................              137          277  Moderate Sedation
                                                                                                                                        equipment--Time
                                                                                                                                        includes
                                                                                                                                        administering
                                                                                                                                        anesthesia,
                                                                                                                                        procedure time,
                                                                                                                                        and monitoring
                                                                                                                                        patient.
                                               EQ168  light, exam......           NF  .................              120           44  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               L037D  RN/LPN/MTA.......            F  Schedule space                   3            5  CMS clinical
                                                                                       and equipment in                                 review.
                                                                                       facility.
                                               L037D  RN/LPN/MTA.......           NF  Obtain vital                     5            3  CMS clinical
                                                                                       signs.                                           review.
                                               L041B  Radiologic                  NF  Prepare room,                    4            2  Standardized time
                                                       Technologist.                   equipment,                                       input.
                                                                                       supplies.
                                               SB019  drape-towel,                NF  .................                4            2  CMS clinical
                                                       sterile 18in x                                                                   review.
                                                       26in.
36221.................  Place cath             EF018  stretcher........           NF  .................              272            0  CMS Code
                         thoracic aorta.                                                                                                correction.
                                               EF027  table,                      NF  .................                0          272  CMS Code
                                                       instrument,                                                                      correction.
                                                       mobile.
                                               EL011  room, angiography           NF  .................               49           45  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.

[[Page 49025]]

 
                                               EQ088  contrast media              NF  .................               49           45  Refined equipment
                                                       warmer.                                                                          time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               ER029  film alternator             NF  .................               49           45  Refined equipment
                                                       (motorized film                                                                  time to reflect
                                                       viewbox).                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               L037D  RN/LPN/MTA.......           NF  Greet patient,                   5            3  Standardized time
                                                                                       provide gowning,                                 input.
                                                                                       assure
                                                                                       appropriate
                                                                                       medical records
                                                                                       are available.
                                               L037D  RN/LPN/MTA.......           NF  Obtain vital                     5            3  CMS clinical
                                                                                       signs.                                           review.
                                               L041A  Angio Technician.           NF  Image Post                       5            0  CMS clinical
                                                                                       Processing.                                      review.
                                               L041B  Radiologic                  NF  Prepare room,                    2            7  CMS clinical
                                                       Technologist.                   equipment,                                       review.
                                                                                       supplies.
                                               L041B  Radiologic                  NF  Prepare and                      2            7  CMS clinical
                                                       Technologist.                   position patient/                                review.
                                                                                       monitor patient/
                                                                                       set up IV.
                                               SD249  Sterile Radio-              NF  .................                1            0  CMS clinical
                                                       opaque ruler (le                                                                 review.
                                                       Maitre,
                                                       documentation
                                                       available).
36222.................  Place cath             EF018  stretcher........           NF  .................              282            0  CMS Code
                         carotid/inom art.                                                                                              correction.
                                               EF027  table,                      NF  .................                0          282  CMS Code
                                                       instrument,                                                                      correction.
                                                       mobile.
                                               EL011  room, angiography           NF  .................               59           55  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ088  contrast media              NF  .................               59           55  Refined equipment
                                                       warmer.                                                                          time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               ER029  film alternator             NF  .................               59           55  Refined equipment
                                                       (motorized film                                                                  time to reflect
                                                       viewbox).                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               L037D  RN/LPN/MTA.......           NF  Greet patient,                   5            3  Standardized time
                                                                                       provide gowning,                                 input.
                                                                                       assure
                                                                                       appropriate
                                                                                       medical records
                                                                                       are available.
                                               L037D  RN/LPN/MTA.......           NF  Obtain vital                     5            3  CMS clinical
                                                                                       signs.                                           review.
                                               SD147  catheter, (Glide)           NF  .................                1            0  CMS clinical
                                                                                                                                        review.
                                               SD249  Sterile Radio-              NF  .................                1            0  CMS clinical
                                                       opaque ruler (le                                                                 review.
                                                       Maitre,
                                                       documentation
                                                       available).
36223.................  Place cath             EF018  stretcher........           NF  .................              287            0  CMS Code
                         carotid/inom art.                                                                                              correction.
                                               EF027  table,                      NF  .................                0          287  CMS Code
                                                       instrument,                                                                      correction.
                                                       mobile.
                                               EL011  room, angiography           NF  .................               64           60  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.

[[Page 49026]]

 
                                               EQ088  contrast media              NF  .................               64           60  Refined equipment
                                                       warmer.                                                                          time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               ER029  film alternator             NF  .................               64           60  Refined equipment
                                                       (motorized film                                                                  time to reflect
                                                       viewbox).                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               L037D  RN/LPN/MTA.......           NF  Greet patient,                   5            3  Standardized time
                                                                                       provide gowning,                                 input.
                                                                                       assure
                                                                                       appropriate
                                                                                       medical records
                                                                                       are available.
                                               L037D  RN/LPN/MTA.......           NF  Obtain vital                     5            3  CMS clinical
                                                                                       signs.                                           review.
                                               SD249  Sterile Radio-              NF  .................                1            0  CMS clinical
                                                       opaque ruler (le                                                                 review.
                                                       Maitre,
                                                       documentation
                                                       available).
36224.................  Place cath carotd      EF018  stretcher........           NF  .................              292            0  CMS Code
                         art.                                                                                                           correction.
                                               EF027  table,                      NF  .................                0          292  CMS Code
                                                       instrument,                                                                      correction.
                                                       mobile.
                                               EL011  room, angiography           NF  .................               69           65  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ088  contrast media              NF  .................               69           65  Refined equipment
                                                       warmer.                                                                          time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               ER029  film alternator             NF  .................               69           65  Refined equipment
                                                       (motorized film                                                                  time to reflect
                                                       viewbox).                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               L037D  RN/LPN/MTA.......           NF  Greet patient,                   5            3  Standardized time
                                                                                       provide gowning,                                 input.
                                                                                       assure
                                                                                       appropriate
                                                                                       medical records
                                                                                       are available.
                                               L037D  RN/LPN/MTA.......           NF  Obtain vital                     5            3  CMS clinical
                                                                                       signs.                                           review.
36225.................  Place cath             EF018  stretcher........           NF  .................              287            0  CMS Code
                         subclavian art.                                                                                                correction.
                                               EF027  table,                      NF  .................                0          287  CMS Code
                                                       instrument,                                                                      correction.
                                                       mobile.
                                               EL011  room, angiography           NF  .................               64           60  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ088  contrast media              NF  .................               64           60  Refined equipment
                                                       warmer.                                                                          time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               ER029  film alternator             NF  .................               64           60  Refined equipment
                                                       (motorized film                                                                  time to reflect
                                                       viewbox).                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               L037D  RN/LPN/MTA.......           NF  Greet patient,                   5            3  Standardized time
                                                                                       provide gowning,                                 input.
                                                                                       assure
                                                                                       appropriate
                                                                                       medical records
                                                                                       are available.
                                               L037D  RN/LPN/MTA.......           NF  Obtain vital                     5            3  CMS clinical
                                                                                       signs.                                           review.

[[Page 49027]]

 
36226.................  Place cath             EF018  stretcher........           NF  .................              292            0  CMS Code
                         vertebral art.                                                                                                 correction.
                                               EF027  table,                      NF  .................                0          292  CMS Code
                                                       instrument,                                                                      correction.
                                                       mobile.
                                               EL011  room, angiography           NF  .................               69           65  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ088  contrast media              NF  .................               69           65  Refined equipment
                                                       warmer.                                                                          time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               ER029  film alternator             NF  .................               69           65  Refined equipment
                                                       (motorized film                                                                  time to reflect
                                                       viewbox).                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               L037D  RN/LPN/MTA.......           NF  Greet patient,                   5            3  Standardized time
                                                                                       provide gowning,                                 input.
                                                                                       assure
                                                                                       appropriate
                                                                                       medical records
                                                                                       are available.
                                               L037D  RN/LPN/MTA.......           NF  Obtain vital                     5            3  CMS clinical
                                                                                       signs.                                           review.
36228.................  Place cath             L041B  Radiologic                  NF  Prepare room,                    1            0  CMS clinical
                         intracranial art.             Technologist.                   equipment,                                       review.
                                                                                       supplies.
                                               L041B  Radiologic                  NF  Assisting with                  23           22  CMS clinical
                                                       Technologist.                   flouroscopy/                                     review.
                                                                                       image
                                                                                       acquisition
                                                                                       (75%).
                                               SC057  syringe 5-6ml....           NF  .................                4            0  CMS clinical
                                                                                                                                        review.
37197.................  Remove intrvas         EF027  table,                      NF  .................              305          302  Moderate Sedation
                         foreign body.                 instrument,                                                                      equipment--Time
                                                       mobile.                                                                          includes
                                                                                                                                        administering
                                                                                                                                        anesthesia,
                                                                                                                                        procedure time,
                                                                                                                                        and monitoring
                                                                                                                                        patient.
                                               EL011  room, angiography           NF  .................               77           72  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ011  ECG, 3-channel              NF  .................              305          302  Moderate Sedation
                                                       (with SpO2,                                                                      equipment--Time
                                                       NIBP, temp,                                                                      includes
                                                       resp).                                                                           administering
                                                                                                                                        anesthesia,
                                                                                                                                        procedure time,
                                                                                                                                        and monitoring
                                                                                                                                        patient.
                                               EQ032  IV infusion pump.           NF  .................              305          302  Moderate Sedation
                                                                                                                                        equipment--Time
                                                                                                                                        includes
                                                                                                                                        administering
                                                                                                                                        anesthesia,
                                                                                                                                        procedure time,
                                                                                                                                        and monitoring
                                                                                                                                        patient.
                                               EQ088  contrast media              NF  .................               77            0  CMS clinical
                                                       warmer.                                                                          review.
                                               EQ250  ultrasound unit,            NF  .................               77            0  CMS clinical
                                                       portable.                                                                        review.
                                               ER029  film alternator             NF  .................               77           72  Refined equipment
                                                       (motorized film                                                                  time to reflect
                                                       viewbox).                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.

[[Page 49028]]

 
                                               L037D  RN/LPN/MTA.......           NF  Greet patient,                   5            3  Standardized time
                                                                                       provide gowning,                                 input.
                                                                                       assure
                                                                                       appropriate
                                                                                       medical records
                                                                                       are available.
                                               L037D  RN/LPN/MTA.......           NF  Obtain vital                     5            3  CMS clinical
                                                                                       signs.                                           review.
                                               L041B  Radiologic                  NF  Prepare room,                    7            5  CMS clinical
                                                       Technologist.                   equipment,                                       review.
                                                                                       supplies
                                                                                       (including
                                                                                       imaging
                                                                                       equipment).
                                               L041B  Radiologic                  NF  Prepare and                      5            2  Standardized time
                                                       Technologist.                   position patient/                                input.
                                                                                       monitor patient/
                                                                                       set up IV.
                                               SB005  cover-condom,               NF  .................                1            0  CMS clinical
                                                       transducer or                                                                    review.
                                                       ultrasound probe.
                                               SB048  sheath-cover,               NF  .................                1            0  CMS clinical
                                                       sterile, 96in x                                                                  review.
                                                       6in (transducer).
                                               SD147  catheter, (Glide)           NF  .................                1            0  CMS clinical
                                                                                                                                        review.
                                               SD252  guidewire,                  NF  .................                1            0  CMS clinical
                                                       Amplatz wire 260                                                                 review.
                                                       cm.
                                               SH065  sodium chloride             NF  .................                2            0  CMS clinical
                                                       0.9% flush                                                                       review.
                                                       syringe.
47600.................  Removal of             SA053  pack, post-op                F  .................                1            0  CMS clinical
                         gallbladder.                  incision care                                                                    review.
                                                       (suture &
                                                       staple).
                                               SA054  pack, post-op                F  .................                0            1  CMS clinical
                                                       incision care                                                                    review.
                                                       (suture).
47605.................  Removal of             SA053  pack, post-op                F  .................                1            0  CMS clinical
                         gallbladder.                  incision care                                                                    review.
                                                       (suture &
                                                       staple).
                                               SA054  pack, post-op                F  .................                0            1  CMS clinical
                                                       incision care                                                                    review.
                                                       (suture).
50590.................  Fragmenting of         EL014  room,                       NF  .................               86            0  Consistent with
                         kidney stone.                 radiographic-                                                                    the AMA RUC's
                                                       fluoroscopic.                                                                    CY2011
                                                                                                                                        recommendation.
                                               EQ175  lithotriptor,               NF  .................               86           67  Refined equipment
                                                       with C-arm                                                                       time to reflect
                                                       (ESWL).                                                                          typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
52214.................  Cystoscopy and         EF027  table,                      NF  .................              100           65  Refined equipment
                         treatment.                    instrument,                                                                      time to reflect
                                                       mobile.                                                                          typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF031  table, power.....           NF  .................              100           65  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ137  instrument pack,            NF  .................              100           65  Refined equipment
                                                       basic ($500-                                                                     time to reflect
                                                       $1499).                                                                          typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ153  laser (gs, uro,             NF  .................              100           65  Refined equipment
                                                       obg, ge) (Indigo                                                                 time to reflect
                                                       Optima).                                                                         typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ167  light source,               NF  .................              100           65  Refined equipment
                                                       xenon.                                                                           time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.

[[Page 49029]]

 
                                               ES006  endoscope                   NF  .................              100           65  Refined equipment
                                                       forceps, biopsy.                                                                 time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               ES007  endoscope                   NF  .................              100           65  Refined equipment
                                                       forceps,                                                                         time to reflect
                                                       grasping.                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               ES018  fiberscope,                 NF  .................              100           92  Refined equipment
                                                       flexible,                                                                        time to reflect
                                                       cystoscopy.                                                                      typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               ES031  video system,               NF  .................              100           65  Refined equipment
                                                       endoscopy                                                                        time to reflect
                                                       (processor,                                                                      typical use
                                                       digital capture,                                                                 exclusive to
                                                       monitor,                                                                         patient.
                                                       printer, cart).
                                               L037D  RN/LPN/MTA.......           NF  Review Chart.....                3            0  CMS clinical
                                                                                                                                        review.
                                               SB019  drape-towel,                NF  .................                1            0  Duplicative.
                                                       sterile 18in x
                                                       26in.
                                               SB024  gloves, sterile..           NF  .................                0            1  CMS clinical
                                                                                                                                        review.
                                               SD270  Penis clamp......           NF  .................                1            0  Not a disposable
                                                                                                                                        according to
                                                                                                                                        submitted
                                                                                                                                        invoice.
                                               SH047  lidocaine 1%-2%             NF  .................               50            0  Duplicative.
                                                       inj (Xylocaine).
52224.................  Cystoscopy and         EF027  table,                      NF  .................              105           67  Refined equipment
                         treatment.                    instrument,                                                                      time to reflect
                                                       mobile.                                                                          typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF031  table, power.....           NF  .................              105           67  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ137  instrument pack,            NF  .................              105           67  Refined equipment
                                                       basic ($500-                                                                     time to reflect
                                                       $1499).                                                                          typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ153  laser (gs, uro,             NF  .................              105           67  Refined equipment
                                                       obg, ge) (Indigo                                                                 time to reflect
                                                       Optima).                                                                         typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ167  light source,               NF  .................              105           67  Refined equipment
                                                       xenon.                                                                           time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               ES006  endoscope                   NF  .................              105           67  Refined equipment
                                                       forceps, biopsy.                                                                 time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               ES007  endoscope                   NF  .................              105           67  Refined equipment
                                                       forceps,                                                                         time to reflect
                                                       grasping.                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               ES018  fiberscope,                 NF  .................              105           94  Refined equipment
                                                       flexible,                                                                        time to reflect
                                                       cystoscopy.                                                                      typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               ES031  video system,               NF  .................              105           67  Refined equipment
                                                       endoscopy                                                                        time to reflect
                                                       (processor,                                                                      typical use
                                                       digital capture,                                                                 exclusive to
                                                       monitor,                                                                         patient.
                                                       printer, cart).

[[Page 49030]]

 
                                               L037D  RN/LPN/MTA.......           NF  Review Chart.....                3            0  CMS clinical
                                                                                                                                        review.
                                               L037D  RN/LPN/MTA.......           NF  Prepare biopsy                   5            2  CMS clinical
                                                                                       Specimen.                                        review.
                                               SB019  drape-towel,                NF  .................                1            0  Duplicative.
                                                       sterile 18in x
                                                       26in.
                                               SB024  gloves, sterile..           NF  .................                3            1  CMS clinical
                                                                                                                                        review.
                                               SD270  Penis clamp......           NF  .................                1            0  Not a disposable
                                                                                                                                        according to
                                                                                                                                        submitted
                                                                                                                                        invoice.
                                               SH047  lidocaine 1%-2%             NF  .................               50            0  Duplicative.
                                                       inj (Xylocaine).
                                               SL036  cup, biopsy-                NF  .................                6            3  CMS clinical
                                                       specimen sterile                                                                 review.
                                                       4oz.
52287.................  Cystoscopy             EF027  table,                      NF  .................               78           49  Refined equipment
                         chemodenervation.             instrument,                                                                      time to reflect
                                                       mobile.                                                                          typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF031  table, power.....           NF  .................               78           49  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ170  light, fiberoptic           NF  .................               78           49  Refined equipment
                                                       headlight w-                                                                     time to reflect
                                                       source.                                                                          typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               ES018  fiberscope,                 NF  .................               78           76  Refined equipment
                                                       flexible,                                                                        time to reflect
                                                       cystoscopy.                                                                      typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               ES031  video system,               NF  .................               78           49  Refined equipment
                                                       endoscopy                                                                        time to reflect
                                                       (processor,                                                                      typical use
                                                       digital capture,                                                                 exclusive to
                                                       monitor,                                                                         patient.
                                                       printer, cart).
                                               L037D  RN/LPN/MTA.......           NF  Assist physician                20           21  Conforming to
                                                                                       in performing                                    physician time.
                                                                                       procedure.
                                               SH048  lidocaine 2%                NF  .................               10            0  Duplicative.
                                                       jelly, topical
                                                       (Xylocaine).
53850.................  Prostatic              EF020  stretcher,                  NF  .................               99           85  Refined equipment
                         microwave                     endoscopy.                                                                       time to reflect
                         thermotx.                                                                                                      typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF027  table,                      NF  .................               99           85  Refined equipment
                                                       instrument,                                                                      time to reflect
                                                       mobile.                                                                          typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF031  table, power.....           NF  .................              169          152  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF031  table, power.....            F  .................              169          152  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ037  TUMT system                 NF  .................               99           85  Refined equipment
                                                       control unit.                                                                    time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ168  light, exam......           NF  .................              169          152  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.

[[Page 49031]]

 
                                               EQ168  light, exam......            F  .................              169          152  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ250  ultrasound unit,            NF  .................               99           85  Refined equipment
                                                       portable.                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               L037D  RN/LPN/MTA.......           NF  Prepare room,                    2            4  CMS clinical
                                                                                       equipment,                                       review.
                                                                                       supplies.
                                               L037D  RN/LPN/MTA.......           NF  Setup ultrasound                 5            0  CMS clinical
                                                                                       probe.                                           review.
                                               L037D  RN/LPN/MTA.......           NF  Setup TUMT                       5            0  CMS clinical
                                                                                       machine.                                         review.
                                               L037D  RN/LPN/MTA.......           NF  Clean TUMT                       3            0  CMS clinical
                                                                                       machine.                                         review.
                                               SB022  gloves, non-                NF  .................                3            2  CMS clinical
                                                       sterile.                                                                         review.
                                               SB024  gloves, sterile..           NF  .................                3            2  CMS clinical
                                                                                                                                        review.
                                               SH047  lidocaine 1%-2%             NF  .................                3           30  CMS clinical
                                                       inj (Xylocaine).                                                                 review.
64612.................  Destroy nerve          EL006  lane, screening              F  .................               39           27  Refined equipment
                         face muscle.                  (oph).                                                                           time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EL006  lane, screening             NF  .................               48           45  Refined equipment
                                                       (oph).                                                                           time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               SC031  needle, 30g......            F  .................                0            1  CMS clinical
                                                                                                                                        review.
64615.................  Chemodenerv musc       EF023  table, exam......           NF  .................               24           18  Refined equipment
                         migraine.                                                                                                      time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
65800.................  Drainage of eye..      EL006  Lane, Screening..           NF  .................               21           22  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ137  instrument pack,            NF  .................               21           22  Refined equipment
                                                       basic ($500-                                                                     time to reflect
                                                       $1499).                                                                          typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
67810.................  Biopsy eyelid &        EF014  light, surgical..           NF  .................               20           22  Refined equipment
                         lid margin.                                                                                                    time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF031  table, power.....           NF  .................               20           22  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ110  electrocautery-             NF  .................                1           22  Refined equipment
                                                       hyfrecator, up                                                                   time to reflect
                                                       to 45 watts.                                                                     typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ137  instrument pack,            NF  .................                1           30  Refined equipment
                                                       basic ($500-                                                                     time to reflect
                                                       $1499).                                                                          typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               SB011  drape, sterile,             NF  .................                0            1  CMS clinical
                                                       fenestrated 16in                                                                 review.
                                                       x 29in.
                                               SB019  drape-towel,                NF  .................                4            1  CMS clinical
                                                       sterile 18in x                                                                   review.
                                                       26in.

[[Page 49032]]

 
                                               SC029  needle, 18-27g...           NF  .................                1            0  Standardized time
                                                                                                                                        input.
72040.................  X-ray exam neck        ED025  film processor,             NF  .................               20            4  Refined equipment
                         spine 3/vws.                 wet.                                                                             time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EL012  room, basic                 NF  .................               36           25  Refined equipment
                                                       radiology.                                                                       time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               ER029  film alternator             NF  .................               36            8  Refined equipment
                                                       (motorized film                                                                  time to reflect
                                                       viewbox).                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                                      Film jacket or              NF  .................                1            0  Non-standard
                                                       jacket insert.                                                                   direct practice
                                                                                                                                        expense input.
72191.................  Ct angiograph          EL007  room, CT.........           NF  .................              101           40  Refined equipment
                         pelv w/o&w/dye.                                                                                                time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               L041B  Radiologic                  NF  Retrieve prior                   0            5  CMS clinical
                                                       Technologist.                   appropriate                                      review.
                                                                                       imaging exams
                                                                                       and hang for MD
                                                                                       review, verify
                                                                                       orders, review
                                                                                       the chart to
                                                                                       incorporate
                                                                                       relevant
                                                                                       clinical
                                                                                       information.
                                               L041B  Radiologic                  NF  Greet patient,                   0            3  CMS clinical
                                                       Technologist.                   provide gowning,                                 review.
                                                                                       assure
                                                                                       appropriate
                                                                                       medical records
                                                                                       are available.

[[Page 49033]]

 
                                               L041B  Radiologic                  NF  Education/                       0            2  CMS clinical
                                                       Technologist.                   instruction/                                     review.
                                                                                       counseling/
                                                                                       obtain consent.
                                               L041B  Radiologic                  NF  Prepare room,                    0            2  Standardized time
                                                       Technologist.                   equipment,                                       input.
                                                                                       supplies.
                                               L041B  Radiologic                  NF  Prepare and                      0            7  CMS clinical
                                                       Technologist.                   position patient/                                review.
                                                                                       monitor patient/
                                                                                       set up IV.
                                               L041B  Radiologic                  NF  Aquire images....                0           28  CMS clinical
                                                       Technologist.                                                                    review.
                                               L041B  Radiologic                  NF  Clean room/                      0            3  CMS clinical
                                                       Technologist.                   equipment by                                     review.
                                                                                       physician staff.
                                               L046A  CT Technologist..           NF  Retrieve prior                   5            0  CMS clinical
                                                                                       appropriate                                      review.
                                                                                       imaging exams
                                                                                       and hang for MD
                                                                                       review, verify
                                                                                       orders, review
                                                                                       the chart to
                                                                                       incorporate
                                                                                       relevant
                                                                                       clinical
                                                                                       information.
                                               L046A  CT Technologist..           NF  Greet patient,                   3            0  CMS clinical
                                                                                       provide gowning,                                 review.
                                                                                       assure
                                                                                       appropriate
                                                                                       medical records
                                                                                       are available.
                                               L046A  CT Technologist..           NF  Education/                       2            0  CMS clinical
                                                                                       instruction/                                     review.
                                                                                       counseling/
                                                                                       obtain consent.
                                               L046A  CT Technologist..           NF  Prepare room,                    5            0  CMS clinical
                                                                                       equipment,                                       review.
                                                                                       supplies.
                                               L046A  CT Technologist..           NF  Prepare and                      7            0  CMS clinical
                                                                                       position patient/                                review.
                                                                                       monitor patient/
                                                                                       set up IV.
                                               L046A  CT Technologist..           NF  Aquire images....               28            0  CMS clinical
                                                                                                                                        review.
                                               L046A  CT Technologist..           NF  Clean room/                      3            0  CMS clinical
                                                                                       equipment by                                     review.
                                                                                       physician staff.
                                               SK016  computer media,             NF  .................                1          0.1  CMS clinical
                                                       optical disk                                                                     review.
                                                       2.6gb.
72192.................  Ct pelvis w/o dye      ED024  film processor,             NF  .................                5            0  CMS clinical
                                                       dry, laser.                                                                      review.
                                               ED032  printer, laser,             NF  .................                0            5  CMS clinical
                                                       paper.                                                                           review.
                                               EL007  room, CT.........           NF  .................               45           22  CMS clinical
                                                                                                                                        review.
                                               L046A  CT Technologist..           NF  Pre-Service                      6            4  CMS clinical
                                                                                       Period.                                          review.
                                               SK013  computer media,             NF  .................                1            0  CMS clinical
                                                       dvd.                                                                             review.
                                               SK016  computer media,             NF  .................                0          0.1  CMS clinical
                                                       optical disk                                                                     review.
                                                       2.6gb.
                                               SK076  slide sleeve                NF  .................                0            1  CMS clinical
                                                       (photo slides).                                                                  review.
                                               SK091  x-ray envelope...           NF  .................                1            0  CMS clinical
                                                                                                                                        review.
                                               SK098  film, x-ray,                NF  .................                4            8  CMS clinical
                                                       laser print.                                                                     review.
72193.................  Ct pelvis w/dye..      ED024  film processor,             NF  .................                5            0  CMS clinical
                                                       dry, laser.                                                                      review.
                                               ED032  printer, laser,             NF  .................                0            5  CMS clinical
                                                       paper.                                                                           review.
                                               EL007  room, CT.........           NF  .................               40           32  CMS clinical
                                                                                                                                        review.
                                               L046A  CT Technologist..           NF  Pre-Service                      7            4  CMS clinical
                                                                                       Period.                                          review.
                                               L046A  CT Technologist..           NF  Service Period...               40           43  CMS clinical
                                                                                                                                        review.

[[Page 49034]]

 
                                               SB006  drape, non-                 NF  .................                1            0  CMS clinical
                                                       sterile, sheet                                                                   review.
                                                       40in x 60in.
                                               SB014  drape, sterile,             NF  .................                0            1  CMS clinical
                                                       three-quarter                                                                    review.
                                                       sheet.
                                               SC001  angiocatheter 14g-          NF  .................                1            0  CMS clinical
                                                       24g.                                                                             review.
                                               SC002  angiocatheter set           NF  .................                0            1  CMS clinical
                                                                                                                                        review.
                                               SC025  needle, 14-20g,             NF  .................                0            1  CMS clinical
                                                       biopsy.                                                                          review.
                                               SC029  needle, 18-27g...           NF  .................                1            0  CMS clinical
                                                                                                                                        review.
                                               SC059  syringe, 25ml               NF  .................                0            1  CMS clinical
                                                       (MRI power                                                                       review.
                                                       injector).
                                               SG068  plaster bandage             NF  .................                1            0  CMS clinical
                                                       (4in x 5yd uou).                                                                 review.
                                               SG075  tape, elastic,              NF  .................                0            6  CMS clinical
                                                       1in                                                                              review.
                                                       (Elastoplast,
                                                       Elasticon) (5yd
                                                       uou).
                                               SG079  tape, surgical              NF  .................                6            0  CMS clinical
                                                       paper 1in                                                                        review.
                                                       (Micropore).
                                               SH065  sodium chloride             NF  .................                0           15  CMS clinical
                                                       0.9% flush                                                                       review.
                                                       syringe.
                                               SK013  computer media,             NF  .................                1            0  CMS clinical
                                                       dvd.                                                                             review.
                                               SK016  computer media,             NF  .................                0          0.1  CMS clinical
                                                       optical disk                                                                     review.
                                                       2.6gb.
                                               SK076  slide sleeve                NF  .................                0            1  CMS clinical
                                                       (photo slides).                                                                  review.
                                               SK091  x-ray envelope...           NF  .................                1            0  CMS clinical
                                                                                                                                        review.
72194.................  Ct pelvis w/o & w/     ED024  film processor,             NF  .................               10            7  CMS clinical
                         dye.                          dry, laser.                                                                      review.
                                               EL007  room, CT.........           NF  .................               54           39  CMS clinical
                                                                                                                                        review.
                                               ER029  film alternator             NF  .................               10            7  CMS clinical
                                                       (motorized film                                                                  review.
                                                       viewbox).
                                               L046A  CT Technologist..           NF  Pre-Service                      7            4  CMS clinical
                                                                                       Period.                                          review.
                                               L046A  CT Technologist..           NF  Service Period...               54           52  CMS clinical
                                                                                                                                        review.
                                               SC025  needle, 14-20g,             NF  .................                0            1  CMS clinical
                                                       biopsy.                                                                          review.
                                               SC029  needle, 18-27g...           NF  .................                1            0  CMS clinical
                                                                                                                                        review.
                                               SK013  computer media,             NF  .................                1            0  CMS clinical
                                                       dvd.                                                                             review.
                                               SK016  computer media,             NF  .................                0          0.1  CMS clinical
                                                       optical disk                                                                     review.
                                                       2.6gb.
                                               SK076  slide sleeve                NF  .................                0            1  CMS clinical
                                                       (photo slides).                                                                  review.
                                               SK091  x-ray envelope...           NF  .................                1            0  CMS clinical
                                                                                                                                        review.
                                               SK098  film, x-ray,                NF  .................                0            8  CMS clinical
                                                       laser print.                                                                     review.
73221.................  Mri joint upr          ED024  film processor,             NF  .................               63           33  Refined equipment
                         extrem w/o dye.               dry, laser.                                                                      time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EL008  room, MR.........           NF  .................               63           33  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               ER029  film alternator             NF  .................               63           33  Refined equipment
                                                       (motorized film                                                                  time to reflect
                                                       viewbox).                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.

[[Page 49035]]

 
                                               L047A  MRI Technologist.           NF  Prepare room,                    5            3  CMS clinical
                                                                                       equipment,                                       review.
                                                                                       supplies.
                                               L047A  MRI Technologist.           NF  Prepare and                      3            2  Standardized time
                                                                                       position patient/                                input.
                                                                                       monitor patient/
                                                                                       set up IV.
                                               L047A  MRI Technologist.           NF  Escort patient                   2            0  Non-standard
                                                                                       from exam room                                   direct practice
                                                                                       due to magnetic                                  expense input.
                                                                                       sensitivity.
                                                      Insert folder....           NF  .................                1            0  Non-standard
                                                                                                                                        direct practice
                                                                                                                                        expense input.
73721.................  Mri jnt of lwr         ED024  film processor,             NF  .................               63           33  Refined equipment
                         extre w/o dye.                dry, laser.                                                                      time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EL008  room, MR.........           NF  .................               63           33  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               ER029  film alternator             NF  .................               63           33  Refined equipment
                                                       (motorized film                                                                  time to reflect
                                                       viewbox).                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               L047A  MRI Technologist.           NF  Prepare room,                    5            3  CMS clinical
                                                                                       equipment,                                       review.
                                                                                       supplies.
                                               L047A  MRI Technologist.           NF  Prepare and                      3            2  Standardized time
                                                                                       position patient/                                input.
                                                                                       monitor patient/
                                                                                       set up IV.
                                               L047A  MRI Technologist.           NF  Escort patient                   2            0  Non-standard
                                                                                       from exam room                                   direct practice
                                                                                       due to magnetic                                  expense input.
                                                                                       sensitivity.
                                                      Insert folder....           NF  .................                1            0  Non-standard
                                                                                                                                        direct practice
                                                                                                                                        expense input.
74150.................  Ct abdomen w/o         ED024  film processor,             NF  .................                5            0  CMS clinical
                         dye.                          dry, laser.                                                                      review.
                                               ED032  printer, laser,             NF  .................                0            5  CMS clinical
                                                       paper.                                                                           review.
                                               EL007  room, CT.........           NF  .................               32           22  CMS clinical
                                                                                                                                        review.
                                               L046A  CT Technologist..           NF  Pre-Service                      6            4  CMS clinical
                                                                                       Period.                                          review.
                                               SK013  computer media,             NF  .................                1            0  CMS clinical
                                                       dvd.                                                                             review.
                                               SK016  computer media,             NF  .................                0          0.1  CMS clinical
                                                       optical disk                                                                     review.
                                                       2.6gb.
                                               SK076  slide sleeve                NF  .................                0            1  CMS clinical
                                                       (photo slides).                                                                  review.
                                               SK091  x-ray envelope...           NF  .................                1            0  CMS clinical
                                                                                                                                        review.
                                               SK098  film, x-ray,                NF  .................                4            8  CMS clinical
                                                       laser print.                                                                     review.
74160.................  Ct abdomen w/dye.      ED024  film processor,             NF  .................                7            0  CMS clinical
                                                       dry, laser.                                                                      review.
                                               ED032  printer, laser,             NF  .................                0            5  CMS clinical
                                                       paper.                                                                           review.
                                               EL007  room, CT.........           NF  .................               47           32  CMS clinical
                                                                                                                                        review.
                                               ER029  film alternator             NF  .................                7            5  CMS clinical
                                                       (motorized film                                                                  review.
                                                       viewbox).
                                               L046A  CT Technologist..           NF  Pre-Service                      7            4  CMS clinical
                                                                                       Period.                                          review.
                                               L046A  CT Technologist..           NF  Service Period...               47           43  CMS clinical
                                                                                                                                        review.
                                               SB006  drape, non-                 NF  .................                1            0  CMS clinical
                                                       sterile, sheet                                                                   review.
                                                       40in x 60in.

[[Page 49036]]

 
                                               SB014  drape, sterile,             NF  .................                0            1  CMS clinical
                                                       three-quarter                                                                    review.
                                                       sheet.
                                               SC001  angiocatheter 14g-          NF  .................                1            0  CMS clinical
                                                       24g.                                                                             review.
                                               SC002  angiocatheter set           NF  .................                0            1  CMS clinical
                                                                                                                                        review.
                                               SC025  needle, 14-20g,             NF  .................                0            1  CMS clinical
                                                       biopsy.                                                                          review.
                                               SC029  needle, 18-27g...           NF  .................                1            0  CMS clinical
                                                                                                                                        review.
                                               SC059  syringe, 25ml               NF  .................                0            1  CMS clinical
                                                       (MRI power                                                                       review.
                                                       injector).
                                               SG075  tape, elastic,              NF  .................                0            6  CMS clinical
                                                       1in                                                                              review.
                                                       (Elastoplast,
                                                       Elasticon) (5yd
                                                       uou).
                                               SG079  tape, surgical              NF  .................                6            0  CMS clinical
                                                       paper 1in                                                                        review.
                                                       (Micropore).
                                               SH065  sodium chloride             NF  .................                0           15  CMS clinical
                                                       0.9% flush                                                                       review.
                                                       syringe.
                                               SH068  sodium chloride             NF  .................                1            0  CMS clinical
                                                       0.9% inj                                                                         review.
                                                       bacteriostatic
                                                       (30ml uou).
                                               SK013  computer media,             NF  .................                1            0  CMS clinical
                                                       dvd.                                                                             review.
                                               SK016  computer media,             NF  .................                0          0.1  CMS clinical
                                                       optical disk                                                                     review.
                                                       2.6gb.
                                               SK076  slide sleeve                NF  .................                0            1  CMS clinical
                                                       (photo slides).                                                                  review.
                                               SK091  x-ray envelope...           NF  .................                1            0  CMS clinical
                                                                                                                                        review.
                                               SK098  film, x-ray,                NF  .................                6            4  CMS clinical
                                                       laser print.                                                                     review.
74170.................  Ct abdomen w/o &       ED024  film processor,             NF  .................               15            7  Refined equipment
                         w/dye.                        dry, laser.                                                                      time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EL007  room, CT.........           NF  .................               65           39  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               ER029  film alternator             NF  .................               15            7  Refined equipment
                                                       (motorized film                                                                  time to reflect
                                                       viewbox).                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               L046A  CT Technologist..           NF  Retrieve prior                   7            4  CMS clinical
                                                                                       appropriate                                      review.
                                                                                       imaging exams
                                                                                       and hang for MD
                                                                                       review, verify
                                                                                       orders, review
                                                                                       the chart to
                                                                                       incorporate
                                                                                       relevant
                                                                                       clinical
                                                                                       information and
                                                                                       confirm contrast
                                                                                       protocol with
                                                                                       interpreting MD.
                                               L046A  CT Technologist..           NF  Assist physician                32           27  CMS clinical
                                                                                       in performing                                    review.
                                                                                       procedure.
                                               L046A  CT Technologist..           NF  Image Post                      15            7  CMS clinical
                                                                                       Processing.                                      review.
                                               SB006  drape, non-                 NF  .................                1            0  CMS clinical
                                                       sterile, sheet                                                                   review.
                                                       40in x 60in.
                                               SB014  drape, sterile,             NF  .................                0            1  CMS clinical
                                                       three-quarter                                                                    review.
                                                       sheet.

[[Page 49037]]

 
                                               SC001  angiocatheter 14g-          NF  .................                1            0  CMS clinical
                                                       24g.                                                                             review.
                                               SC002  angiocatheter set           NF  .................                0            1  CMS clinical
                                                                                                                                        review.
                                               SC025  needle, 14-20g,             NF  .................                0            1  CMS clinical
                                                       biopsy.                                                                          review.
                                               SC029  needle, 18-27g...           NF  .................                1            0  CMS clinical
                                                                                                                                        review.
                                               SC059  syringe, 25ml               NF  .................                0            1  CMS clinical
                                                       (MRI power                                                                       review.
                                                       injector).
                                               SG050  gauze, non-                 NF  .................                0            1  CMS clinical
                                                       sterile 2in x                                                                    review.
                                                       2in.
                                               SG075  tape, elastic,              NF  .................                0            6  CMS clinical
                                                       1in                                                                              review.
                                                       (Elastoplast,
                                                       Elasticon) (5yd
                                                       uou).
                                               SG079  tape, surgical              NF  .................                6            0  CMS clinical
                                                       paper 1in                                                                        review.
                                                       (Micropore).
                                               SH016  barium suspension           NF  .................              900            0  CMS clinical
                                                       (Polibar).                                                                       review.
                                               SH065  sodium chloride             NF  .................                0           15  CMS clinical
                                                       0.9% flush                                                                       review.
                                                       syringe.
                                               SH068  sodium chloride             NF  .................                1            0  CMS clinical
                                                       0.9% inj                                                                         review.
                                                       bacteriostatic
                                                       (30ml uou).
                                               SK013  computer media,             NF  .................                1            0  CMS clinical
                                                       dvd.                                                                             review.
                                               SK016  computer media,             NF  .................                0          0.1  CMS clinical
                                                       optical disk                                                                     review.
                                                       2.6gb.
                                               SK076  slide sleeve                NF  .................                0            1  CMS clinical
                                                       (photo slides).                                                                  review.
                                               SK091  x-ray envelope...           NF  .................                1            0  CMS clinical
                                                                                                                                        review.
                                               SK098  film, x-ray,                NF  .................               14            8  CMS clinical
                                                       laser print.                                                                     review.
74175.................  Ct angio abdom w/      EL007  room, CT.........           NF  .................              101           40  Refined equipment
                         o & w/dye.                                                                                                     time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               L041B  Radiologic                  NF  Retrieve prior                   0            5  CMS clinical
                                                       Technologist.                   appropriate                                      review.
                                                                                       imaging exams
                                                                                       and hang for MD
                                                                                       review, verify
                                                                                       orders, review
                                                                                       the chart to
                                                                                       incorporate
                                                                                       relevant
                                                                                       clinical
                                                                                       information.
                                               L041B  Radiologic                  NF  Greet patient,                   0            3  CMS clinical
                                                       Technologist.                   provide gowning,                                 review.
                                                                                       assure
                                                                                       appropriate
                                                                                       medical records
                                                                                       are available.
                                               L041B  Radiologic                  NF  Education/                       0            2  CMS clinical
                                                       Technologist.                   instruction/                                     review.
                                                                                       counseling/
                                                                                       obtain consent.
                                               L041B  Radiologic                  NF  Prepare room,                    0            2  Standardized time
                                                       Technologist.                   equipment,                                       input.
                                                                                       supplies.
                                               L041B  Radiologic                  NF  Prepare and                      0            7  CMS clinical
                                                       Technologist.                   position patient/                                review.
                                                                                       monitor patient/
                                                                                       set up IV.
                                               L041B  Radiologic                  NF  Aquire images....                0           28  CMS clinical
                                                       Technologist.                                                                    review.
                                               L041B  Radiologic                  NF  Clean room/                      0            3  CMS clinical
                                                       Technologist.                   equipment by                                     review.
                                                                                       physician staff.

[[Page 49038]]

 
                                               L046A  CT Technologist..           NF  Retrieve prior                   5            0  CMS clinical
                                                                                       appropriate                                      review.
                                                                                       imaging exams
                                                                                       and hang for MD
                                                                                       review, verify
                                                                                       orders, review
                                                                                       the chart to
                                                                                       incorporate
                                                                                       relevant
                                                                                       clinical
                                                                                       information.
                                               L046A  CT Technologist..           NF  Greet patient,                   3            0  CMS clinical
                                                                                       provide gowning,                                 review.
                                                                                       assure
                                                                                       appropriate
                                                                                       medical records
                                                                                       are available.
                                               L046A  CT Technologist..           NF  Education/                       2            0  CMS clinical
                                                                                       instruction/                                     review.
                                                                                       counseling/
                                                                                       obtain consent.
                                               L046A  CT Technologist..           NF  Prepare room,                    5            0  CMS clinical
                                                                                       equipment,                                       review.
                                                                                       supplies.
                                               L046A  CT Technologist..           NF  Prepare and                      7            0  CMS clinical
                                                                                       position patient/                                review.
                                                                                       monitor patient/
                                                                                       set up IV.
                                               L046A  CT Technologist..           NF  Aquire images....               28            0  CMS clinical
                                                                                                                                        review.
                                               L046A  CT Technologist..           NF  Clean room/                      3            0  CMS clinical
                                                                                       equipment by                                     review.
                                                                                       physician staff.
                                               SK016  computer media,             NF  .................                1          0.1  CMS clinical
                                                       optical disk                                                                     review.
                                                       2.6gb.
74176.................  Ct abd & pelvis..      ED032  printer, laser,             NF  .................                8            7  CMS clinical
                                                       paper.                                                                           review.
                                               ER029  film alternator             NF  .................               27            7  CMS clinical
                                                       (motorized film                                                                  review.
                                                       viewbox).
                                               L046A  CT Technologist..           NF  Service Period...               40           39  CMS clinical
                                                                                                                                        review.
                                               SK016  computer media,             NF  .................                0          0.1  CMS clinical
                                                       optical disk                                                                     review.
                                                       2.6gb.
                                               SK076  slide sleeve                NF  .................                0            1  CMS clinical
                                                       (photo slides).                                                                  review.
74177.................  Ct abd & pelv w/       ED032  printer, laser,             NF  .................               10            7  CMS clinical
                         contrast.                     paper.                                                                           review.
                                               EL007  room, CT.........           NF  .................               42           39  CMS clinical
                                                                                                                                        review.
                                               ER029  film alternator             NF  .................               42            7  CMS clinical
                                                       (motorized film                                                                  review.
                                                       viewbox).
                                               L046A  CT Technologist..           NF  Pre-Service                      7            6  CMS clinical
                                                                                       Period.                                          review.
                                               L046A  CT Technologist..           NF  Service Period...               58           52  CMS clinical
                                                                                                                                        review.
                                               SK016  computer media,             NF  .................                0          0.1  CMS clinical
                                                       optical disk                                                                     review.
                                                       2.6gb.
                                               SK076  slide sleeve                NF  .................                0            1  CMS clinical
                                                       (photo slides).                                                                  review.
                                               SK098  film, x-ray,                NF  .................               10            8  CMS clinical
                                                       laser print.                                                                     review.
74178.................  Ct abd & pelv 1/>      ED032  printer, laser,             NF  .................               20           10  CMS clinical
                         regns.                        paper.                                                                           review.
                                               EL007  room, CT.........           NF  .................               57           48  CMS clinical
                                                                                                                                        review.
                                               ER029  film alternator             NF  .................               57           10  CMS clinical
                                                       (motorized film                                                                  review.
                                                       viewbox).
                                               L046A  CT Technologist..           NF  Pre-Service                      7            6  CMS clinical
                                                                                       Period.                                          review.
                                               L046A  CT Technologist..           NF  Service Period...               83           64  CMS clinical
                                                                                                                                        review.
                                               SK016  computer media,             NF  .................                0          0.1  CMS clinical
                                                       optical disk                                                                     review.
                                                       2.6gb.

[[Page 49039]]

 
                                               SK076  slide sleeve                NF  .................                0            1  CMS clinical
                                                       (photo slides).                                                                  review.
                                               SK098  film, x-ray,                NF  .................               23           16  CMS clinical
                                                       laser print.                                                                     review.
76830.................  Transvaginal us        ED024  film processor,             NF  .................                5            0  CMS clinical
                         non-ob.                       dry, laser.                                                                      review.
                                               ED032  printer, laser,             NF  .................                1            0  CMS clinical
                                                       paper.                                                                           review.
                                               EF027  table,                      NF  .................                0           36  Refined equipment
                                                       instrument,                                                                      time to reflect
                                                       mobile.                                                                          typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF034  table, ultrasound           NF  .................                0           36  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EL015  room, ultrasound,           NF  .................               37            0  CMS clinical
                                                       general.                                                                         review.
                                               EQ250  ultrasound unit,            NF  .................                0           36  Refined equipment
                                                       portable.                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               ER029  film alternator             NF  .................               10            0  CMS clinical
                                                       (motorized film                                                                  review.
                                                       viewbox).
                                               ER086  ultrasound probe.           NF  .................                0           37  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               L051B  RN/Diagnostic               NF  Clean room/                      3            2  CMS clinical
                                                       Medical                         equipment by                                     review.
                                                       Sonographer.                    physician staff.
                                               SB026  gown, patient....           NF  .................                0            1  CMS clinical
                                                                                                                                        review.
                                               SJ033  lubricating jelly           NF  .................                1            0  CMS clinical
                                                       (Surgilube).                                                                     review.
76872.................  Us transrectal...      EF027  table,                      NF  .................               68           34  Refined equipment
                                                       instrument,                                                                      time to reflect
                                                       mobile.                                                                          typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EF034  table, ultrasound           NF  .................               68           34  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ250  ultrasound unit,            NF  .................               68           34  Refined equipment
                                                       portable.                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               ER086  ultrasound probe.           NF  .................               68           35  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               L051B  RN/Diagnostic               NF  Retrieve prior                   0            3  CMS clinical
                                                       Medical                         images for                                       review.
                                                       Sonographer.                    comparison:.
                                               L051B  RN/Diagnostic               NF  Review Chart.....                3            0  CMS clinical
                                                       Medical                                                                          review.
                                                       Sonographer.
                                               L051B  RN/Diagnostic               NF  Obtain vital                     3            0  CMS clinical
                                                       Medical                         signs.                                           review.
                                                       Sonographer.
                                               L051B  RN/Diagnostic               NF  Prepare room,                    2            3  CMS clinical
                                                       Medical                         equipment,                                       review.
                                                       Sonographer.                    supplies.
                                               L051B  RN/Diagnostic               NF  Prepare                          5            0  CMS clinical
                                                       Medical                         ultrasound probe.                                review.
                                                       Sonographer.
                                               L051B  RN/Diagnostic               NF  Obtain vital                     3            0  CMS clinical
                                                       Medical                         signs.                                           review.
                                                       Sonographer.

[[Page 49040]]

 
                                               L051B  RN/Diagnostic               NF  Clean room/                      3            2  CMS clinical
                                                       Medical                         equipment by                                     review.
                                                       Sonographer.                    physician staff.
                                               SB012  drape, sterile,             NF  .................                1            0  CMS clinical
                                                       for Mayo stand.                                                                  review.
                                               SC019  iv tubing                   NF  .................                1            0  CMS clinical
                                                       (extension).                                                                     review.
                                               SH048  lidocaine 2%                NF  .................               10            0  CMS clinical
                                                       jelly, topical                                                                   review.
                                                       (Xylocaine).
                                               SJ001  alcohol isopropyl           NF  .................                5            0  CMS clinical
                                                       70%.                                                                             review.
                                               SJ032  lubricating jelly           NF  .................                2            0  CMS clinical
                                                       (K-Y) (5gm uou).                                                                 review.
                                               SM018  glutaraldehyde              NF  .................               32            0  CMS clinical
                                                       3.4% (Cidex,                                                                     review.
                                                       Maxicide,
                                                       Wavicide).
                                               SM019  glutaraldehyde              NF  .................                1            0  CMS clinical
                                                       test strips                                                                      review.
                                                       (Cidex, Metrex).
                                               SM022  sanitizing cloth-           NF  .................                2            0  CMS clinical
                                                       wipe (surface,                                                                   review.
                                                       instruments,
                                                       equipment).
77003.................  Fluoroguide for        ED025  film processor,             NF  .................                3            2  Refined equipment
                         spine inject.                 wet.                                                                             time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EL014  room,                       NF  .................                9           18  Refined equipment
                                                       radiographic-                                                                    time to reflect
                                                       fluoroscopic.                                                                    typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               ER029  film alternator             NF  .................                3            2  Refined equipment
                                                       (motorized film                                                                  time to reflect
                                                       viewbox).                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               L041B  Radiologic                  NF  Clean room/                      2            1  CMS clinical
                                                       Technologist.                   equipment by                                     review.
                                                                                       physician staff.
                                               L041B  Radiologic                  NF  Process films,                   3            2  CMS clinical
                                                       Technologist.                   hang films and                                   review.
                                                                                       review study
                                                                                       with
                                                                                       interpreting MD
                                                                                       prior to patient
                                                                                       discharge.
77080.................  Dxa bone density       ER078  phantom, spine,             NF  .................                1            2  Refined equipment
                         axial.                        DXA calibration                                                                  time to reflect
                                                       check.                                                                           typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
77301.................  Radiotherapy dose      ED011  computer system,            NF  .................               20            0  CMS clinical
                         plan imrt.                    record and                                                                       review.
                                                       verify.
                                               ED033  treatment                   NF  .................              376          330  CMS clinical
                                                       planning system,                                                                 review.
                                                       IMRT (Corvus w-
                                                       Peregrine 3D
                                                       Monte Carlo).
                                               ER005  IMRT CT-based               NF  .................               58           47  CMS clinical
                                                       simulator.                                                                       review.
                                               ER014  chamber, Farmer-            NF  .................               45           47  Refined equipment
                                                       type.                                                                            time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               ER028  electrometer, PC-           NF  .................               45           47  Refined equipment
                                                       based, dual                                                                      time to reflect
                                                       channel.                                                                         typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.

[[Page 49041]]

 
                                               ER050  phantom, solid              NF  .................               45           47  Refined equipment
                                                       water                                                                            time to reflect
                                                       calibration                                                                      typical use
                                                       check.                                                                           exclusive to
                                                                                                                                        patient.
                                               ER089  IMRT accelerator.           NF  .................               45           47  CMS clinical
                                                                                                                                        review.
                                               L037D  RN/LPN/MTA.......           NF  Obtain vital                     3            0  CMS clinical
                                                                                       signs.                                           review.
78012.................  Thyroid uptake         EF010  chair, thyroid              NF  .................               40           30  Refined equipment
                         measurement.                  imaging.                                                                         time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               ER063  thyroid uptake              NF  .................               40           30  Refined equipment
                                                       system.                                                                          time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
78013.................  Thyroid imaging w/     ER032  gamma camera                NF  .................               48           38  Refined equipment
                         blood flow.                   system, single-                                                                  time to reflect
                                                       dual head.                                                                       typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
78014.................  Thyroid imaging w/     EF010  chair, thyroid              NF  .................               65           55  Refined equipment
                         blood flow.                   imaging.                                                                         time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               ER032  gamma camera                NF  .................               65           50  Refined equipment
                                                       system, single-                                                                  time to reflect
                                                       dual head.                                                                       typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               ER063  thyroid uptake              NF  .................               65           55  Refined equipment
                                                       system.                                                                          time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
78070.................  Parathyroid            ER032  gamma camera                NF  .................               73           68  Refined equipment
                         planar imaging.               system, single-                                                                  time to reflect
                                                       dual head.                                                                       typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
78071.................  Parathyrd planar       ER032  gamma camera                NF  .................               86           81  Refined equipment
                         w/wo subtrj.                  system, single-                                                                  time to reflect
                                                       dual head.                                                                       typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
86153.................  Cell enumeration       EP106  CELLSEARCH system           NF  .................               16            0  Laboratory
                         phys interp.                                                                                                   physician
                                                                                                                                        interpretation
                                                                                                                                        code.
                                               EP107  Laboratory                  NF  .................                4            0  Laboratory
                                                       Information                                                                      physician
                                                       System.                                                                          interpretation
                                                                                                                                        code.
                                               L045A  Cytotechnologist.           NF  Collate images                   5            0  Laboratory
                                                                                       and review with                                  physician
                                                                                       Pathologist.                                     interpretation
                                                                                                                                        code.
88120.................  Cytp urne 3-5          EP088  ThermoBrite......           NF  .................              107          321  CMS clinical
                         probes ea spec.                                                                                                review.
                                               EP092  Olympus BX41                NF  .................             1.33        73.00  CMS clinical
                                                       Fluorescent                                                                      review.
                                                       Microscope
                                                       (without filters
                                                       or camera ).
88121.................  Cytp urine 3-5         EP088  ThermoBrite......           NF  .................            26.75       160.50  CMS clinical
                         probes cmptr.                                                                                                  review.
                                               EP090  IkoniLan Software           NF  .................             2.97        29.70  CMS clinical
                                                                                                                                        review.
                                               EP091  IkoniScope.......           NF  .................             2.97        29.70  CMS clinical
                                                                                                                                        review.
88300.................  Surgical path      .........  courier                     NF  .................             2.02            0  Indirect Practice
                         gross.                        transportation                                                                   Expense.
                                                       cost.
                                                      Copath System               NF  .................                3            0  Indirect Practice
                                                       with maintenance                                                                 Expense.
                                                       contract.
                                                      Copath software..           NF  .................                3            0  Indirect Practice
                                                                                                                                        Expense.

[[Page 49042]]

 
88302.................  Tissue exam by     .........  specimen,                   NF  .................             0.18            0  Indirect Practice
                         pathologist.                  solvent, and                                                                     Expense.
                                                       formalin
                                                       disposal cost.
                                                      courier                     NF  .................             2.02            0  Indirect Practice
                                                       transportation                                                                   Expense.
                                                       cost.
                                                      equipment                   NF  .................             0.61            0  Included in
                                                       maintenance cost.                                                                equipment cost
                                                                                                                                        per minute
                                                                                                                                        calculation.
                                                      Copath System               NF  .................                3            0  Indirect Practice
                                                       with maintenance                                                                 Expense.
                                                       contract.
                                                      Copath software..           NF  .................                3            0  Indirect Practice
                                                                                                                                        Expense.
88304.................  Tissue exam by     .........  specimen,                   NF  .................             0.35            0  Indirect Practice
                         pathologist.                  solvent, and                                                                     Expense.
                                                       formalin
                                                       disposal cost.
                                                      courier                     NF  .................             2.02            0  Indirect Practice
                                                       transportation                                                                   Expense.
                                                       cost.
                                                      equipment                   NF  .................             0.61            0  Included in
                                                       maintenance cost.                                                                equipment cost
                                                                                                                                        per minute
                                                                                                                                        calculation.
                                                      Copath System               NF  .................                5            0  Indirect Practice
                                                       with maintenance                                                                 Expense.
                                                       contract.
                                                      Copath software..           NF  .................                5            0  Indirect Practice
                                                                                                                                        Expense.
88305.................  Tissue exam by     .........  specimen,                   NF  .................             0.35            0  Indirect Practice
                         pathologist.                  solvent, and                                                                     Expense.
                                                       formalin
                                                       disposal cost.
                                                      courier                     NF  .................             2.02            0  Indirect Practice
                                                       transportation                                                                   Expense.
                                                       cost.
                                                      equipment                   NF  .................             0.61            0  Included in
                                                       maintenance cost.                                                                equipment cost
                                                                                                                                        per minute
                                                                                                                                        calculation.
                                                      Copath System               NF  .................                4            0  Indirect Practice
                                                       with maintenance                                                                 Expense.
                                                       contract.
                                                      Copath software..           NF  .................                4            0  Indirect Practice
                                                                                                                                        Expense.
88307.................  Tissue exam by     .........  specimen,                   NF  .................             1.85            0  Indirect Practice
                         pathologist.                  solvent, and                                                                     Expense.
                                                       formalin
                                                       disposal cost.
                                                      courier                     NF  .................             2.02            0  Indirect Practice
                                                       transportation                                                                   Expense.
                                                       cost.
                                                      equipment                   NF  .................             0.61            0  Included in
                                                       maintenance cost.                                                                equipment cost
                                                                                                                                        per minute
                                                                                                                                        calculation.
                                                      Copath System               NF  .................               10            0  Indirect Practice
                                                       with maintenance                                                                 Expense.
                                                       contract.
                                                      Copath software..           NF  .................               10            0  Indirect Practice
                                                                                                                                        Expense.
88309.................  Tissue exam by     .........  specimen,                   NF  .................             1.85            0  Indirect Practice
                         pathologist.                  solvent, and                                                                     Expense.
                                                       formalin
                                                       disposal cost.
                                                      courier                     NF  .................             2.02            0  Indirect Practice
                                                       transportation                                                                   Expense.
                                                       cost.
                                                      equipment                   NF  .................             0.61            0  Included in
                                                       maintenance cost.                                                                equipment cost
                                                                                                                                        per minute
                                                                                                                                        calculation.
                                                      Copath System               NF  .................               12            0  Indirect Practice
                                                       with maintenance                                                                 Expense.
                                                       contract.
                                                      Copath software..           NF  .................               12            0  Indirect Practice
                                                                                                                                        Expense.
90791.................  Psych diagnostic   .........  .................           NF  .................  ...............  ...........  2012 Fully
                         evaluation.                                                                                                    Implemented PE
                                                                                                                                        RVUs maintained.
90832.................  Psytx pt&/family   .........  .................           NF  .................  ...............  ...........  2012 Fully
                         30 minutes.                                                                                                    Implemented PE
                                                                                                                                        RVUs maintained.

[[Page 49043]]

 
90834.................  Psytx pt&/family   .........  .................           NF  .................  ...............  ...........  2012 Fully
                         45 minutes.                                                                                                    Implemented PE
                                                                                                                                        RVUs maintained.
90836.................  Psytx pt&/fam w/   .........  .................           NF  .................  ...............  ...........  2012 Fully
                         e&m 45 min.                                                                                                    Implemented PE
                                                                                                                                        RVUs maintained.
91112.................  Gi wireless        .........  Activation                  NF  .................                5            0  CMS clinical
                         capsule measure.              Fixture.                                                                         review.
                                                      Docking Station..           NF  .................               40            0  CMS clinical
                                                                                                                                        review.
                                                      MotiliGI software           NF  .................               40            0  CMS clinical
                                                                                                                                        review.
                                               EQ352  Data receiver....           NF  .................            7,220        2,880  CMS clinical
                                                                                                                                        review.
                                               SA048  pack, minimum               NF  .................                1            0  CMS clinical
                                                       multi-specialty                                                                  review.
                                                       visit.
                                                      SmartBar.........           NF  .................                1            0  CMS clinical
                                                                                                                                        review.
92081.................  Visual field           SA050  pack,                       NF  .................                1            0  CMS clinical
                         examination(s).               ophthalmology                                                                    review.
                                                       visit (no
                                                       dilation).
                                               EL006  lane, screening             NF  .................               12           17  Refined equipment
                                                       (oph).                                                                           time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ029  Humphrey field              NF  .................               12           17  Refined equipment
                                                       analyzer.                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ165  lens set, trial,            NF  .................               12           17  CMS clinical
                                                       full diameter, w-                                                                review.
                                                       frame.
92082.................  Visual field           SA050  pack,                       NF  .................                1            0  CMS clinical
                         examination(s).               ophthalmology                                                                    review.
                                                       visit (no
                                                       dilation).
                                               EL006  lane, screening             NF  .................               22           27  Refined equipment
                                                       (oph).                                                                           time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ029  Humphrey field              NF  .................               22           27  Refined equipment
                                                       analyzer.                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ165  lens set, trial,            NF  .................               22           27  CMS clinical
                                                       full diameter, w-                                                                review.
                                                       frame.
92083.................  Visual field           SA050  pack,                       NF  .................                1            0  CMS clinical
                         examination(s).               ophthalmology                                                                    review.
                                                       visit (no
                                                       dilation).
                                               EL006  lane, screening             NF  .................               32           37  Refined equipment
                                                       (oph).                                                                           time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ029  Humphrey field              NF  .................               32           37  Refined equipment
                                                       analyzer.                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ165  lens set, trial,            NF  .................               32           37  CMS clinical
                                                       full diameter, w-                                                                review.
                                                       frame.
92235.................  Eye exam with          ED008  camera, retinal             NF  .................               60           35  Refined equipment
                         photos.                       (TRC 50IX, w-                                                                    time to reflect
                                                       ICG, filters,                                                                    typical use
                                                       motor drives).                                                                   exclusive to
                                                                                                                                        patient.

[[Page 49044]]

 
                                               EF030  table, motorized            NF  .................               60           35  Refined equipment
                                                       (for instruments-                                                                time to reflect
                                                       equipment).                                                                      typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EL005  lane, exam (oph).           NF  .................               60           35  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               L038A  COMT/COT/RN/CST..           NF  Monitor pt.                      5            2  CMS clinical
                                                                                       following                                        review.
                                                                                       service/check
                                                                                       tubes, monitors,
                                                                                       drains.
                                               L039A  Certified Retinal           NF  Assist physician                40           20  CMS clinical
                                                       Angio.                          in performing                                    review.
                                                                                       procedure.
93015.................  Cardiovascular         EF023  table, exam......           NF  .................               58           46  Refined equipment
                         stress test.                                                                                                   time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ078  cardiac monitor w-          NF  .................               58           46  Refined equipment
                                                       treadmill (12-                                                                   time to reflect
                                                       lead PC-based                                                                    typical use
                                                       ECG).                                                                            exclusive to
                                                                                                                                        patient.
                                               L051A  RN...............           NF  Assist physician                20           14  CMS clinical
                                                                                       in performing                                    review.
                                                                                       procedure.
93017.................  Cardiovascular         EF023  table, exam......           NF  .................               58           46  Refined equipment
                         stress test.                                                                                                   time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ078  cardiac monitor w-          NF  .................               58           46  Refined equipment
                                                       treadmill (12-                                                                   time to reflect
                                                       lead PC-based                                                                    typical use
                                                       ECG).                                                                            exclusive to
                                                                                                                                        patient.
                                               L051A  RN...............           NF  Assist physician                20           14  CMS clinical
                                                                                       in performing                                    review.
                                                                                       procedure.
                                               L051A  RN...............           NF  Complete                         0            4  CMS clinical
                                                                                       diagnostic                                       review.
                                                                                       forms, lab & X-
                                                                                       ray requisitions.
93925.................  Lower extremity        ED011  computer system,            NF  .................               10            0  CMS clinical
                         study.                        record and                                                                       review.
                                                       verify.
                                               ED021  computer,                   NF  .................               95            7  Refined equipment
                                                       desktop, w-                                                                      time to reflect
                                                       monitor.                                                                         typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               ED025  film processor,             NF  .................               10            7  Refined equipment
                                                       wet.                                                                             time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               ED034  video SVHS VCR              NF  .................               95            0  CMS clinical
                                                       (medical grade).                                                                 review.
                                               EL016  room, ultrasound,           NF  .................               95           76  Refined equipment
                                                       vascular.                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               ER067  x-ray view box, 4           NF  .................               10            7  Refined equipment
                                                       panel.                                                                           time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               L054A  Vascular                    NF  Provide pre-                     3            2  CMS clinical
                                                       Technologist.                   service                                          review.
                                                                                       education/obtain
                                                                                       consent.
                                               L054A  Vascular                    NF  Prepare room,                    3            2  Standardized time
                                                       Technologist.                   equipment,                                       input.
                                                                                       supplies.

[[Page 49045]]

 
                                               L054A  Vascular                    NF  Prepare and                      3            2  Standardized time
                                                       Technologist.                   position patient.                                input.
                                               L054A  Vascular                    NF  Other Clinical                  10            7  CMS clinical
                                                       Technologist.                   Activity:                                        review.
                                                                                       Collate
                                                                                       preliminary
                                                                                       data, arrange
                                                                                       images, archive.
                                               L054A  Vascular                    NF  Other Clinical                   1            0  CMS clinical
                                                       Technologist.                   Activity: Record                                 review.
                                                                                       patient history.
                                               L054A  Vascular                    NF  Other Clinical                   4            0  CMS clinical
                                                       Technologist.                   Activity: QA                                     review.
                                                                                       documentation.
                                               SK086  video tape, VHS..           NF  .................                1            0  CMS clinical
                                                                                                                                        review.
93926.................  Lower extremity        ED011  computer system,            NF  .................               10            0  CMS clinical
                         study.                        record and                                                                       review.
                                                       verify.
                                               ED021  computer,                   NF  .................               59            4  Refined equipment
                                                       desktop, w-                                                                      time to reflect
                                                       monitor.                                                                         typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               ED025  film processor,             NF  .................               10            4  Refined equipment
                                                       wet.                                                                             time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               ED034  video SVHS VCR              NF  .................               59            0  CMS clinical
                                                       (medical grade).                                                                 review.
                                               EL016  room, ultrasound,           NF  .................               59           42  Refined equipment
                                                       vascular.                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               ER067  x-ray view box, 4           NF  .................               10            4  Refined equipment
                                                       panel.                                                                           time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               L054A  Vascular                    NF  Provide pre-                     3            2  CMS clinical
                                                       Technologist.                   service                                          review.
                                                                                       education/obtain
                                                                                       consent.
                                               L054A  Vascular                    NF  Prepare room,                    3            2  Standardized time
                                                       Technologist.                   equipment,                                       input.
                                                                                       supplies.
                                               L054A  Vascular                    NF  Prepare and                      3            2  Standardized time
                                                       Technologist.                   position patient.                                input.
                                               L054A  Vascular                    NF  Other Clinical                   8            4  CMS clinical
                                                       Technologist.                   Activity:                                        review.
                                                                                       Collate
                                                                                       preliminary
                                                                                       data, arrange
                                                                                       images, archive.
                                               L054A  Vascular                    NF  Other Clinical                   1            0  CMS clinical
                                                       Technologist.                   Activity: Record                                 review.
                                                                                       patient history.
                                               L054A  Vascular                    NF  Other Clinical                   4            0  CMS clinical
                                                       Technologist.                   Activity: QA                                     review.
                                                                                       documentation.
                                               SK086  video tape, VHS..           NF  .................                1            0  CMS clinical
                                                                                                                                        review.
93970.................  Extremity study..      ED011  computer system,            NF  .................               10            0  CMS clinical
                                                       record and                                                                       review.
                                                       verify.
                                               ED021  computer,                   NF  .................               71            7  Refined equipment
                                                       desktop, w-                                                                      time to reflect
                                                       monitor.                                                                         typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               ED025  film processor,             NF  .................               10            7  Refined equipment
                                                       wet.                                                                             time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               ED034  video SVHS VCR              NF  .................               71            0  CMS clinical
                                                       (medical grade).                                                                 review.

[[Page 49046]]

 
                                               EL016  room, ultrasound,           NF  .................               71           52  Refined equipment
                                                       vascular.                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               ER067  x-ray view box, 4           NF  .................               10            7  Refined equipment
                                                       panel.                                                                           time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               L054A  Vascular                    NF  Provide pre-                     3            2  CMS clinical
                                                       Technologist.                   service                                          review.
                                                                                       education/obtain
                                                                                       consent.
                                               L054A  Vascular                    NF  Prepare room,                    3            2  Standardized time
                                                       Technologist.                   equipment,                                       input.
                                                                                       supplies.
                                               L054A  Vascular                    NF  Prepare and                      3            2  Standardized time
                                                       Technologist.                   position patient.                                input.
                                               L054A  Vascular                    NF  Other Clinical                  10            7  CMS clinical
                                                       Technologist.                   Activity:                                        review.
                                                                                       Collate
                                                                                       preliminary
                                                                                       data, arrange
                                                                                       images, archive.
                                               L054A  Vascular                    NF  Other Clinical                   1            0  CMS clinical
                                                       Technologist.                   Activity: Record                                 review.
                                                                                       patient history.
                                               L054A  Vascular                    NF  Other Clinical                   4            0  CMS clinical
                                                       Technologist.                   Activity: QA                                     review.
                                                                                       documentation.
                                               SK086  video tape, VHS..           NF  .................                1            0  CMS clinical
                                                                                                                                        review.
93971.................  Extremity study..      ED011  computer system,            NF  .................               10            0  CMS clinical
                                                       record and                                                                       review.
                                                       verify.
                                               ED021  computer,                   NF  .................               45            4  Refined equipment
                                                       desktop, w-                                                                      time to reflect
                                                       monitor.                                                                         typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               ED025  film processor,             NF  .................               10            4  Refined equipment
                                                       wet.                                                                             time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               ED034  video SVHS VCR              NF  .................               45            0  CMS clinical
                                                       (medical grade).                                                                 review.
                                               EL016  room, ultrasound,           NF  .................               45           30  CMS clinical
                                                       vascular.                                                                        review.
                                               ER067  x-ray view box, 4           NF  .................               10            4  Refined equipment
                                                       panel.                                                                           time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               L054A  Vascular                    NF  Provide pre-                     3            2  CMS clinical
                                                       Technologist.                   service                                          review.
                                                                                       education/obtain
                                                                                       consent.
                                               L054A  Vascular                    NF  Prepare room,                    3            2  Standardized time
                                                       Technologist.                   equipment,                                       input.
                                                                                       supplies.
                                               L054A  Vascular                    NF  Prepare and                      3            2  Standardized time
                                                       Technologist.                   position patient.                                input.
                                               L054A  Vascular                    NF  Other Clinical                   6            4  CMS clinical
                                                       Technologist.                   Activity:                                        review.
                                                                                       Collate
                                                                                       preliminary
                                                                                       data, arrange
                                                                                       images, archive.
                                               L054A  Vascular                    NF  Other Clinical                   1            0  CMS clinical
                                                       Technologist.                   Activity: Record                                 review.
                                                                                       patient history.
                                               L054A  Vascular                    NF  Other Clinical                   4            0  CMS clinical
                                                       Technologist.                   Activity: QA                                     review.
                                                                                       documentation.
                                               SB006  drape, non-                 NF  .................                2            1  CMS clinical
                                                       sterile, sheet                                                                   review.
                                                       40in x 60in.
                                               SK086  video tape, VHS..           NF  .................                1            0  CMS clinical
                                                                                                                                        review.

[[Page 49047]]

 
95076.................  Ingest challenge       EF023  table, exam......           NF  .................              141          133  Refined equipment
                         ini 120 min.                                                                                                   time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ168  light, exam......           NF  .................              141          133  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               L037D  RN/LPN/MTA.......           NF  Prepare testing                 15            7  CMS clinical
                                                                                       doses.                                           review.
95115.................  Immunotherapy one      EF040  refrigerator,               NF  .................               15            0  CMS clinical
                         injection.                    vaccine,                                                                         review.
                                                       commercial
                                                       grade, w-alarm
                                                       lock.
95117.................  Immunotherapy          EF041  x-ray machine,              NF  .................               17            0  CMS clinical
                         injections.                   portable.                                                                        review.
95782.................  Polysom <6 yrs 4/      EF003  bedroom furniture           NF  .................              660          602  Refined equipment
                         > paramtrs.                   (hospital bed,                                                                   time to reflect
                                                       table, reclining                                                                 typical use
                                                       chair).                                                                          exclusive to
                                                                                                                                        patient.
                                                      Crib.............           NF  .................              660            0  CMS clinical
                                                                                                                                        review.
                                               EQ134  impedance meter,            NF  .................              660          602  Refined equipment
                                                       32-channel.                                                                      time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ272  sleep diagnostic            NF  .................              660          662  Refined equipment
                                                       system, attended                                                                 time to reflect
                                                       (w-acquisition                                                                   typical use
                                                       station, review                                                                  exclusive to
                                                       master,                                                                          patient.
                                                       computer).
                                                      Capnograph.......           NF  .................              660            0  Duplicative.
                                               ER088  Infrared                    NF  .................              660          602  Refined equipment
                                                       illuminator.                                                                     time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               L047B  REEGT............           NF  Provide pre-                     5            3  CMS clinical
                                                                                       service                                          review.
                                                                                       education/obtain
                                                                                       consent.
                                               L047B  REEGT............           NF  Other Clinical                   6            5  CMS clinical
                                                                                       Activity--specif                                 review.
                                                                                       y: Set up and
                                                                                       calibrate all
                                                                                       monitoring and
                                                                                       recording
                                                                                       equipment
                                                                                       (initial),
                                                                                       including
                                                                                       capnograph (for
                                                                                       child).
                                               L047B  REEGT............           NF  Other Clinical                  30           20  CMS clinical
                                                                                       Activity--specif                                 review.
                                                                                       y: Measure and
                                                                                       mark head and
                                                                                       face. Apply and
                                                                                       secure
                                                                                       electrodes to
                                                                                       head and face.
                                                                                       Check
                                                                                       impedances.
                                                                                       Reapply
                                                                                       electrodes as
                                                                                       needed. (1.5 min
                                                                                       per electrode
                                                                                       for child, 1 min
                                                                                       per electrode
                                                                                       for adult).

[[Page 49048]]

 
                                               L047B  REEGT............           NF  Other Clinical                   0           15  CMS clinical
                                                                                       Activity--specif                                 review.
                                                                                       y: Apply
                                                                                       recording
                                                                                       devices for
                                                                                       cardio-
                                                                                       respiratory, leg
                                                                                       movements, body
                                                                                       positioning and
                                                                                       snoring.
                                               L047B  REEGT............           NF  Other Clinical                  20            0  CMS clinical
                                                                                       Activity--specif                                 review.
                                                                                       y: Apply
                                                                                       recording
                                                                                       devices for
                                                                                       cardio-
                                                                                       respiratory, leg
                                                                                       movements, body
                                                                                       positioning,
                                                                                       snoring and
                                                                                       capnography.
                                               L047B  REEGT............           NF  Other Clinical                 100           97  CMS clinical
                                                                                       Activity--specif                                 review.
                                                                                       y: Daytime tech
                                                                                       reviews and
                                                                                       edits recording,
                                                                                       marks artifacts,
                                                                                       scores sleep
                                                                                       stages, performs
                                                                                       evaluation of
                                                                                       physiological
                                                                                       changes.
95783.................  Polysom <6 yrs         EF003  bedroom furniture           NF  .................              660          647  Refined equipment
                         cpap/bilvl.                   (hospital bed,                                                                   time to reflect
                                                       table, reclining                                                                 typical use
                                                       chair).                                                                          exclusive to
                                                                                                                                        patient.
                                                      Crib.............           NF  .................              660            0  CMS clinical
                                                                                                                                        review.
                                               EQ134  impedance meter,            NF  .................              660          647  Refined equipment
                                                       32-channel.                                                                      time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ272  sleep diagnostic            NF  .................              660          707  Refined equipment
                                                       system, attended                                                                 time to reflect
                                                       (w-acquisition                                                                   typical use
                                                       station, review                                                                  exclusive to
                                                       master,                                                                          patient.
                                                       computer).
                                                      Capnograph.......           NF  .................              660            0  Duplicative.
                                               ER088  Infrared                    NF  .................              660          647  Refined equipment
                                                       illuminator.                                                                     time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               L047B  REEGT............           NF  Provide pre-                     5            3  CMS clinical
                                                                                       service                                          review.
                                                                                       education/obtain
                                                                                       consent.
                                               L047B  REEGT............           NF  Other Clinical                   6            5  CMS clinical
                                                                                       Activity--specif                                 review.
                                                                                       y: Set up and
                                                                                       calibrate all
                                                                                       monitoring and
                                                                                       recording
                                                                                       equipment
                                                                                       (initial),
                                                                                       including
                                                                                       capnograph (for
                                                                                       child).

[[Page 49049]]

 
                                               L047B  REEGT............           NF  Other Clinical                  30           20  CMS clinical
                                                                                       Activity--specif                                 review.
                                                                                       y: Measure and
                                                                                       mark head and
                                                                                       face. Apply and
                                                                                       secure
                                                                                       electrodes to
                                                                                       head and face.
                                                                                       Check
                                                                                       impedances.
                                                                                       Reapply
                                                                                       electrodes as
                                                                                       needed. (1.5 min
                                                                                       per electrode
                                                                                       for child, 1 min
                                                                                       per electrode
                                                                                       for adult).
                                               L047B  REEGT............           NF  Other Clinical                   0           15  CMS clinical
                                                                                       Activity--specif                                 review.
                                                                                       y: Apply
                                                                                       recording
                                                                                       devices for
                                                                                       cardio-
                                                                                       respiratory, leg
                                                                                       movements, body
                                                                                       positioning and
                                                                                       snoring.
                                               L047B  REEGT............           NF  Other Clinical                  20            0  CMS clinical
                                                                                       Activity--specif                                 review.
                                                                                       y: Apply
                                                                                       recording
                                                                                       devices for
                                                                                       cardio-
                                                                                       respiratory, leg
                                                                                       movements, body
                                                                                       positioning,
                                                                                       snoring and
                                                                                       capnography.
                                               L047B  REEGT............           NF  Other Clinical                 100           97  CMS clinical
                                                                                       Activity--specif                                 review.
                                                                                       y: Daytime tech
                                                                                       reviews and
                                                                                       edits recording,
                                                                                       marks artifacts,
                                                                                       scores sleep
                                                                                       stages, performs
                                                                                       evaluation of
                                                                                       physiological
                                                                                       changes.
95861.................  Muscle test 2          EF023  table, exam......           NF  .................               44           41  Refined equipment
                         limbs.                                                                                                         time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ024  EMG-NCV-EP                  NF  .................               44           41  Refined equipment
                                                       system, 8                                                                        time to reflect
                                                       channel.                                                                         typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               L037A  Electrodiagnostic           NF  Assist physician                19           29  Conforming to
                                                       Technologist.                   in performing                                    physician time.
                                                                                       procedure.
95863.................  Muscle test 3          EF023  table, exam......           NF  .................               58           52  Refined equipment
                         limbs.                                                                                                         time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ024  EMG-NCV-EP                  NF  .................               58           52  Refined equipment
                                                       system, 8                                                                        time to reflect
                                                       channel.                                                                         typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
95864.................  Muscle test 4          EF023  table, exam......           NF  .................               71           62  Refined equipment
                         limbs.                                                                                                         time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.

[[Page 49050]]

 
                                               EQ024  EMG-NCV-EP                  NF  .................               71           62  Refined equipment
                                                       system, 8                                                                        time to reflect
                                                       channel.                                                                         typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
95868.................  Muscle test cran       EF023  table, exam......           NF  .................               35           32  Refined equipment
                         nerve bilat.                                                                                                   time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ024  EMG-NCV-EP                  NF  .................               35           32  Refined equipment
                                                       system, 8                                                                        time to reflect
                                                       channel.                                                                         typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
95907.................  Motor&/sens 1-2        SG051  gauze, non-                 NF  .................                0            4  CMS clinical
                         nrv cndj tst.                 sterile 4in x                                                                    review.
                                                       4in.
                                               SG055  gauze, sterile              NF  .................                4            0  CMS clinical
                                                       4in x 4in.                                                                       review.
                                               SG079  tape, surgical              NF  .................               12            0  CMS clinical
                                                       paper 1in                                                                        review.
                                                       (Micropore).
                                               SJ022  electrode skin              NF  .................              100            0  CMS clinical
                                                       prep gel                                                                         review.
                                                       (NuPrep).
95908.................  Motor&/sens 3-4        SG051  gauze, non-                 NF  .................                0            8  CMS clinical
                         nrv cndj tst.                 sterile 4in x                                                                    review.
                                                       4in.
                                               SG055  gauze, sterile              NF  .................                8            0  CMS clinical
                                                       4in x 4in.                                                                       review.
                                               SG079  tape, surgical              NF  .................               24            0  CMS clinical
                                                       paper 1in                                                                        review.
                                                       (Micropore).
                                               SJ022  electrode skin              NF  .................              100            0  CMS clinical
                                                       prep gel                                                                         review.
                                                       (NuPrep).
95909.................  Motor&/sens 5-6        SG051  gauze, non-                 NF  .................                0           12  CMS clinical
                         nrv cndj tst.                 sterile 4in x                                                                    review.
                                                       4in.
                                               SG055  gauze, sterile              NF  .................               12            0  CMS clinical
                                                       4in x 4in.                                                                       review.
                                               SG079  tape, surgical              NF  .................               36            0  CMS clinical
                                                       paper 1in                                                                        review.
                                                       (Micropore).
                                               SJ022  electrode skin              NF  .................              100            0  CMS clinical
                                                       prep gel                                                                         review.
                                                       (NuPrep).
95910.................  Motor&sens 7-8         L037A  Electrodiagnostic           NF  .................               50           40  Conforming to
                         nrv cndj test.                Technologist.                                                                    physician time.
                                               SG051  gauze, non-                 NF  .................                0           16  CMS clinical
                                                       sterile 4in x                                                                    review.
                                                       4in.
                                               SG055  gauze, sterile              NF  .................               16            0  CMS clinical
                                                       4in x 4in.                                                                       review.
                                               SG079  tape, surgical              NF  .................               48            0  CMS clinical
                                                       paper 1in                                                                        review.
                                                       (Micropore).
                                               SJ022  electrode skin              NF  .................              100            0  CMS clinical
                                                       prep gel                                                                         review.
                                                       (NuPrep).
95911.................  Motor&sen 9-10         L037A  Electrodiagnostic           NF  .................               64           50  Conforming to
                         nrv cndj test.                Technologist.                                                                    physician time.
                                               SG051  gauze, non-                 NF  .................                0           20  CMS clinical
                                                       sterile 4in x                                                                    review.
                                                       4in.
                                               SG055  gauze, sterile              NF  .................               20            0  CMS clinical
                                                       4in x 4in.                                                                       review.
                                               SG079  tape, surgical              NF  .................               60            0  CMS clinical
                                                       paper 1in                                                                        review.
                                                       (Micropore).
                                               SJ022  electrode skin              NF  .................              100            0  CMS clinical
                                                       prep gel                                                                         review.
                                                       (NuPrep).
95912.................  Motor&sen 11-12        L037A  Electrodiagnostic           NF  .................               77           60  Conforming to
                         nrv cnd test.                 Technologist.                                                                    physician time.
                                               SG051  gauze, non-                 NF  .................                0           24  CMS clinical
                                                       sterile 4in x                                                                    review.
                                                       4in.
                                               SG055  gauze, sterile              NF  .................               24            0  CMS clinical
                                                       4in x 4in.                                                                       review.
                                               SG079  tape, surgical              NF  .................               72            0  CMS clinical
                                                       paper 1in                                                                        review.
                                                       (Micropore).

[[Page 49051]]

 
                                               SJ022  electrode skin              NF  .................              100            0  CMS clinical
                                                       prep gel                                                                         review.
                                                       (NuPrep).
95913.................  Motor&sens 13/>        L037A  Electrodiagnostic           NF  .................               87           70  Conforming to
                         nrv cnd test.                 Technologist.                                                                    physician time.
                                               SG051  gauze, non-                 NF  .................                0           26  CMS clinical
                                                       sterile 4in x                                                                    review.
                                                       4in.
                                               SG055  gauze, sterile              NF  .................               26            0  CMS clinical
                                                       4in x 4in.                                                                       review.
                                               SG079  tape, surgical              NF  .................               78            0  CMS clinical
                                                       paper 1in                                                                        review.
                                                       (Micropore).
                                               SJ022  electrode skin              NF  .................              100            0  CMS clinical
                                                       prep gel                                                                         review.
                                                       (NuPrep).
95921.................  Autonomic nrv          EF032  table, tilt (w-             NF  .................               64           55  Refined equipment
                         parasym inervj.               trendelenberg).                                                                  time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ051  arterial                    NF  .................               64           55  Refined equipment
                                                       tonometry                                                                        time to reflect
                                                       acquisition                                                                      typical use
                                                       system (WR                                                                       exclusive to
                                                       Testworks).                                                                      patient.
                                               EQ052  arterial                    NF  .................               64           55  Refined equipment
                                                       tonometry                                                                        time to reflect
                                                       monitor (Colin                                                                   typical use
                                                       Pilot).                                                                          exclusive to
                                                                                                                                        patient.
                                               L037A  Electrodiagnostic           NF  Greet patient,                   3            0  CMS clinical
                                                       Technologist.                   provide gowning,                                 review.
                                                                                       assure
                                                                                       appropriate
                                                                                       medical records
                                                                                       are available.
                                               L037A  Electrodiagnostic           NF  Obtain vital                     3            0  CMS clinical
                                                       Technologist.                   signs.                                           review.
                                               L037A  Electrodiagnostic           NF  Monitor pt.                      5            2  CMS clinical
                                                       Technologist.                   following                                        review.
                                                                                       service/check
                                                                                       tubes, monitors,
                                                                                       drains.
95922.................  Autonomic nrv          EF032  table, tilt (w-             NF  .................               79           70  Refined equipment
                         adrenrg inervj.               trendelenberg).                                                                  time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ051  arterial                    NF  .................               79           70  Refined equipment
                                                       tonometry                                                                        time to reflect
                                                       acquisition                                                                      typical use
                                                       system (WR                                                                       exclusive to
                                                       Testworks).                                                                      patient.
                                               EQ052  arterial                    NF  .................               79           70  Refined equipment
                                                       tonometry                                                                        time to reflect
                                                       monitor (Colin                                                                   typical use
                                                       Pilot).                                                                          exclusive to
                                                                                                                                        patient.
                                               L037A  Electrodiagnostic           NF  Greet patient,                   3            0  CMS clinical
                                                       Technologist.                   provide gowning,                                 review.
                                                                                       assure
                                                                                       appropriate
                                                                                       medical records
                                                                                       are available.
                                               L037A  Electrodiagnostic           NF  Obtain vital                     3            0  CMS clinical
                                                       Technologist.                   signs.                                           review.
                                               L037A  Electrodiagnostic           NF  Monitor pt.                      5            2  CMS clinical
                                                       Technologist.                   following                                        review.
                                                                                       service/check
                                                                                       tubes, monitors,
                                                                                       drains.
95923.................  Autonomic nrv          EQ035  QSART acquisition           NF  .................               74           61  Refined equipment
                         syst funj test.               system (Q-Sweat).                                                                time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.

[[Page 49052]]

 
                                               EQ124  stimulator,                 NF  .................               74           61  Refined equipment
                                                       constant                                                                         time to reflect
                                                       current, w-                                                                      typical use
                                                       stimulating and                                                                  exclusive to
                                                       grounding                                                                        patient.
                                                       electrodes
                                                       (Grass
                                                       Telefactor).
                                               EQ171  light, infra-red,           NF  .................               74           61  Refined equipment
                                                       ceiling mount.                                                                   time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               L037A  Electrodiagnostic           NF  Assist physician                55           45  CMS clinical
                                                       Technologist.                   in performing                                    review.
                                                                                       procedure.
                                               L037A  Electrodiagnostic           NF  Monitor pt.                      5            2  CMS clinical
                                                       Technologist.                   following                                        review.
                                                                                       service/check
                                                                                       tubes, monitors,
                                                                                       drains.
                                               SJ020  electrode                   NF  .................                5            0  CMS clinical
                                                       conductive gel.                                                                  review.
95924.................  Ans parasymp &         EF032  table, tilt (w-             NF  .................               79           76  Refined equipment
                         symp w/tilt.                  trendelenberg).                                                                  time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ051  arterial                    NF  .................               79           76  Refined equipment
                                                       tonometry                                                                        time to reflect
                                                       acquisition                                                                      typical use
                                                       system (WR                                                                       exclusive to
                                                       Testworks).                                                                      patient.
                                               EQ052  arterial                    NF  .................               79           76  Refined equipment
                                                       tonometry                                                                        time to reflect
                                                       monitor (Colin                                                                   typical use
                                                       Pilot).                                                                          exclusive to
                                                                                                                                        patient.
                                               L037A  Electrodiagnostic           NF  Monitor pt.                      5            2  CMS clinical
                                                       Technologist.                   following                                        review.
                                                                                       service/check
                                                                                       tubes, monitors,
                                                                                       drains.
96920.................  Laser tx skin <        EF031  table, power.....           NF  .................               20           26  Refined equipment
                         250 sq cm.                                                                                                     time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ161  laser, excimer...           NF  .................               20           26  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ168  light, exam......           NF  .................               17           26  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                                      Annual Laser                NF  .................                1            0  Included in
                                                       Service Package.                                                                 equipment cost
                                                                                                                                        per minute
                                                                                                                                        calculation.
                                               L037D  RN/LPN/MTA.......           NF  Monitor pt.                      3            1  CMS clinical
                                                                                       following                                        review.
                                                                                       service/check
                                                                                       tubes, monitors,
                                                                                       drains.
                                               L037D  RN/LPN/MTA.......           NF  Clean room/                      3            2  CMS clinical
                                                                                       equipment by                                     review.
                                                                                       physician staff.
                                               SF028  laser tip (single           NF  .................                1            0  CMS clinical
                                                       use).                                                                            review.
                                               SJ029  ice pack, instant           NF  .................                4            1  CMS Code
                                                                                                                                        correction.
96921.................  Laser tx skin 250-     EF031  table, power.....           NF  .................               23           29  Refined equipment
                         500 sq cm.                                                                                                     time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.

[[Page 49053]]

 
                                               EQ161  laser, excimer...           NF  .................               23           29  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ168  light, exam......           NF  .................               23           29  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                                      Annual Laser                NF  .................                1            0  Included in
                                                       Service Package.                                                                 equipment cost
                                                                                                                                        per minute
                                                                                                                                        calculation.
                                               L037D  RN/LPN/MTA.......           NF  Monitor pt.                      3            1  CMS clinical
                                                                                       following                                        review.
                                                                                       service/check
                                                                                       tubes, monitors,
                                                                                       drains.
                                               L037D  RN/LPN/MTA.......           NF  Clean room/                      3            2  CMS clinical
                                                                                       equipment by                                     review.
                                                                                       physician staff.
                                               SF028  laser tip (single           NF  .................                1            0  CMS clinical
                                                       use).                                                                            review.
                                               SJ029  ice pack, instant           NF  .................                4            2  CMS Code
                                                                                                                                        correction.
96922.................  Laser tx skin          EF031  table, power.....           NF  .................               33           39  Refined equipment
                         >500 sq cm.                                                                                                    time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ161  laser, excimer...           NF  .................               33           39  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ168  light, exam......           NF  .................               30           39  Refined equipment
                                                                                                                                        time to reflect
                                                                                                                                        typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                                      Annual Laser                NF  .................                1            0  Included in
                                                       Service Package.                                                                 equipment cost
                                                                                                                                        per minute
                                                                                                                                        calculation.
                                               L037D  RN/LPN/MTA.......           NF  Monitor pt.                      3            1  CMS clinical
                                                                                       following                                        review.
                                                                                       service/check
                                                                                       tubes, monitors,
                                                                                       drains.
                                               L037D  RN/LPN/MTA.......           NF  Clean room/                      3            2  CMS clinical
                                                                                       equipment by                                     review.
                                                                                       physician staff.
                                               SF028  laser tip (single           NF  .................                1            0  CMS clinical
                                                       use).                                                                            review.
97150.................  Group therapeutic      EQ248  ultrasonic                  NF  .................               10            5  Refined equipment
                         procedures.                   biometry,                                                                        time to reflect
                                                       pachymeter.                                                                      typical use
                                                                                                                                        exclusive to
                                                                                                                                        patient.
                                               EQ269  blood pressure              NF  .................                1            0  CMS clinical
                                                       monitor,                                                                         review.
                                                       ambulatory, w-
                                                       battery charger.
                                               SA007  kit, cooking                NF  .................                1            0  CMS clinical
                                                       activity                                                                         review.
                                                       ingredients (mac-
                                                       cheese).
99495.................  Trans care mgmt        L042A  RN/LPN...........            F  Communication                    0           45  CMS clinical
                         14 day disch.                                                 (with patient,                                   review.
                                                                                       family members,
                                                                                       guardian or
                                                                                       caretaker,
                                                                                       surrogate
                                                                                       decision makers,
                                                                                       and/or other
                                                                                       professionals)
                                                                                       regarding
                                                                                       aspects of care,
                                                                                       etc..

[[Page 49054]]

 
99496.................  Trans care mgmt 7      L042A  RN/LPN...........           NF  Communication                   60           70  CMS clinical
                         day disch.                                                    (with patient,                                   review.
                                                                                       family members,
                                                                                       guardian or
                                                                                       caretaker,
                                                                                       surrogate
                                                                                       decision makers,
                                                                                       and/or other
                                                                                       professionals)
                                                                                       regarding
                                                                                       aspects of care,
                                                                                       etc..
                                               L042A  RN/LPN...........            F  Communication                    0           70  CMS clinical
                                                                                       (with patient,                                   review.
                                                                                       family members,
                                                                                       guardian or
                                                                                       caretaker,
                                                                                       surrogate
                                                                                       decision makers,
                                                                                       and/or other
                                                                                       professionals)
                                                                                       regarding
                                                                                       aspects of care,
                                                                                       etc..
--------------------------------------------------------------------------------------------------------------------------------------------------------

    17. On page 69138,
    a. Top two thirds of the page, first column, first full paragraph, 
line 1, the phrase ``The CY 2013 PFS CF is $25.0008'' is corrected to 
read ``The CY 2013 PFS CF is $25.0070.''
    b. Third column, first full paragraph, line 19, the phrase CF to be 
$25.0008'' is corrected to read ``CF to be $25.0070.''
    c. Lower half of the page, in Table 87: Calculation of the CY 2013 
PFS CF, the list entry

------------------------------------------------------------------------
 
------------------------------------------------------------------------
CY 2013 Conversion Factor..............  ..............        $25.0008
------------------------------------------------------------------------

    is corrected to read as follows:

------------------------------------------------------------------------
 
------------------------------------------------------------------------
CY 2013 Conversion Factor..............  ..............        $25.0070
------------------------------------------------------------------------

    18. On page 69139, top quarter of the page, in Table 88: 
Calculation of the CY 2013 Anesthesia CF, the list entry

------------------------------------------------------------------------
 
------------------------------------------------------------------------
CY 2013 Anesthesia Factor..............  ..............          $15.93
------------------------------------------------------------------------

    is corrected to read as follows:

------------------------------------------------------------------------
 
------------------------------------------------------------------------
CY 2013 Anesthesia Factor..............  ..............        $16.1236
------------------------------------------------------------------------

    19. On page 69145, second column, first partial paragraph, lines 20 
and 21, the phrase that reads ``pharmacy for use upon a physician's 
order'' is corrected to read ``pharmacy for use upon a valid 
prescription.''
    20. On page 69212, second column, first full paragraph, lines 5-8, 
the phrase ``Measure 190: Referral for Otologic Evaluation for Patients 
with Acute or Chronic Dizziness'' is corrected to read ``Measure 190: 
Referral for Otologic Evaluation for Patients with a History of Sudden 
or Rapidly Progressive Hearing Loss.''
    21. On page 69237, in Table 95: Individual Quality Measures for the 
Physician Quality Reporting System Proposed to be Available for 
Reporting via Claims, Registry, EHR, or GRPO Web Interface Beginning in 
2013 or 2014*, Measures 189 and 190 are deleted.
    22. On page 69267, after Table 95: Individual Quality Measures for 
the Physician Quality Reporting System Proposed to be Available for 
Reporting via Claims, Registry, EHR, or GRPO Web Interface Beginning in 
2013 or 2014*, the following note is added:
    *Measures that can be reported using the GPRO web interface.
    [dagger]These measures can only be reported by participants using 
the GPRO. They are not available for reporting for individual Eligible 
Professionals using this reporting method.
    [yen] Titles and descriptions in this table are aligned with 2013 
Physician Quality Reporting System Claims and Qualified Registry 
measure titles and descriptions, and may differ from existing measures 
in other programs. Please reference the National Quality Forum (NQF) 
and

[[Page 49055]]

Physician Quality Reporting System numbers for clarification.
    [diam]Measures to be deleted in 2014.
    [Dagger]Measures to be added in 2013.
    [cir]Measures to be added in 2014.
    23. On page 69269, in Table 96: PQRS Quality Measures Available for 
Reporting for Group Practices Using the GPRO Web Interface for 2013 and 
Beyond, in the Measure and Title description for NQF/PQRS 0097/46 the 
phrase that reads ``seen within 60 days following discharge'' is 
corrected to read ``seen within 30 days following discharge.''
    24. On page 69277, in Table 108: HIV/AIDS Measures Group, the 
following measures: HIV/AIDS Measures Group: PQRS Measure 206 
(``HIV/AIDS: Screening for High Risk Sexual Behaviors'') and 
207 (``HIV/AIDS: Screening for Injection Drug Use'') are 
deleted.
    25. On page 69300,
    a. Third column, line 22-23, the phrase ``a deadline of February 
28, 2013 to request an informal review'' is corrected to read ``a 
deadline of 90 days following the receipt of the feedback reports to 
request an informal review.''
    b. Lines 27-28, the phrase ``a deadline of February 28, 2014 to 
request an informal review'' is corrected to read ``a deadline of 90 
days following the receipt of the feedback reports to request an 
informal review.''
    26. On pages 69344 through 69345, we are correcting Table 134: CY 
2013 PFS Final Rule with Comment Period Estimated Impact on Total 
Allowed Charges by Specialty* and the first footnote (*) that reads: 
*Table 83 shows only the final payment policy impact on PFS services. 
We note that these impacts do not include the effects of the negative 
January 2013 conversion factor change under current law.'' to read as 
follows:

   Table 134--CY 2013 Final Rule With Comment Period Estimated Impact on Total Allowed Charges by Specialty *
                                      [Estimated impact for RVU changes *]
----------------------------------------------------------------------------------------------------------------
                                                                  Impact of work
                    Specialty                         Allowed       and MP RVU     Impact of PE      Combined
                                                   charges (mil)     changes %     RVU changes %     impact %
(A)                                                          (B)             (C)             (D)             (E)
----------------------------------------------------------------------------------------------------------------
TOTAL...........................................         $86,384               0               0               0
01-ALLERGY/IMMUNOLOGY...........................             200               0               2               2
02-ANESTHESIOLOGY...............................           1,817               0               2               2
03-CARDIAC SURGERY..............................             369               0              -1              -1
04-CARDIOLOGY...................................           6,733              -1              -2              -2
05-COLON AND RECTAL SURGERY.....................             153               0               2               2
06-CRITICAL CARE................................             263               0               1               1
07-DERMATOLOGY..................................           3,024               0               0               0
08-EMERGENCY MEDICINE...........................           2,839               0               0               0
09-ENDOCRINOLOGY................................             437               0               1               1
10-FAMILY PRACTICE..............................           5,943               2               5               7
11-GASTROENTEROLOGY.............................           1,896               0               0               0
12-GENERAL PRACTICE.............................             587               0               1               1
13-GENERAL SURGERY..............................           2,283               0               1               1
14-GERIATRICS...................................             220               1               3               5
15-HAND SURGERY.................................             135               0               1               1
16-HEMATOLOGY/ONCOLOGY..........................           1,909               0               2               2
17-INFECTIOUS DISEASE...........................             629               0               1               1
18-INTERNAL MEDICINE............................          11,163               1               3               5
19-INTERVENTIONAL PAIN MGMT.....................             538               0               1               1
20-INTERVENTIONAL RADIOLOGY.....................             204               0              -2              -3
21-MULTISPECIALTY CLINIC/OTHER PHY..............              81               0               0               0
22-NEPHROLOGY...................................           2,080               0               0               0
23-NEUROLOGY....................................           1,604              -2              -5              -7
24-NEUROSURGERY.................................             687               0               0               0
25-NUCLEAR MEDICINE.............................              49               0              -2              -3
27-OBSTETRICS/GYNECOLOGY........................             704               0               0               0
28-OPHTHALMOLOGY................................           5,645              -3               0              -3
29-ORTHOPEDIC SURGERY...........................           3,643               0               0               0
30-OTOLARNGOLOGY................................           1,076               0               2               2
31-PATHOLOGY....................................           1,210               0              -6              -6
32-PEDIATRICS...................................              65               1               3               3
33-PHYSICAL MEDICINE............................             999              -1              -3              -4
34-PLASTIC SURGERY..............................             356               0               1               1
35-PSYCHIATRY...................................           1,170              -1               3               2
36-PULMONARY DISEASE............................           1,703               0               1               1
37-RADIATION ONCOLOGY...........................           1,988               0              -7              -7
38-RADIOLOGY....................................           4,818               0              -3              -3
39-RHEUMATOLOGY.................................             548               0               0               0
40-THORACIC SURGERY.............................             343               0              -1              -1
41-UROLOGY......................................           1,918               0              -1              -2
42-VASCULAR SURGERY.............................             888               0              -2              -2
43-AUDIOLOGIST..................................              57               0              -4              -4
44-CHIROPRACTOR.................................             746               0               1               1
45-CLINICAL PSYCHOLOGIST........................             575               1              -3              -2
46-CLINICAL SOCIAL WORKER.......................             406               1              -3              -2

[[Page 49056]]

 
47-DIAGNOSTIC TESTING FACILITY..................             888               0              -7              -7
48-INDEPENDENT LABORATORY.......................           1,073               0             -14             -14
49-NURSE ANES/ANES ASST.........................           1,008               0               2               2
50-NURSE PRACTITIONER...........................           1,623               1               3               4
51-OPTOMETRY....................................           1,061              -1               1               1
52-ORAL/MAXILLOFACIAL SURGERY...................              45               0               1               1
53-PHYSICAL/OCCUPATIONAL THERAPY................           2,636               0               4               4
54-PHYSICIAN ASSISTANT..........................           1,229               1               2               3
55-PODIATRY.....................................           1,925               0               2               2
56-PORTABLE X-RAY SUPPLIER......................             106               0               5               5
57-RADIATION THERAPY CENTERS....................              72               0              -9              -9
98-OTHER........................................              19               0               1               1
----------------------------------------------------------------------------------------------------------------
* Table 134 shows only the final payment policy impact on PFS services. We note that these impacts do not
  include the effects of the negative January 2013 conversion factor change under current law.

    27. On pages 69347 through 69348, we are correcting Table 135: CY 
2013 PFS Final Rule with Comment Period Estimated Impact on Total 
Allowed Charges by Specialty by Selected Policy* and the text in the 
first footnote (*) for Table 135 that reads ``*Table 135 shows only the 
proposed payment policy impact on PFS services. We note that these 
impacts do not include the effects of the negative January 2013 
conversion factor change under current law.'' to read as follows:

  Table 135--CY 2013 PFS Final Rule With Comment Period Estimated Impact on Total Allowed Charges by Specialty by Selected Policy* Estimated Impact for
                                                                      RVU Changes*
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                           New, revised,
                                                                            potentially
                                                                             misvalued        Updated                      Input changes
                                              Allowed      Impact of end   codes, MPPR,      equipment     Transitional     for certain        Total
                Specialty                  charges (mil)      of PPIS           new        interest rate       care          radiation      (cumulative
                                                           transition %     utilization    assumption %    management %       therapy        impact) %
                                                                             and other                                     procedures %
                                                                             factors %
(A)                                                  (B)             (C)             (D)             (E)             (F)             (G)             (H)
--------------------------------------------------------------------------------------------------------------------------------------------------------
TOTAL...................................          86,384               0               0               0               0               0               0
01-ALLERGY/IMMUNOLOGY...................             200               0               0               2               0               0               2
02-ANESTHESIOLOGY.......................           1,817               1               1               0               0               0               2
03-CARDIAC SURGERY......................             369              -1               0               0               0               0              -1
04-CARDIOLOGY...........................           6,733              -2               0               0              -1               0              -2
05-COLON AND RECTAL SURGERY.............             153               1               0               0               0               0               2
06-CRITICAL CARE........................             263               0               0               0               0               0               1
07-DERMATOLOGY..........................           3,024               0               0               1              -1               0               0
08-EMERGENCY MEDICINE...................           2,839               0               0               0               0               0               0
09-ENDOCRINOLOGY........................             437               1               1               0              -1               0               1
10-FAMILY PRACTICE......................           5,943               1               1               0               4               0               7
11-GASTROENTEROLOGY.....................           1,896               0               0               0               0               0               0
12-GENERAL PRACTICE.....................             587               1               0               0              -1               0               1
13-GENERAL SURGERY......................           2,283               1               0               0               0               0               1
14-GERIATRICS...........................             220               1               1               0               2               0               5
15-HAND SURGERY.........................             135               1               0               0              -1               0               1
16-HEMATOLOGY/ONCOLOGY..................           1,909              -1               3               1              -1               0               2
17-INFECTIOUS DISEASE...................             629               1               1               0               0               0               1
18-INTERNAL MEDICINE....................          11,163               1               1               0               3               0               5
19-INTERVENTIONAL PAIN MGMT.............             538               1               0               0              -1               0               1
20-INTERVENTIONAL RADIOLOGY.............             204              -2               0               0               0               0              -3
21-MULTISPECIALTY CLINIC/OTHER PHY......              81               0               0               0               0               0               0
22-NEPHROLOGY...........................           2,080               0               0               0               0               0               0
23-NEUROLOGY............................           1,604               1              -8               0               0               0              -7
24-NEUROSURGERY.........................             687               0               0               0               0               0               0
25-NUCLEAR MEDICINE.....................              49              -2               0              -1               0               0              -3
27-OBSTETRICS/GYNECOLOGY................             704               0               0               0              -1               0               0
28-OPHTHALMOLOGY........................           5,645               2              -4               0               0               0              -3
29-ORTHOPEDIC SURGERY...................           3,643               1               0               0               0               0               0
30-OTOLARNGOLOGY........................           1,076               1               1               1              -1               0               2
31-PATHOLOGY............................           1,210              -1              -5               0               0               0              -6
32-PEDIATRICS...........................              65               1               0               0               3               0               3
33-PHYSICAL MEDICINE....................             999               1              -5               0              -1               0              -4

[[Page 49057]]

 
34-PLASTIC SURGERY......................            $356               1               0               0               0               0               1
35-PSYCHIATRY...........................           1,170               0               2               0              -1               0               2
36-PULMONARY DISEASE....................           1,703               0               1               0              -1               0               1
37-RADIATION ONCOLOGY...................           1,988              -4               2              -3              -1              -1              -7
38-RADIOLOGY............................           4,818              -2               0              -1               0               0              -3
39-RHEUMATOLOGY.........................             548               0               1               0              -1               0               0
40-THORACIC SURGERY.....................             343              -1               0               0               0               0              -1
41-UROLOGY..............................           1,918              -2               0               0              -1               0              -2
42-VASCULAR SURGERY.....................             888              -1              -1               0               0               0              -2
43-AUDIOLOGIST..........................              57              -3               0               0               0               0              -4
44-CHIROPRACTOR.........................             746               1               0               0               0               0               1
45-CLINICAL PSYCHOLOGIST................             575              -2               1               0               0               0              -2
46-CLINICAL SOCIAL WORKER...............             406              -2               0               0               0               0              -2
47-DIAGNOSTIC TESTING FACILITY..........             888              -5               0              -2              -1               0              -7
48-INDEPENDENT LABORATORY...............           1,073              -2             -12               1              -1               0             -14
49-NURSE ANES/ANES ASST.................           1,008               2               0               0               0               0               2
50-NURSE PRACTITIONER...................           1,623               1               1               0               2               0               4
51-OPTOMETRY............................           1,061               2              -1               0               0               0               1
52-ORAL/MAXILLOFACIAL SURGERY...........              45               1               0               1              -1               0               1
53-PHYSICAL/OCCUPATIONAL THERAPY........           2,636               2               2               0               0               0               4
54-PHYSICIAN ASSISTANT..................           1,229               1               0               0               2               0               3
55-PODIATRY.............................           1,925               2               0               1              -1               0               2
56-PORTABLE X-RAY SUPPLIER..............             106               1               4               1              -1               0               5
57-RADIATION THERAPY CENTERS............              72              -5               4              -5              -1              -1              -9
98-OTHER................................              19               1               0               0               0               0               1
--------------------------------------------------------------------------------------------------------------------------------------------------------
``*Table 135 shows only the final payment policy impact on PFS services. We note that these impacts do not include the effects of the negative January
  2013 conversion factor change under current law.''

    28. On pages 69350 through 69351, we are correcting Table 136 
Impact of Final Rule with Comment Period on CY 2013 Payment for 
Selected Procedures* to read as follows:

[[Page 49058]]

[GRAPHIC] [TIFF OMITTED] TR12AU13.000


[[Page 49059]]


[GRAPHIC] [TIFF OMITTED] TR12AU13.001

    29. On page 69351,
    a. Footnote 3 ``Payments based on the 2012 conversion factor of 
34.0376, adjusted to 34.0066 to include the budget neutrality 
adjustment'' is corrected to read ``Payments based on the 2012 
conversion factor of 34.0376, adjusted to 34.0230 to include the budget 
neutrality adjustment.''
    b. Footnote 4 for Table 136 ``Payments based on the 2013 conversion 
factor of 25.0008, which includes the budget neutrality adjustment'' is 
corrected to read ``Payments based on the 2013 conversion factor of 
25.0070, which includes the budget neutrality adjustment.''

(Catalog of Federal Domestic Assistance Program No. 93.773, 
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)

    Dated: August 2, 2013.
Jennifer M. Cannistra,
Executive Secretary to the Department, Department of Health and Human 
Services.
[FR Doc. 2013-19378 Filed 8-9-13; 8:45 am]
BILLING CODE 4120-01-P