1HNPRDS21
0
NOTE
----
#
#
#
#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
1
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------G0076
54.13
51.42
59.13
G0249
55.87
53.08
61.04
G0077
76.36
72.54
83.42
G0250
8.09
7.69
8.84
G0078
126.90
120.56
138.64
G0268
51.68
49.10
56.47
G0079
180.88
171.84
197.62
#
G0268
34.64
32.91
37.85
G0080
221.14
210.08
241.59
G0270
31.78
30.19
34.72
G0081
54.43
51.71
59.47
#
G0270
27.84
26.45
30.42
G0082
83.51
79.33
91.23
G0271
16.76
15.92
18.31
G0083
128.78
122.34
140.69
#
G0271
15.45
14.68
16.88
G0084
178.54
169.61
195.05
G0276
386.51
367.18
422.26
G0085
221.14
210.08
241.59
G0277
156.63
148.80
171.12
G0086
77.13
73.27
84.26
G0278
14.18
13.47
15.49
G0087
108.00
102.60
117.99
G0279
54.07
51.37
59.08
G0101
39.35
37.38
42.99
G0279
TC
23.92
22.72
26.13
G0101
28.21
26.80
30.82
G0279
26
30.15
28.64
32.94
G0102
22.18
21.07
24.23
G0281
13.01
12.36
14.21
G0102
9.07
8.62
9.91
G0283
13.01
12.36
14.21
G0104
187.17
177.81
204.48
G0288
35.48
33.71
38.77
G0104
56.77
53.93
62.02
G0289
90.24
85.73
98.59
G0105
349.22
331.76
381.52
G0296
28.99
27.54
31.67
G0105
190.96
181.41
208.62
#
G0296
26.70
25.37
29.18
G0105
53
174.36
165.64
190.49
G0329
10.79
10.25
11.79
G0105
53
95.07
90.32
103.87
G0341
2,089.70
1,985.22
2,283.00
G0106
224.23
213.02
244.97
#
G0341
365.30
347.04
399.10
G0106
TC
163.01
154.86
178.09
G0342
689.90
655.41
753.72
G0106
26
61.21
58.15
66.87
G0343
1,327.82
1,261.43
1,450.64
G0108
55.53
52.75
60.66
G0372
9.05
8.60
9.89
G0109
15.45
14.68
16.88
G0396
36.32
34.50
39.68
G0117
55.85
53.06
61.02
#
G0396
33.38
31.71
36.47
G0118
40.68
38.65
44.45
G0397
68.23
64.82
74.54
G0120
224.23
213.02
244.97
#
G0397
65.29
62.03
71.33
G0120
TC
163.01
154.86
178.09
G0402
167.37
159.00
182.85
G0120
26
61.21
58.15
66.87
#
G0402
135.58
128.80
148.12
G0121
349.72
332.23
382.06
G0403
14.80
14.06
16.17
G0121
191.46
181.89
209.17
G0404
6.40
6.08
6.99
G0121
53
174.86
166.12
191.04
G0405
8.40
7.98
9.18
G0121
53
95.57
90.79
104.41
G0406
38.52
36.59
42.08
G0124
21.37
20.30
23.35
G0407
72.18
68.57
78.86
G0127
23.47
22.30
25.65
G0408
103.66
98.48
113.25
G0127
7.74
7.35
8.45
G0409
13.61
12.93
14.87
G0128
7.38
7.01
8.06
G0412
760.73
722.69
831.09
G0130
35.22
33.46
38.48
G0413
1,113.65
1,057.97
1,216.67
G0130
TC
24.09
22.89
26.32
G0414
1,052.36
999.74
1,149.70
G0130
26
11.13
10.57
12.16
G0415
1,442.45
1,370.33
1,575.88
G0141
21.37
20.30
23.35
G0416
341.78
324.69
373.39
G0166
111.76
106.17
122.10
G0416
TC
165.50
157.23
180.81
G0168
118.17
112.26
129.10
G0416
26
176.28
167.47
192.59
G0168
15.94
15.14
17.41
G0420
113.90
108.21
124.44
G0179
40.64
38.61
44.40
G0421
27.31
25.94
29.83
G0180
52.42
49.80
57.27
G0422
116.19
110.38
126.94
G0181
105.52
100.24
115.28
G0423
116.19
110.38
126.94
G0182
106.83
101.49
116.71
G0424
29.45
27.98
32.18
G0237
9.35
8.88
10.21
#
G0424
14.05
13.35
15.35
G0238
9.67
9.19
10.57
G0425
102.57
97.44
112.06
G0239
11.64
11.06
12.72
G0426
136.97
130.12
149.64
G0245
64.99
61.74
71.00
G0427
201.13
191.07
219.73
G0245
42.06
39.96
45.95
G0429
98.49
93.57
107.61
G0246
38.00
36.10
41.52
#
G0429
70.31
66.79
76.81
G0246
20.64
19.61
22.55
G0438
167.04
158.69
182.49
G0247
80.70
76.67
88.17
G0439
131.83
125.24
144.03
G0247
22.05
20.95
24.09
G0442
18.25
17.34
19.94
G0248
63.27
60.11
69.13
#
G0442
9.40
8.93
10.27
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
---#
#
#
#
#
#
#
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#
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#
#
#
#
#
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#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
2
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------G0443
26.88
25.54
29.37
G2086
389.92
370.42
425.98
G0443
24.26
23.05
26.51
#
G2086
289.01
274.56
315.74
G0444
18.25
17.34
19.94
G2087
348.93
331.48
381.20
G0444
9.40
8.93
10.27
#
G2087
282.42
268.30
308.55
G0445
28.19
26.78
30.80
G2088
65.02
61.77
71.04
G0445
23.93
22.73
26.14
#
G2088
34.22
32.51
37.39
G0446
26.88
25.54
29.37
G2212
33.62
31.94
36.73
G0446
24.26
23.05
26.51
#
G2212
32.63
31.00
35.65
G0447
26.88
25.54
29.37
G2213
69.89
66.40
76.36
G0447
24.26
23.05
26.51
#
G2213
66.94
63.59
73.13
G0451
9.67
9.19
10.57
G2214
63.12
59.96
68.95
G0452
49.37
46.90
53.94
#
G2214
38.87
36.93
42.47
G0452
TC
3.12
2.96
3.40
G2250
12.02
11.42
13.13
G0452
26
46.25
43.94
50.53
#
G2250
9.40
8.93
10.27
G0453
33.27
31.61
36.35
G2251
14.64
13.91
16.00
G0454
9.07
8.62
9.91
#
G2251
13.33
12.66
14.56
G0455
129.45
122.98
141.43
G2252
26.99
25.64
29.49
G0455
73.43
69.76
80.22
#
G2252
25.67
24.39
28.05
G0459
42.86
40.72
46.83
G6001
148.87
141.43
162.64
G0473
12.79
12.15
13.97
G6001
TC
117.14
111.28
127.97
G0473
11.80
11.21
12.89
G6001
26
31.72
30.13
34.65
G0500
55.93
53.13
61.10
G6002
73.59
69.91
80.40
G0500
5.80
5.51
6.34
G6002
TC
53.25
50.59
58.18
G0506
60.71
57.67
66.32
G6002
26
20.33
19.31
22.21
G0506
44.98
42.73
49.14
G6003
147.29
139.93
160.92
G0508
211.80
201.21
231.39
G6004
136.15
129.34
148.74
G0509
192.48
182.86
210.29
G6005
136.47
129.65
149.10
G0513
65.65
62.37
71.73
G6006
135.82
129.03
148.38
G0513
62.04
58.94
67.78
G6007
258.69
245.76
282.62
G0514
65.65
62.37
71.73
G6008
188.24
178.83
205.65
G0514
61.71
58.62
67.41
G6009
186.93
177.58
204.22
G0516
216.89
206.05
236.96
G6010
186.60
177.27
203.86
G0516
101.56
96.48
110.95
G6011
250.17
237.66
273.31
G0517
219.97
208.97
240.32
G6012
249.03
236.58
272.07
G0517
116.76
110.92
127.56
G6013
249.68
237.20
272.78
G0518
410.56
390.03
448.53
G6014
249.03
236.58
272.07
G0518
188.42
179.00
205.85
G6015
362.74
344.60
396.29
G2001
54.13
51.42
59.13
G6016
361.24
343.18
394.66
G2002
76.36
72.54
83.42
G9157
98.06
93.16
107.13
G2003
126.90
120.56
138.64
G9187
43.00
40.85
46.98
G2004
180.88
171.84
197.62
G9481
19.25
18.29
21.03
G2005
221.14
210.08
241.59
G9482
36.96
35.11
40.38
G2006
54.43
51.71
59.47
G9483
57.06
54.21
62.34
G2007
83.51
79.33
91.23
G9484
96.31
91.49
105.21
G2008
128.78
122.34
140.69
G9485
126.13
119.82
137.79
G2009
178.54
169.61
195.05
G9486
19.25
18.29
21.03
G2010
12.02
11.42
13.13
G9487
38.85
36.91
42.45
G2010
9.40
8.93
10.27
G9488
59.35
56.38
64.84
G2011
17.10
16.25
18.69
G9489
84.14
79.93
91.92
G2012
14.64
13.91
16.00
G9490
43.50
41.33
47.53
G2012
13.33
12.66
14.56
G9685
201.63
191.55
220.28
G2013
221.14
210.08
241.59
G9868
27.91
26.51
30.49
G2014
77.13
73.27
84.26
G9869
37.34
35.47
40.79
G2015
108.00
102.60
117.99
G9870
46.76
44.42
51.08
G2064
89.85
85.36
98.16
G9978
28.75
27.31
31.41
G2064
77.07
73.22
84.20
G9979
50.39
47.87
55.05
G2065
38.36
36.44
41.91
G9980
79.01
75.06
86.32
G2082
606.21
575.90
662.29
G9981
132.68
126.05
144.96
G2082
32.50
30.88
35.51
G9982
176.59
167.76
192.92
G2083
863.74
820.55
943.63
G9983
28.75
27.31
31.41
G2083
32.50
30.88
35.51
G9984
56.87
54.03
62.13
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
3
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------G9985
86.22
81.91
94.20
11000
57.51
54.63
62.82
G9986
124.44
118.22
135.95
#
11000
28.68
27.25
31.34
G9987
43.00
40.85
46.98
11001
25.58
24.30
27.95
P3001
21.37
20.30
23.35
#
11001
15.09
14.34
16.49
Q0035
19.06
18.11
20.83
11004
605.41
575.14
661.41
Q0035
TC
10.33
9.81
11.28
11005
834.90
793.16
912.13
Q0035
26
8.73
8.29
9.53
11006
747.50
710.13
816.65
Q0091
42.76
40.62
46.71
11008
293.82
279.13
321.00
Q0091
19.50
18.53
21.31
11010
476.63
452.80
520.72
Q0092
22.13
21.02
24.17
#
11010
284.31
270.09
310.60
0446T
1,803.74
1,713.55
1,970.58
11011
531.70
505.12
580.89
0446T
58.70
55.77
64.14
#
11011
313.49
297.82
342.49
0447T
103.05
97.90
112.59
11012
683.55
649.37
746.78
0447T
69.30
65.84
75.72
#
11012
436.18
414.37
476.53
0448T
1,815.92
1,725.12
1,983.89
11042
129.56
123.08
141.54
0448T
98.40
93.48
107.50
#
11042
62.07
58.97
67.82
0509T
75.25
71.49
82.21
11043
239.09
227.14
261.21
0509T
TC
53.91
51.21
58.89
#
11043
161.11
153.05
176.01
0509T
26
21.34
20.27
23.31
11044
319.93
303.93
349.52
10004
52.75
50.11
57.63
#
11044
235.07
223.32
256.82
10004
44.56
42.33
48.68
11045
42.27
40.16
46.18
10005
136.43
129.61
149.05
#
11045
27.85
26.46
30.43
10005
74.84
71.10
81.77
11046
76.75
72.91
83.85
10006
61.85
58.76
67.57
#
11046
59.06
56.11
64.53
10006
52.02
49.42
56.83
11047
127.01
120.66
138.76
10007
303.99
288.79
332.11
#
11047
103.09
97.94
112.63
10007
94.62
89.89
103.37
11055
68.60
65.17
74.95
10008
162.01
153.91
177.00
#
11055
16.84
16.00
18.40
10008
60.12
57.11
65.68
11056
78.75
74.81
86.03
10009
464.20
440.99
507.14
#
11056
23.05
21.90
25.19
10009
114.93
109.18
125.56
11057
86.78
82.44
94.81
10010
275.43
261.66
300.91
#
11057
29.77
28.28
32.52
10010
83.43
79.26
91.15
11102
102.20
97.09
111.65
10021
103.56
98.38
113.14
#
11102
37.98
36.08
41.49
10021
57.37
54.50
62.68
11103
52.29
49.68
57.13
10030
650.25
617.74
710.40
#
11103
22.47
21.35
24.55
10030
139.77
132.78
152.70
11104
128.49
122.07
140.38
10035
418.07
397.17
456.75
#
11104
48.54
46.11
53.03
10035
86.82
82.48
94.85
11105
60.47
57.45
66.07
10036
356.41
338.59
389.38
#
11105
26.40
25.08
28.84
10036
44.50
42.28
48.62
11106
157.06
149.21
171.59
10040
115.55
109.77
126.24
#
11106
59.10
56.15
64.57
10040
53.30
50.64
58.24
11107
72.13
68.52
78.80
10060
123.45
117.28
134.87
#
11107
31.50
29.93
34.42
10060
103.47
98.30
113.05
11200
89.47
85.00
97.75
10061
214.05
203.35
233.85
#
11200
74.73
70.99
81.64
10061
185.22
175.96
202.35
11201
19.00
18.05
20.76
10080
243.10
230.95
265.59
#
11201
17.04
16.19
18.62
10080
106.14
100.83
115.95
11300
101.42
96.35
110.80
10081
340.06
323.06
371.52
#
11300
34.25
32.54
37.42
10081
178.21
169.30
194.70
11301
123.39
117.22
134.80
10120
152.46
144.84
166.57
#
11301
52.29
49.68
57.13
10120
104.62
99.39
114.30
11302
141.09
134.04
154.15
10121
274.04
260.34
299.39
#
11302
61.48
58.41
67.17
10121
189.51
180.03
207.03
11303
155.63
147.85
170.03
10140
172.46
163.84
188.42
#
11303
72.73
69.09
79.45
10140
120.36
114.34
131.49
11305
106.93
101.58
116.82
10160
130.75
124.21
142.84
#
11305
38.78
36.84
42.37
10160
96.01
91.21
104.89
11306
124.17
117.96
135.65
10180
267.78
254.39
292.55
#
11306
50.78
48.24
55.48
10180
184.23
175.02
201.27
11307
144.04
136.84
157.37
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
---#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
4
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------11307
65.07
61.82
71.09
11601
231.86
220.27
253.31
11308
153.45
145.78
167.65
#
11601
149.95
142.45
163.82
11308
74.16
70.45
81.02
11602
247.36
234.99
270.24
11310
117.61
111.73
128.49
#
11602
162.50
154.38
177.54
11310
46.84
44.50
51.18
11603
282.18
268.07
308.28
11311
139.58
132.60
152.49
#
11603
194.69
184.96
212.70
11311
64.88
61.64
70.89
11604
316.11
300.30
345.35
11312
159.18
151.22
173.90
#
11604
216.83
205.99
236.89
11312
76.29
72.48
83.35
11606
456.35
433.53
498.56
11313
185.09
175.84
202.22
#
11606
326.60
310.27
356.81
11313
97.93
93.03
106.98
11620
201.75
191.66
220.41
11400
128.00
121.60
139.84
#
11620
124.42
118.20
135.93
11400
83.11
78.95
90.79
11621
232.54
220.91
254.05
11401
156.37
148.55
170.83
#
11621
150.30
142.79
164.21
11401
105.25
99.99
114.99
11622
255.36
242.59
278.98
11402
173.15
164.49
189.16
#
11622
169.85
161.36
185.56
11402
116.46
110.64
127.24
11623
300.54
285.51
328.34
11403
200.09
190.09
218.60
#
11623
212.41
201.79
232.06
11403
149.63
142.15
163.47
11624
342.35
325.23
374.01
11404
228.59
217.16
249.73
#
11624
242.09
229.99
264.49
11404
166.34
158.02
181.72
11626
417.11
396.25
455.69
11406
328.04
311.64
358.39
#
11626
301.77
286.68
329.68
11406
255.96
243.16
279.63
11640
206.07
195.77
225.14
11420
128.60
122.17
140.50
#
11640
127.44
121.07
139.23
11420
82.40
78.28
90.02
11641
240.11
228.10
262.32
11421
160.87
152.83
175.75
#
11641
156.56
148.73
171.04
11421
109.76
104.27
119.91
11642
271.42
257.85
296.53
11422
181.85
172.76
198.67
#
11642
183.61
174.43
200.59
11422
135.98
129.18
148.56
11643
320.92
304.87
350.60
11423
207.61
197.23
226.81
#
11643
231.47
219.90
252.89
11423
157.15
149.29
171.68
11644
396.92
377.07
433.63
11424
239.22
227.26
261.35
#
11644
289.12
274.66
315.86
11424
180.57
171.54
197.27
11646
519.25
493.29
567.28
11426
345.81
328.52
377.80
#
11646
402.94
382.79
440.21
11426
282.25
268.14
308.36
11719
13.97
13.27
15.26
11440
143.06
135.91
156.30
#
11719
7.74
7.35
8.45
11440
103.42
98.25
112.99
11720
33.16
31.50
36.23
11441
174.96
166.21
191.14
#
11720
15.46
14.69
16.89
11441
131.71
125.12
143.89
11721
44.44
42.22
48.55
11442
194.51
184.78
212.50
#
11721
24.78
23.54
27.07
11442
146.01
138.71
159.52
11730
116.18
110.37
126.93
11443
231.68
220.10
253.12
#
11730
55.23
52.47
60.34
11443
180.24
171.23
196.91
11732
34.27
32.56
37.44
11444
290.13
275.62
316.96
#
11732
18.21
17.30
19.90
11444
230.17
218.66
251.46
11740
55.54
52.76
60.67
11446
397.12
377.26
433.85
#
11740
31.30
29.74
34.20
11446
328.64
312.21
359.04
11750
161.90
153.81
176.88
11450
437.87
415.98
478.38
#
11750
102.60
97.47
112.09
11450
268.15
254.74
292.95
11755
126.60
120.27
138.31
11451
539.60
512.62
589.51
#
11755
62.71
59.57
68.51
11451
342.03
324.93
373.67
11760
195.17
185.41
213.22
11462
422.43
401.31
461.51
#
11760
115.88
110.09
126.60
11462
253.69
241.01
277.16
11762
298.00
283.10
325.57
11463
544.17
516.96
594.50
#
11762
193.81
184.12
211.74
11463
343.00
325.85
374.73
11765
167.82
159.43
183.34
11470
461.12
438.06
503.77
#
11765
92.46
87.84
101.02
11470
293.37
278.70
320.51
11770
354.99
337.24
387.83
11471
557.79
529.90
609.39
#
11770
195.75
185.96
213.85
11471
362.51
344.38
396.04
11771
645.77
613.48
705.50
11600
201.07
191.02
219.67
#
11771
466.54
443.21
509.69
11600
123.75
117.56
135.19
11772
794.97
755.22
868.50
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
---#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
5
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------11772
610.18
579.67
666.62
#
12031
152.75
145.11
166.88
11900
56.03
53.23
61.21
12032
306.71
291.37
335.08
11900
30.48
28.96
33.30
#
12032
189.74
180.25
207.29
11901
70.76
67.22
77.30
12034
338.11
321.20
369.38
11901
47.49
45.12
51.89
#
12034
209.35
198.88
228.71
11920
194.53
184.80
212.52
12035
402.53
382.40
439.76
11920
113.60
107.92
124.11
#
12035
249.84
237.35
272.95
11921
221.65
210.57
242.16
12036
447.19
424.83
488.55
11921
134.83
128.09
147.30
#
12036
295.16
280.40
322.46
11922
60.59
57.56
66.19
12037
502.40
477.28
548.87
11922
30.78
29.24
33.63
#
12037
343.82
326.63
375.62
11950
81.38
77.31
88.91
12041
265.19
251.93
289.72
11950
54.51
51.78
59.55
#
12041
147.24
139.88
160.86
11951
109.05
103.60
119.14
12042
311.10
295.55
339.88
11951
76.28
72.47
83.34
#
12042
197.41
187.54
215.67
11952
146.73
139.39
160.30
12044
385.47
366.20
421.13
11952
107.74
102.35
117.70
#
12044
218.05
207.15
238.22
11954
161.35
153.28
176.27
12045
414.85
394.11
453.23
11954
118.10
112.20
129.03
#
12045
276.92
263.07
302.53
11960
1,041.06
989.01
1,137.36
12046
518.95
493.00
566.95
11970
579.42
550.45
633.02
#
12046
332.85
316.21
363.64
11971
563.10
534.95
615.19
12047
569.47
541.00
622.15
11976
148.37
140.95
162.09
#
12047
371.90
353.31
406.31
11976
97.91
93.01
106.96
12051
284.05
269.85
310.33
11980
95.85
91.06
104.72
#
12051
170.35
161.83
186.10
11980
58.17
55.26
63.55
12052
317.03
301.18
346.36
11981
105.99
100.69
115.79
#
12052
201.70
191.62
220.36
11981
67.33
63.96
73.55
12053
370.67
352.14
404.96
11982
119.89
113.90
130.99
#
12053
219.30
208.34
239.59
11982
79.26
75.30
86.60
12054
393.26
373.60
429.64
11983
149.18
141.72
162.98
#
12054
225.18
213.92
246.01
11983
109.21
103.75
119.31
12055
515.05
489.30
562.70
12001
94.81
90.07
103.58
#
12055
308.96
293.51
337.54
12001
46.98
44.63
51.32
12056
594.05
564.35
649.00
12002
115.49
109.72
126.18
#
12056
396.81
376.97
433.52
12002
62.42
59.30
68.20
12057
631.54
599.96
689.95
12004
134.69
127.96
147.15
#
12057
435.93
414.13
476.25
12004
77.68
73.80
84.87
13100
348.13
330.72
380.33
12005
180.82
171.78
197.55
#
13100
204.29
194.08
223.19
12005
102.84
97.70
112.36
13101
405.41
385.14
442.91
12006
211.43
200.86
230.99
#
13101
252.40
239.78
275.75
12006
125.26
119.00
136.85
13102
121.26
115.20
132.48
12007
242.29
230.18
264.71
#
13102
75.06
71.31
82.01
12007
156.77
148.93
171.27
13120
361.89
343.80
395.37
12011
115.35
109.58
126.02
#
13120
236.73
224.89
258.62
12011
59.32
56.35
64.80
13121
434.36
412.64
474.54
12013
120.27
114.26
131.40
#
13121
262.02
248.92
286.26
12013
62.60
59.47
68.39
13122
131.69
125.11
143.88
12014
147.46
140.09
161.10
#
13122
85.82
81.53
93.76
12014
80.62
76.59
88.08
13131
396.11
376.30
432.75
12015
177.89
169.00
194.35
#
13131
246.70
234.37
269.53
12015
101.88
96.79
111.31
13132
479.98
455.98
524.38
12016
227.17
215.81
248.18
#
13132
306.66
291.33
335.03
12016
138.38
131.46
151.18
13133
173.97
165.27
190.06
12017
164.96
156.71
180.22
#
13133
129.41
122.94
141.38
12018
187.26
177.90
204.59
13151
432.21
410.60
472.19
12020
305.39
290.12
333.64
#
13151
283.79
269.60
310.04
12020
194.31
184.59
212.28
13152
509.46
483.99
556.59
12021
178.28
169.37
194.78
#
13152
342.36
325.24
374.03
12021
143.55
136.37
156.83
13153
191.81
182.22
209.55
12031
263.82
250.63
288.22
#
13153
142.01
134.91
155.15
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
6
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------13160
828.14
786.73
904.74
15152
157.59
149.71
172.17
14000
639.82
607.83
699.00
#
15152
148.75
141.31
162.51
14000
508.44
483.02
555.47
15155
824.67
783.44
900.96
14001
819.69
778.71
895.52
#
15155
754.23
716.52
824.00
14001
665.37
632.10
726.92
15156
172.60
163.97
188.57
14020
703.17
668.01
768.21
#
15156
163.42
155.25
178.54
14020
567.86
539.47
620.39
15157
191.53
181.95
209.24
14021
869.96
826.46
950.43
#
15157
178.43
169.51
194.94
14021
714.32
678.60
780.39
15200
854.74
812.00
933.80
14040
761.54
723.46
831.98
#
15200
687.64
653.26
751.25
14040
627.53
596.15
685.57
15201
149.33
141.86
163.14
14041
926.71
880.37
1,012.43
#
15201
81.51
77.43
89.04
14041
767.47
729.10
838.47
15220
777.07
738.22
848.95
14060
771.24
732.68
842.58
#
15220
616.85
586.01
673.91
14060
666.73
633.39
728.40
15221
137.23
130.37
149.93
14061
997.80
947.91
1,090.10
#
15221
73.01
69.36
79.76
14061
823.49
782.32
899.67
15240
937.70
890.82
1,024.44
14301
1,102.71
1,047.57
1,204.71
#
15240
801.07
761.02
875.17
14301
888.43
844.01
970.61
15241
180.32
171.30
197.00
14302
226.42
215.10
247.37
#
15241
109.87
104.38
120.04
14350
693.45
658.78
757.60
15260
1,002.02
951.92
1,094.71
15002
361.24
343.18
394.66
#
15260
848.35
805.93
926.82
15002
230.50
218.98
251.83
15261
211.44
200.87
231.00
15003
73.93
70.23
80.76
#
15261
140.67
133.64
153.69
15003
48.05
45.65
52.50
15271
156.08
148.28
170.52
15004
408.43
388.01
446.21
#
15271
87.27
82.91
95.35
15004
271.80
258.21
296.94
15272
25.81
24.52
28.20
15005
124.93
118.68
136.48
#
15272
17.95
17.05
19.61
15005
96.43
91.61
105.35
15273
325.20
308.94
355.28
15040
273.93
260.23
299.26
#
15273
208.89
198.45
228.22
15040
130.10
123.60
142.14
15274
84.42
80.20
92.23
15050
606.48
576.16
662.58
#
15274
47.72
45.33
52.13
15050
472.14
448.53
515.81
15275
161.18
153.12
176.09
15100
895.33
850.56
978.14
#
15275
96.96
92.11
105.93
15100
739.70
702.72
808.13
15276
33.56
31.88
36.66
15101
195.32
185.55
213.38
#
15276
26.02
24.72
28.43
15101
117.67
111.79
128.56
15277
355.81
338.02
388.72
15110
852.87
810.23
931.76
#
15277
236.55
224.72
258.43
15110
731.97
695.37
799.68
15278
98.97
94.02
108.12
15111
118.97
113.02
129.97
#
15278
59.98
56.98
65.53
15111
108.48
103.06
118.52
15570
935.45
888.68
1,021.98
15115
834.89
793.15
912.12
#
15570
755.57
717.79
825.46
15115
717.59
681.71
783.97
15572
896.44
851.62
979.36
15116
171.69
163.11
187.58
#
15572
753.59
715.91
823.30
15116
157.60
149.72
172.18
15574
894.18
849.47
976.89
15120
867.58
824.20
947.83
#
15574
751.98
714.38
821.54
15120
709.66
674.18
775.31
15576
801.61
761.53
875.76
15121
219.06
208.11
239.33
#
15576
665.63
632.35
727.20
15121
141.74
134.65
154.85
15600
338.81
321.87
370.15
15130
740.71
703.67
809.22
#
15600
212.01
201.41
231.62
15130
611.62
581.04
668.20
15610
368.96
350.51
403.09
15131
101.73
96.64
111.14
#
15610
245.11
232.85
267.78
15131
94.19
89.48
102.90
15620
448.87
426.43
490.39
15135
893.30
848.64
975.94
#
15620
328.63
312.20
359.03
15135
770.43
731.91
841.70
15630
462.15
439.04
504.90
15136
100.42
95.40
109.71
#
15630
343.54
326.36
375.31
15136
94.19
89.48
102.90
15650
510.50
484.98
557.73
15150
748.66
711.23
817.91
#
15650
383.70
364.52
419.20
15150
678.22
644.31
740.96
15730
1,492.07
1,417.47
1,630.09
15151
127.24
120.88
139.01
#
15730
930.81
884.27
1,016.91
15151
118.07
112.17
129.00
15731
1,145.08
1,087.83
1,251.00
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
---#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
7
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------15731
1,019.92
968.92
1,114.26
15835
961.10
913.05
1,050.01
15733
1,065.02
1,011.77
1,163.54
15836
786.96
747.61
859.75
15734
1,578.18
1,499.27
1,724.16
15837
887.37
843.00
969.45
15736
1,263.97
1,200.77
1,380.89
#
15837
738.29
701.38
806.59
15738
1,336.02
1,269.22
1,459.60
15838
663.39
630.22
724.75
15740
1,017.30
966.44
1,111.41
15839
916.27
870.46
1,001.03
15740
851.51
808.93
930.27
#
15839
764.90
726.66
835.66
15750
959.68
911.70
1,048.46
15840
1,038.19
986.28
1,134.22
15756
2,367.49
2,249.12
2,586.49
15841
1,844.74
1,752.50
2,015.38
15757
2,354.53
2,236.80
2,572.32
15842
2,809.71
2,669.22
3,069.60
15758
2,362.34
2,244.22
2,580.85
15845
1,016.83
965.99
1,110.89
15760
857.07
814.22
936.35
15851
107.43
102.06
117.37
15760
711.92
676.32
777.77
#
15851
47.14
44.78
51.50
15769
495.12
470.36
540.91
15852
48.99
46.54
53.52
15770
681.50
647.43
744.54
15860
112.26
106.65
122.65
15771
586.31
556.99
640.54
15920
655.94
623.14
716.61
15771
491.62
467.04
537.10
15922
818.01
777.11
893.68
15772
185.43
176.16
202.58
15931
741.59
704.51
810.19
15772
146.44
139.12
159.99
15933
904.66
859.43
988.34
15773
591.11
561.55
645.78
15934
990.52
940.99
1,082.14
15773
496.42
471.60
542.34
15935
1,190.96
1,131.41
1,301.12
15774
179.98
170.98
196.63
15936
947.30
899.94
1,034.93
15774
140.99
133.94
154.03
15937
1,088.93
1,034.48
1,189.65
15775
385.85
366.56
421.54
15940
737.96
701.06
806.22
15775
265.60
252.32
290.17
15941
961.50
913.43
1,050.44
15776
525.12
498.86
573.69
15944
951.97
904.37
1,040.03
15776
364.90
346.66
398.66
15945
1,049.50
997.03
1,146.58
15777
225.95
214.65
246.85
15946
1,689.56
1,605.08
1,845.84
15780
862.68
819.55
942.48
15950
637.74
605.85
696.73
15780
665.44
632.17
727.00
15951
923.15
876.99
1,008.54
15781
552.83
525.19
603.97
15952
943.35
896.18
1,030.61
15781
435.21
413.45
475.47
15953
1,039.12
987.16
1,135.23
15782
510.33
484.81
557.53
15956
1,218.85
1,157.91
1,331.60
15782
378.61
359.68
413.63
15958
1,231.98
1,170.38
1,345.94
15783
455.22
432.46
497.33
16000
75.57
71.79
82.56
15783
353.98
336.28
386.72
#
16000
47.39
45.02
51.77
15786
238.22
226.31
260.26
16020
85.67
81.39
93.60
15786
134.36
127.64
146.79
#
16020
56.51
53.68
61.73
15787
35.78
33.99
39.09
16025
158.27
150.36
172.91
15787
17.43
16.56
19.04
#
16025
113.71
108.02
124.22
15788
409.14
388.68
446.98
16030
198.57
188.64
216.94
15788
219.11
208.15
239.37
#
16030
136.32
129.50
148.93
15789
535.53
508.75
585.06
16035
203.10
192.95
221.89
15789
407.75
387.36
445.46
16036
83.05
78.90
90.74
15792
357.52
339.64
390.59
17000
65.40
62.13
71.45
15792
216.96
206.11
237.03
#
17000
53.28
50.62
58.21
15793
476.10
452.30
520.15
17003
6.31
5.99
6.89
15793
352.25
334.64
384.84
#
17003
2.05
1.95
2.24
15819
821.09
780.04
897.05
17004
164.07
155.87
179.25
15820
573.06
544.41
626.07
#
17004
98.22
93.31
107.31
15820
510.81
485.27
558.06
17106
342.25
325.14
373.91
15821
616.23
585.42
673.23
#
17106
275.08
261.33
300.53
15821
548.08
520.68
598.78
17107
448.78
426.34
490.29
15822
460.33
437.31
502.91
#
17107
359.00
341.05
392.21
15822
398.40
378.48
435.25
17108
638.34
606.42
697.38
15823
618.07
587.17
675.25
#
17108
529.56
503.08
578.54
15823
548.94
521.49
599.71
17110
111.63
106.05
121.96
15830
1,220.10
1,159.10
1,332.97
#
17110
65.11
61.85
71.13
15832
949.20
901.74
1,037.00
17111
131.40
124.83
143.55
15833
902.91
857.76
986.42
#
17111
80.62
76.59
88.08
15834
919.25
873.29
1,004.28
17250
88.27
83.86
96.44
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
---#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
8
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------17250
36.83
34.99
40.24
19082
448.93
426.48
490.45
17260
98.62
93.69
107.74
#
19082
85.24
80.98
93.13
17260
70.44
66.92
76.96
19083
565.53
537.25
617.84
17261
147.37
140.00
161.00
#
19083
160.89
152.85
175.78
17261
87.41
83.04
95.50
19084
440.68
418.65
481.45
17262
177.42
168.55
193.83
#
19084
79.94
75.94
87.33
17262
110.26
104.75
120.46
19085
863.18
820.02
943.02
17263
192.31
182.69
210.09
#
19085
185.28
176.02
202.42
17263
122.52
116.39
133.85
19086
680.11
646.10
743.02
17264
206.41
196.09
225.50
#
19086
92.64
88.01
101.21
17264
131.37
124.80
143.52
19100
161.23
153.17
176.15
17266
235.47
223.70
257.26
#
19100
75.06
71.31
82.01
17266
154.54
146.81
168.83
19101
352.57
334.94
385.18
17270
149.18
141.72
162.98
#
19101
235.93
224.13
257.75
17270
95.44
90.67
104.27
19105
2,644.77
2,512.53
2,889.41
17271
165.44
157.17
180.75
#
19105
227.40
216.03
248.43
17271
105.48
100.21
115.24
19110
515.20
489.44
562.86
17272
188.00
178.60
205.39
#
19110
368.74
350.30
402.85
17272
121.49
115.42
132.73
19112
483.56
459.38
528.29
17273
209.61
199.13
229.00
#
19112
334.49
317.77
365.44
17273
138.51
131.58
151.32
19120
538.96
512.01
588.81
17274
245.52
233.24
268.23
#
19120
440.01
418.01
480.71
17274
168.85
160.41
184.47
19125
595.67
565.89
650.77
17276
285.54
271.26
311.95
#
19125
488.53
464.10
533.72
17276
203.63
193.45
222.47
19126
173.83
165.14
189.91
17280
140.16
133.15
153.12
19281
244.24
232.03
266.83
17280
87.09
82.74
95.15
#
19281
101.39
96.32
110.77
17281
178.88
169.94
195.43
19282
173.08
164.43
189.09
17281
118.26
112.35
129.20
#
19282
51.19
48.63
55.92
17282
205.98
195.68
225.03
19283
269.84
256.35
294.80
17282
137.83
130.94
150.58
#
19283
103.39
98.22
112.95
17283
244.49
232.27
267.11
19284
204.57
194.34
223.49
17283
172.08
163.48
188.00
#
19284
53.20
50.54
58.12
17284
278.88
264.94
304.68
19285
421.67
400.59
460.68
17284
201.23
191.17
219.85
#
19285
87.14
82.78
95.20
17286
359.21
341.25
392.44
19286
354.28
336.57
387.06
17286
274.03
260.33
299.38
#
19286
44.32
42.10
48.42
17311
671.49
637.92
733.61
19287
722.68
686.55
789.53
17311
362.85
344.71
396.42
#
19287
129.64
123.16
141.63
17312
406.22
385.91
443.80
19288
568.51
540.08
621.09
17312
192.59
182.96
210.40
#
19288
65.24
61.98
71.28
17313
629.27
597.81
687.48
19294
177.58
168.70
194.01
17313
324.89
308.65
354.95
19296
4,069.02
3,865.57
4,445.41
17314
388.15
368.74
424.05
#
19296
224.42
213.20
245.18
17314
178.46
169.54
194.97
19297
102.84
97.70
112.36
17315
77.46
73.59
84.63
19298
988.65
939.22
1,080.10
17315
51.25
48.69
55.99
#
19298
329.10
312.65
359.55
17340
53.33
50.66
58.26
19300
594.14
564.43
649.09
17340
50.05
47.55
54.68
#
19300
445.39
423.12
486.59
17360
123.98
117.78
135.45
19301
702.03
666.93
766.97
17360
93.19
88.53
101.81
19302
965.87
917.58
1,055.22
19000
107.56
102.18
117.51
19303
1,022.45
971.33
1,117.03
19000
44.98
42.73
49.14
19305
1,218.26
1,157.35
1,330.95
19001
27.64
26.26
30.20
19306
1,296.10
1,231.30
1,416.00
19001
22.07
20.97
24.12
19307
1,260.32
1,197.30
1,376.90
19020
490.26
465.75
535.61
19316
821.73
780.64
897.74
19020
324.14
307.93
354.12
19318
1,137.19
1,080.33
1,242.38
19030
168.67
160.24
184.28
19325
632.80
601.16
691.33
19030
77.92
74.02
85.12
19328
572.45
543.83
625.40
19081
565.28
537.02
617.57
19330
668.91
635.46
730.78
19081
169.81
161.32
185.52
19340
784.24
745.03
856.78
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
9
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------19342
787.46
748.09
860.30
20561
38.08
36.18
41.61
19350
850.49
807.97
929.17
#
20561
24.98
23.73
27.29
19350
693.87
659.18
758.06
20600
52.76
50.12
57.64
19355
776.56
737.73
848.39
#
20600
37.37
35.50
40.83
19355
637.96
606.06
696.97
20604
81.28
77.22
88.80
19357
1,198.69
1,138.76
1,309.57
#
20604
47.86
45.47
52.29
19361
1,624.15
1,542.94
1,774.38
20605
54.77
52.03
59.83
19364
2,848.73
2,706.29
3,112.23
#
20605
38.72
36.78
42.30
19367
1,846.03
1,753.73
2,016.79
20606
89.57
85.09
97.85
19368
2,271.62
2,158.04
2,481.75
#
20606
55.16
52.40
60.26
19369
2,109.57
2,004.09
2,304.70
20610
65.53
62.25
71.59
19370
692.21
657.60
756.24
#
20610
47.84
45.45
52.27
19371
737.66
700.78
805.90
20611
99.95
94.95
109.19
19380
834.56
792.83
911.75
#
20611
62.60
59.47
68.39
19396
290.20
275.69
317.04
20612
64.16
60.95
70.09
19396
148.98
141.53
162.76
#
20612
42.87
40.73
46.84
20100
637.99
606.09
697.00
20615
256.35
243.53
280.06
20101
609.81
579.32
666.22
#
20615
163.95
155.75
179.11
20101
223.84
212.65
244.55
20650
221.40
210.33
241.88
20102
635.76
603.97
694.57
#
20650
162.42
154.30
177.45
20102
270.44
256.92
295.46
20660
262.57
249.44
286.86
20103
589.89
560.40
644.46
20661
531.55
504.97
580.72
20103
360.54
342.51
393.89
20662
537.03
510.18
586.71
20150
1,051.11
998.55
1,148.33
20663
493.45
468.78
539.10
20200
228.19
216.78
249.30
20664
936.86
890.02
1,023.52
20200
99.42
94.45
108.62
20665
114.06
108.36
124.61
20205
318.48
302.56
347.94
#
20665
95.38
90.61
104.20
20205
164.48
156.26
179.70
20670
375.77
356.98
410.53
20206
236.95
225.10
258.87
#
20670
147.73
140.34
161.39
20206
58.05
55.15
63.42
20680
626.65
595.32
684.62
20220
247.91
235.51
270.84
#
20680
434.65
412.92
474.86
20220
89.66
85.18
97.96
20690
622.92
591.77
680.54
20225
407.44
387.07
445.13
20692
1,160.35
1,102.33
1,267.68
20225
132.87
126.23
145.16
20693
457.11
434.25
499.39
20240
147.55
140.17
161.20
20694
439.84
417.85
480.53
20245
364.30
346.09
398.00
#
20694
349.08
331.63
381.37
20250
412.67
392.04
450.85
20696
1,240.14
1,178.13
1,354.85
20251
451.32
428.75
493.06
20697
2,006.54
1,906.21
2,192.14
20500
119.50
113.53
130.56
20700
87.64
83.26
95.75
20500
88.70
84.27
96.91
20701
66.65
63.32
72.82
20501
143.22
136.06
156.47
20702
147.12
139.76
160.72
20501
38.04
36.14
41.56
20703
105.70
100.42
115.48
20520
218.74
207.80
238.97
20704
153.25
145.59
167.43
20520
150.26
142.75
164.16
20705
126.66
120.33
138.38
20525
485.33
461.06
530.22
20802
2,885.88
2,741.59
3,152.83
20525
256.31
243.49
280.01
20805
3,433.49
3,261.82
3,751.09
20526
82.42
78.30
90.05
20808
4,152.90
3,945.26
4,537.05
20526
59.49
56.52
65.00
20816
2,161.01
2,052.96
2,360.90
20527
88.29
83.88
96.46
20822
1,857.98
1,765.08
2,029.84
20527
67.65
64.27
73.91
20824
2,164.29
2,056.08
2,364.49
20550
56.89
54.05
62.16
20827
1,909.36
1,813.89
2,085.97
20550
40.51
38.48
44.25
20838
2,926.60
2,780.27
3,197.31
20551
58.20
55.29
63.58
20900
411.99
391.39
450.10
20551
40.83
38.79
44.61
#
20900
190.83
181.29
208.48
20552
55.06
52.31
60.16
20902
292.80
278.16
319.88
20552
39.33
37.36
42.96
20910
488.20
463.79
533.36
20553
62.79
59.65
68.60
20912
488.58
464.15
533.77
20553
44.11
41.90
48.19
20920
401.33
381.26
438.45
20555
338.62
321.69
369.94
20922
619.36
588.39
676.65
20560
26.60
25.27
29.06
#
20922
505.99
480.69
552.79
20560
17.10
16.25
18.69
20924
524.16
497.95
572.64
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
10
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------20931
119.68
113.70
130.76
21073
376.91
358.06
411.77
20932
802.18
762.07
876.38
#
21073
250.12
237.61
273.25
20933
735.81
699.02
803.87
21076
885.27
841.01
967.16
20934
801.84
761.75
876.01
#
21076
736.85
700.01
805.01
20937
178.77
169.83
195.30
21077
2,165.93
2,057.63
2,366.27
20938
199.59
189.61
218.05
#
21077
1,809.45
1,718.98
1,976.83
20939
75.00
71.25
81.94
21079
1,477.80
1,403.91
1,614.50
20950
271.23
257.67
296.32
#
21079
1,216.01
1,155.21
1,328.49
20950
90.69
86.16
99.08
21080
1,706.73
1,621.39
1,864.60
20955
2,553.81
2,426.12
2,790.04
#
21080
1,385.31
1,316.04
1,513.45
20956
2,776.71
2,637.87
3,033.55
21081
1,570.11
1,491.60
1,715.34
20957
2,889.95
2,745.45
3,157.27
#
21081
1,266.38
1,203.06
1,383.52
20962
2,784.60
2,645.37
3,042.18
21082
1,435.72
1,363.93
1,568.52
20969
2,801.96
2,661.86
3,061.14
#
21082
1,150.67
1,093.14
1,257.11
20970
2,996.23
2,846.42
3,273.38
21083
1,367.21
1,298.85
1,493.68
20972
2,988.70
2,839.27
3,265.16
#
21083
1,067.41
1,014.04
1,166.15
20973
3,157.92
3,000.02
3,450.02
21084
1,564.33
1,486.11
1,709.03
20974
82.22
78.11
89.83
#
21084
1,236.36
1,174.54
1,350.72
20974
52.41
49.79
57.26
21085
683.20
649.04
746.40
20975
186.66
177.33
203.93
#
21085
500.38
475.36
546.66
20979
55.30
52.54
60.42
21086
1,613.22
1,532.56
1,762.44
20979
33.35
31.68
36.43
#
21086
1,335.05
1,268.30
1,458.55
20982
3,806.18
3,615.87
4,158.25
21087
1,613.22
1,532.56
1,762.44
20982
380.31
361.29
415.48
#
21087
1,335.05
1,268.30
1,458.55
20983
5,582.48
5,303.36
6,098.86
21100
640.85
608.81
700.13
20983
352.59
334.96
385.20
#
21100
359.40
341.43
392.64
20985
153.21
145.55
167.38
21110
864.30
821.09
944.25
21010
754.61
716.88
824.41
#
21110
720.46
684.44
787.11
21011
374.95
356.20
409.63
21116
213.30
202.64
233.04
21011
262.56
249.43
286.84
#
21116
47.19
44.83
51.55
21012
350.21
332.70
382.61
21120
689.76
655.27
753.56
21013
548.43
521.01
599.16
#
21120
533.47
506.80
582.82
21013
413.44
392.77
451.69
21121
659.75
626.76
720.77
21014
541.30
514.24
591.38
#
21121
554.25
526.54
605.52
21015
724.40
688.18
791.41
21122
787.81
748.42
860.68
21016
1,045.98
993.68
1,142.73
21123
881.89
837.80
963.47
21025
807.76
767.37
882.48
21125
2,771.00
2,632.45
3,027.32
21025
677.68
643.80
740.37
#
21125
689.13
654.67
752.87
21026
546.69
519.36
597.26
21127
4,096.67
3,891.84
4,475.62
21026
437.59
415.71
478.07
#
21127
789.41
749.94
862.43
21029
778.61
739.68
850.63
21137
776.41
737.59
848.23
21029
630.84
599.30
689.20
21138
947.89
900.50
1,035.58
21030
478.91
454.96
523.20
21139
1,142.68
1,085.55
1,248.38
21030
374.39
355.67
409.02
21141
1,354.58
1,286.85
1,479.88
21031
388.68
369.25
424.64
21142
1,391.70
1,322.12
1,520.44
21031
275.32
261.55
300.78
21143
1,440.08
1,368.08
1,573.29
21032
386.16
366.85
421.88
21145
1,580.82
1,501.78
1,727.05
21032
268.87
255.43
293.74
21146
1,649.39
1,566.92
1,801.96
21034
1,332.88
1,266.24
1,456.18
21147
1,738.46
1,651.54
1,899.27
21034
1,162.50
1,104.38
1,270.04
21150
1,697.12
1,612.26
1,854.10
21040
485.13
460.87
530.00
21151
1,869.33
1,775.86
2,042.24
21040
377.34
358.47
412.24
21154
2,010.59
1,910.06
2,196.57
21044
883.51
839.33
965.23
21155
2,230.11
2,118.60
2,436.39
21045
1,228.04
1,166.64
1,341.64
21159
2,675.56
2,541.78
2,923.05
21046
1,028.98
977.53
1,124.16
21160
2,902.24
2,757.13
3,170.70
21047
1,293.26
1,228.60
1,412.89
21172
2,283.45
2,169.28
2,494.67
21048
1,043.86
991.67
1,140.42
21175
2,308.04
2,192.64
2,521.54
21049
1,245.22
1,182.96
1,360.40
21179
1,584.00
1,504.80
1,730.52
21050
882.52
838.39
964.15
21180
1,770.75
1,682.21
1,934.54
21060
801.86
761.77
876.04
21181
766.67
728.34
837.59
21070
630.68
599.15
689.02
21182
2,208.15
2,097.74
2,412.40
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
#
#
#
#
#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
11
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------21183
2,404.69
2,284.46
2,627.13
21340
765.41
727.14
836.21
21184
2,587.98
2,458.58
2,827.37
21343
1,106.97
1,051.62
1,209.36
21188
1,631.99
1,550.39
1,782.95
21344
1,430.18
1,358.67
1,562.47
21193
1,256.44
1,193.62
1,372.66
21345
803.02
762.87
877.30
21194
1,452.12
1,379.51
1,586.44
#
21345
644.77
612.53
704.41
21195
1,385.60
1,316.32
1,513.77
21346
1,028.10
976.70
1,123.21
21196
1,430.13
1,358.62
1,562.41
21347
1,053.58
1,000.90
1,151.04
21198
1,099.43
1,044.46
1,201.13
21348
1,117.97
1,062.07
1,221.38
21199
1,044.56
992.33
1,141.18
21355
446.14
423.83
487.40
21206
1,017.45
966.58
1,111.57
#
21355
330.81
314.27
361.41
21208
1,699.85
1,614.86
1,857.09
21356
512.88
487.24
560.33
21208
757.54
719.66
827.61
#
21356
384.77
365.53
420.36
21209
800.40
760.38
874.44
21360
526.86
500.52
575.60
21209
611.35
580.78
667.90
21365
1,122.87
1,066.73
1,226.74
21210
1,888.82
1,794.38
2,063.54
21366
1,326.03
1,259.73
1,448.69
21210
778.10
739.20
850.08
21385
767.49
729.12
838.49
21215
4,167.65
3,959.27
4,553.16
21386
715.72
679.93
781.92
21215
807.64
767.26
882.35
21387
801.83
761.74
876.00
21230
772.75
734.11
844.23
21390
818.81
777.87
894.55
21235
735.73
698.94
803.78
21395
1,049.55
997.07
1,146.63
21235
572.89
544.25
625.89
21400
208.54
198.11
227.83
21240
1,072.26
1,018.65
1,171.45
#
21400
164.64
156.41
179.87
21242
1,026.06
974.76
1,120.97
21401
520.86
494.82
569.04
21243
1,636.56
1,554.73
1,787.94
#
21401
331.48
314.91
362.15
21244
1,034.55
982.82
1,130.24
21406
601.23
571.17
656.85
21245
1,257.42
1,194.55
1,373.73
21407
655.42
622.65
716.05
21245
971.06
922.51
1,060.89
21408
936.22
889.41
1,022.82
21246
866.07
822.77
946.19
21421
666.78
633.44
728.46
21247
1,612.42
1,531.80
1,761.57
#
21421
563.24
535.08
615.34
21248
1,017.32
966.45
1,111.42
21422
655.75
622.96
716.40
21248
819.42
778.45
895.22
21423
837.76
795.87
915.25
21249
1,384.68
1,315.45
1,512.77
21431
707.14
671.78
772.55
21249
1,153.36
1,095.69
1,260.04
21432
745.14
707.88
814.06
21255
1,378.83
1,309.89
1,506.37
21433
1,806.78
1,716.44
1,973.91
21256
1,283.39
1,219.22
1,402.10
21435
1,458.61
1,385.68
1,593.53
21260
1,432.21
1,360.60
1,564.69
21436
2,117.91
2,012.01
2,313.81
21261
2,541.67
2,414.59
2,776.78
21440
666.86
633.52
728.55
21263
2,349.21
2,231.75
2,566.51
#
21440
537.77
510.88
587.51
21267
1,674.69
1,590.96
1,829.60
21445
798.78
758.84
872.67
21268
2,101.15
1,996.09
2,295.50
#
21445
647.41
615.04
707.30
21270
1,034.67
982.94
1,130.38
21450
595.66
565.88
650.76
21270
775.50
736.73
847.24
#
21450
484.92
460.67
529.77
21275
874.75
831.01
955.66
21451
775.89
737.10
847.67
21280
581.19
552.13
634.95
#
21451
649.74
617.25
709.84
21282
393.73
374.04
430.15
21452
754.64
716.91
824.45
21295
192.03
182.43
209.79
#
21452
460.41
437.39
503.00
21296
415.25
394.49
453.66
21453
1,086.60
1,032.27
1,187.11
21310
132.25
125.64
144.49
#
21453
927.70
881.32
1,013.52
21310
30.35
28.83
33.15
21454
496.59
471.76
542.52
21315
285.10
270.85
311.48
21461
1,952.07
1,854.47
2,132.64
21315
156.01
148.21
170.44
#
21461
1,061.20
1,008.14
1,159.36
21320
262.43
249.31
286.71
21462
2,135.04
2,028.29
2,332.53
21320
136.61
129.78
149.25
#
21462
1,187.16
1,127.80
1,296.97
21325
449.79
427.30
491.40
21465
816.80
775.96
892.35
21330
541.87
514.78
592.00
21470
1,188.39
1,128.97
1,298.32
21335
733.67
696.99
801.54
21480
136.24
129.43
148.84
21336
658.19
625.28
719.07
#
21480
34.02
32.32
37.17
21337
420.67
399.64
459.59
21485
965.82
917.53
1,055.16
21337
300.09
285.09
327.85
#
21485
790.20
750.69
863.29
21338
679.48
645.51
742.34
21490
804.79
764.55
879.23
21339
770.30
731.79
841.56
21497
712.24
676.63
778.12
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
---#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
12
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------21497
595.27
565.51
650.34
22208
635.56
603.78
694.35
21501
492.12
467.51
537.64
22210
1,916.71
1,820.87
2,094.00
21501
338.46
321.54
369.77
22212
1,598.59
1,518.66
1,746.46
21502
537.81
510.92
587.56
22214
1,602.11
1,522.00
1,750.30
21510
475.53
451.75
519.51
22216
391.65
372.07
427.88
21550
271.61
258.03
296.73
22220
1,728.20
1,641.79
1,888.06
21550
158.24
150.33
172.88
22222
1,890.57
1,796.04
2,065.45
21552
470.75
447.21
514.29
22224
1,681.21
1,597.15
1,836.72
21554
768.11
729.70
839.16
22226
389.16
369.70
425.16
21555
445.07
422.82
486.24
22310
318.96
303.01
348.46
21555
316.31
300.49
345.56
#
22310
305.86
290.57
334.16
21556
552.20
524.59
603.28
22315
916.62
870.79
1,001.41
21557
1,000.81
950.77
1,093.39
#
22315
807.18
766.82
881.84
21558
1,418.52
1,347.59
1,549.73
22318
1,770.95
1,682.40
1,934.76
21600
580.62
551.59
634.33
22319
1,983.42
1,884.25
2,166.89
21601
1,241.03
1,178.98
1,355.83
22325
1,564.43
1,486.21
1,709.14
21602
1,660.34
1,577.32
1,813.92
22326
1,613.06
1,532.41
1,762.27
21603
1,816.09
1,725.29
1,984.08
22327
1,632.39
1,550.77
1,783.39
21610
1,297.81
1,232.92
1,417.86
22328
306.49
291.17
334.85
21615
656.06
623.26
716.75
22505
136.87
130.03
149.53
21616
763.29
725.13
833.90
22510
1,881.20
1,787.14
2,055.21
21620
533.85
507.16
583.23
#
22510
445.78
423.49
487.01
21627
565.98
537.68
618.33
22511
1,872.90
1,779.26
2,046.15
21630
1,261.05
1,198.00
1,377.70
#
22511
419.13
398.17
457.90
21632
1,287.52
1,223.14
1,406.61
22512
819.84
778.85
895.68
21685
1,015.55
964.77
1,109.49
#
22512
216.64
205.81
236.68
21700
381.47
362.40
416.76
22513
6,444.48
6,122.26
7,040.60
21705
574.43
545.71
627.57
#
22513
536.03
509.23
585.61
21720
560.68
532.65
612.55
22514
6,417.60
6,096.72
7,011.23
21725
565.44
537.17
617.75
#
22514
500.63
475.60
546.94
21740
1,095.65
1,040.87
1,197.00
22515
3,459.64
3,286.66
3,779.66
21750
721.59
685.51
788.34
#
22515
231.67
220.09
253.10
21811
635.88
604.09
694.70
22532
1,928.01
1,831.61
2,106.35
21812
769.12
730.66
840.26
22533
1,756.47
1,668.65
1,918.95
21813
1,062.75
1,009.61
1,161.05
22534
387.11
367.75
422.91
21820
150.90
143.36
164.86
22548
2,125.81
2,019.52
2,322.45
21820
148.61
141.18
162.36
22551
1,831.20
1,739.64
2,000.59
21825
573.81
545.12
626.89
22552
428.79
407.35
468.45
21920
264.57
251.34
289.04
22554
1,345.41
1,278.14
1,469.86
21920
158.74
150.80
173.42
22556
1,780.23
1,691.22
1,944.90
21925
497.16
472.30
543.15
22558
1,633.13
1,551.47
1,784.19
21925
382.81
363.67
418.22
22585
351.92
334.32
384.47
21930
516.86
491.02
564.67
22586
2,201.00
2,090.95
2,404.59
21930
379.91
360.91
415.05
22590
1,701.92
1,616.82
1,859.34
21931
496.59
471.76
542.52
22595
1,621.80
1,540.71
1,771.82
21932
699.01
664.06
763.67
22600
1,385.97
1,316.67
1,514.17
21933
782.07
742.97
854.42
22610
1,359.38
1,291.41
1,485.12
21935
1,083.78
1,029.59
1,184.03
22612
1,693.33
1,608.66
1,849.96
21936
1,499.73
1,424.74
1,638.45
22614
423.02
401.87
462.15
22010
1,026.91
975.56
1,121.89
22630
1,696.75
1,611.91
1,853.70
22015
1,002.29
952.18
1,095.01
22632
347.64
330.26
379.80
22100
910.52
864.99
994.74
22633
1,985.78
1,886.49
2,169.46
22101
915.68
869.90
1,000.39
22634
535.77
508.98
585.33
22102
868.54
825.11
948.88
22800
1,439.43
1,367.46
1,572.58
22103
152.36
144.74
166.45
22802
2,257.23
2,144.37
2,466.03
22110
1,115.36
1,059.59
1,218.53
22804
2,598.19
2,468.28
2,838.52
22112
1,211.33
1,150.76
1,323.37
22808
1,945.99
1,848.69
2,125.99
22114
1,211.33
1,150.76
1,323.37
22810
2,238.25
2,126.34
2,445.29
22116
153.53
145.85
167.73
22812
2,317.38
2,201.51
2,531.74
22206
2,624.25
2,493.04
2,867.00
22818
2,271.69
2,158.11
2,481.83
22207
2,561.36
2,433.29
2,798.28
22819
2,612.98
2,482.33
2,854.68
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
13
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------22830
871.75
828.16
952.38
23125
741.80
704.71
810.42
22840
819.59
778.61
895.40
23130
641.97
609.87
701.35
22842
823.81
782.62
900.01
23140
579.05
550.10
632.62
22843
881.28
837.22
962.80
23145
727.50
691.13
794.80
22844
1,061.91
1,008.81
1,160.13
23146
650.07
617.57
710.21
22845
788.54
749.11
861.48
23150
687.32
652.95
750.89
22846
819.63
778.65
895.45
23155
832.76
791.12
909.79
22847
849.67
807.19
928.27
23156
709.46
673.99
775.09
22848
386.92
367.57
422.71
23170
587.94
558.54
642.32
22849
1,398.63
1,328.70
1,528.01
23172
593.57
563.89
648.47
22850
778.33
739.41
850.32
23174
794.17
754.46
867.63
22852
747.58
710.20
816.73
23180
693.17
658.51
757.29
22853
279.69
265.71
305.57
23182
698.65
663.72
763.28
22854
362.32
344.20
395.83
23184
770.86
732.32
842.17
22855
1,186.57
1,127.24
1,296.33
23190
599.67
569.69
655.14
22856
1,750.86
1,663.32
1,912.82
23195
779.43
740.46
851.53
22857
1,858.09
1,765.19
2,029.97
23200
1,580.83
1,501.79
1,727.06
22858
547.40
520.03
598.03
23210
1,860.10
1,767.10
2,032.17
22859
360.65
342.62
394.01
23220
2,035.03
1,933.28
2,223.27
22861
2,521.43
2,395.36
2,754.66
23330
305.17
289.91
333.40
22862
2,513.26
2,387.60
2,745.74
#
23330
172.15
163.54
188.07
22864
2,247.57
2,135.19
2,455.47
23333
492.57
467.94
538.13
22865
2,452.27
2,329.66
2,679.11
23334
1,113.18
1,057.52
1,216.15
22867
1,050.45
997.93
1,147.62
23335
1,327.02
1,260.67
1,449.77
22868
266.38
253.06
291.02
23350
163.91
155.71
179.07
22869
449.26
426.80
490.82
#
23350
51.52
48.94
56.28
22870
124.29
118.08
135.79
23395
1,339.60
1,272.62
1,463.51
22900
597.26
567.40
652.51
23397
1,184.76
1,125.52
1,294.35
22901
706.96
671.61
772.35
23400
1,018.44
967.52
1,112.65
22902
487.08
462.73
532.14
23405
644.58
612.35
704.20
22902
349.46
331.99
381.79
23406
790.73
751.19
863.87
22903
464.81
441.57
507.81
23410
856.22
813.41
935.42
22904
1,105.86
1,050.57
1,208.16
23412
889.90
845.41
972.22
22905
1,403.17
1,333.01
1,532.96
23415
727.08
690.73
794.34
23000
578.38
549.46
631.88
23420
1,016.86
966.02
1,110.92
23000
370.98
352.43
405.29
23430
775.54
736.76
847.27
23020
719.16
683.20
785.68
23440
791.28
751.72
864.48
23030
457.06
434.21
499.34
23450
993.01
943.36
1,084.86
23030
265.06
251.81
289.58
23455
1,040.34
988.32
1,136.57
23031
434.46
412.74
474.65
23460
1,142.05
1,084.95
1,247.69
23031
223.78
212.59
244.48
23462
1,119.37
1,063.40
1,222.91
23035
711.86
676.27
777.71
23465
1,173.00
1,114.35
1,281.50
23040
748.57
711.14
817.81
23466
1,166.36
1,108.04
1,274.25
23044
589.15
559.69
643.64
23470
1,256.98
1,194.13
1,373.25
23065
230.28
218.77
251.59
23472
1,518.72
1,442.78
1,659.20
23065
166.07
157.77
181.44
23473
1,696.40
1,611.58
1,853.32
23066
589.55
560.07
644.08
23474
1,829.39
1,737.92
1,998.61
23066
378.55
359.62
413.56
23480
858.74
815.80
938.17
23071
442.71
420.57
483.66
23485
994.57
944.84
1,086.57
23073
734.43
697.71
802.37
23490
901.30
856.24
984.68
23075
528.42
502.00
577.30
23491
1,063.75
1,010.56
1,162.14
23075
340.68
323.65
372.20
23500
228.39
216.97
249.52
23076
567.18
538.82
619.64
#
23500
232.65
221.02
254.17
23077
1,201.40
1,141.33
1,312.53
23505
369.25
350.79
403.41
23078
1,517.24
1,441.38
1,657.59
#
23505
345.00
327.75
376.91
23100
525.64
499.36
574.26
23515
750.39
712.87
819.80
23101
476.04
452.24
520.08
23520
246.60
234.27
269.41
23105
668.82
635.38
730.69
#
23520
243.98
231.78
266.55
23106
522.22
496.11
570.53
23525
404.55
384.32
441.97
23107
690.35
655.83
754.20
#
23525
372.44
353.82
406.89
23120
610.12
579.61
666.55
23530
600.35
570.33
655.88
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
14
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------23532
653.12
620.46
713.53
24110
604.95
574.70
660.91
23540
242.66
230.53
265.11
24115
770.75
732.21
842.04
23540
240.04
228.04
262.25
24116
900.79
855.75
984.11
23545
357.06
339.21
390.09
24120
553.89
526.20
605.13
23545
323.32
307.15
353.22
24125
649.54
617.06
709.62
23550
596.28
566.47
651.44
24126
679.34
645.37
742.18
23552
682.35
648.23
745.46
24130
529.33
502.86
578.29
23570
241.18
229.12
263.49
24134
781.49
742.42
853.78
23570
248.06
235.66
271.01
24136
660.29
627.28
721.37
23575
421.63
400.55
460.63
24138
711.81
676.22
777.65
23575
391.82
372.23
428.06
24140
733.68
697.00
801.55
23585
1,020.98
969.93
1,115.42
24145
620.93
589.88
678.36
23600
341.29
324.23
372.86
24147
652.57
619.94
712.93
23600
322.95
306.80
352.82
24149
1,223.90
1,162.71
1,337.12
23605
487.46
463.09
532.55
24150
1,623.86
1,542.67
1,774.07
23605
444.86
422.62
486.01
24152
1,410.74
1,340.20
1,541.23
23615
923.05
876.90
1,008.44
24155
893.28
848.62
975.91
23616
1,294.67
1,229.94
1,414.43
24160
1,315.00
1,249.25
1,436.64
23620
276.51
262.68
302.08
24164
750.69
713.16
820.13
23620
265.69
252.41
290.27
24200
224.15
212.94
244.88
23625
393.29
373.63
429.67
#
24200
145.52
138.24
158.98
23625
362.82
344.68
396.38
24201
568.25
539.84
620.82
23630
812.70
772.07
887.88
#
24201
380.19
361.18
415.36
23650
334.17
317.46
365.08
24220
192.95
183.30
210.80
23650
304.68
289.45
332.87
#
24220
69.76
66.27
76.21
23655
422.68
401.55
461.78
24300
440.14
418.13
480.85
23660
609.23
578.77
665.59
24301
784.27
745.06
856.82
23665
445.88
423.59
487.13
24305
602.19
572.08
657.89
23665
413.12
392.46
451.33
24310
493.62
468.94
539.28
23670
909.69
864.21
993.84
24320
816.71
775.87
892.25
23675
569.49
541.02
622.17
24330
749.83
712.34
819.19
23675
519.36
493.39
567.40
24331
823.16
782.00
899.30
23680
968.72
920.28
1,058.32
24332
640.83
608.79
700.11
23700
202.50
192.38
221.24
24340
644.64
612.41
704.27
23800
1,074.66
1,020.93
1,174.07
24341
772.83
734.19
844.32
23802
1,341.73
1,274.64
1,465.84
24342
810.23
769.72
885.18
23900
1,453.86
1,381.17
1,588.35
24343
740.12
703.11
808.58
23920
1,176.61
1,117.78
1,285.45
24344
1,139.03
1,082.08
1,244.39
23921
488.82
464.38
534.04
24345
735.68
698.90
803.74
23930
377.18
358.32
412.07
24346
1,151.80
1,094.21
1,258.34
23930
226.13
214.82
247.04
24357
427.84
406.45
467.42
23931
309.92
294.42
338.58
24358
547.59
520.21
598.24
23931
164.12
155.91
179.30
24359
689.89
655.40
753.71
23935
531.42
504.85
580.58
24360
944.59
897.36
1,031.96
24000
495.48
470.71
541.32
24361
1,055.09
1,002.34
1,152.69
24006
741.42
704.35
810.00
24362
1,111.76
1,056.17
1,214.60
24065
264.31
251.09
288.75
24363
1,517.72
1,441.83
1,658.10
24065
166.67
158.34
182.09
24365
670.82
637.28
732.87
24066
645.94
613.64
705.69
24366
710.76
675.22
776.50
24066
436.90
415.06
477.32
24370
1,609.72
1,529.23
1,758.61
24071
426.61
405.28
466.07
24371
1,855.53
1,762.75
2,027.16
24073
730.46
693.94
798.03
24400
861.67
818.59
941.38
24075
546.83
519.49
597.41
24410
1,107.67
1,052.29
1,210.13
24075
342.05
324.95
373.69
24420
1,097.59
1,042.71
1,199.12
24076
568.11
539.70
620.66
24430
1,104.15
1,048.94
1,206.28
24077
1,083.51
1,029.33
1,183.73
24435
1,127.32
1,070.95
1,231.59
24079
1,397.10
1,327.25
1,526.34
24470
701.00
665.95
765.84
24100
436.04
414.24
476.38
24495
788.55
749.12
861.49
24101
522.53
496.40
570.86
24498
906.47
861.15
990.32
24102
644.00
611.80
703.57
24500
370.07
351.57
404.31
24105
368.81
350.37
402.93
#
24500
341.57
324.49
373.16
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
---#
#
#
#
#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
15
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------24505
519.82
493.83
567.90
25040
582.08
552.98
635.93
24505
469.69
446.21
513.14
25065
260.80
247.76
284.92
24515
918.52
872.59
1,003.48
#
25065
160.87
152.83
175.75
24516
899.70
854.72
982.93
25066
372.84
354.20
407.33
24530
392.35
372.73
428.64
25071
444.10
421.90
485.19
24530
360.57
342.54
393.92
25073
557.93
530.03
609.53
24535
644.37
612.15
703.97
25075
532.23
505.62
581.46
24535
594.90
565.16
649.93
#
25075
326.79
310.45
357.02
24538
811.39
770.82
886.44
25076
535.97
509.17
585.55
24545
969.87
921.38
1,059.59
25077
931.66
885.08
1,017.84
24546
1,084.20
1,029.99
1,184.49
25078
1,225.30
1,164.04
1,338.65
24560
341.25
324.19
372.82
25085
465.60
442.32
508.67
24560
304.23
289.02
332.37
25100
361.34
343.27
394.76
24565
558.41
530.49
610.06
25101
418.38
397.46
457.08
24565
512.21
486.60
559.59
25105
503.99
478.79
550.61
24566
749.81
712.32
819.17
25107
639.09
607.14
698.21
24575
761.58
723.50
832.03
25109
553.72
526.03
604.93
24576
358.13
340.22
391.25
25110
355.28
337.52
388.15
24576
320.45
304.43
350.09
25111
332.65
316.02
363.42
24577
574.83
546.09
628.00
25112
401.94
381.84
439.12
24577
526.67
500.34
575.39
25115
783.94
744.74
856.45
24579
868.76
825.32
949.12
25116
623.67
592.49
681.36
24582
845.50
803.23
923.71
25118
393.51
373.83
429.90
24586
1,137.12
1,080.26
1,242.30
25119
516.55
490.72
564.33
24587
1,139.35
1,082.38
1,244.74
25120
519.48
493.51
567.54
24600
386.23
366.92
421.96
25125
620.27
589.26
677.65
24600
352.16
334.55
384.73
25126
625.20
593.94
683.03
24605
495.32
470.55
541.13
25130
465.25
441.99
508.29
24615
744.47
707.25
813.34
25135
584.69
555.46
638.78
24620
585.82
556.53
640.01
25136
518.64
492.71
566.62
24635
703.14
667.98
768.18
25145
542.48
515.36
592.66
24640
103.82
98.63
113.42
25150
589.86
560.37
644.43
24640
80.56
76.53
88.01
25151
608.91
578.46
665.23
24650
270.06
256.56
295.04
25170
1,542.65
1,465.52
1,685.35
24650
251.06
238.51
274.29
25210
509.44
483.97
556.57
24655
457.75
434.86
500.09
25215
642.19
610.08
701.59
24655
415.48
394.71
453.92
25230
447.60
425.22
489.00
24665
683.24
649.08
746.44
25240
444.68
422.45
485.82
24666
763.86
725.67
834.52
25246
197.84
187.95
216.14
24670
299.28
284.32
326.97
#
25246
76.28
72.47
83.34
24670
274.38
260.66
299.76
25248
436.78
414.94
477.18
24675
473.30
449.64
517.09
25250
556.61
528.78
608.10
24675
431.03
409.48
470.90
25251
751.38
713.81
820.88
24685
680.00
646.00
742.90
25259
434.38
412.66
474.56
24800
870.24
826.73
950.74
25260
655.41
622.64
716.04
24802
1,050.14
997.63
1,147.27
25263
659.64
626.66
720.66
24900
770.41
731.89
841.67
25265
785.28
746.02
857.92
24920
766.18
727.87
837.05
25270
511.71
486.12
559.04
24925
592.89
563.25
647.74
25272
584.33
555.11
638.38
24930
810.42
769.90
885.39
25274
691.37
656.80
755.32
24931
976.34
927.52
1,066.65
25275
697.16
662.30
761.65
24935
1,265.58
1,202.30
1,382.65
25280
588.23
558.82
642.64
25000
351.52
333.94
384.03
25290
451.16
428.60
492.89
25001
353.69
336.01
386.41
25295
546.05
518.75
596.56
25020
724.91
688.66
791.96
25300
719.40
683.43
785.94
25023
1,325.13
1,258.87
1,447.70
25301
669.47
636.00
731.40
25024
815.35
774.58
890.77
25310
643.70
611.52
703.25
25025
1,245.79
1,183.50
1,361.03
25312
742.37
705.25
811.04
25028
674.11
640.40
736.46
25315
805.47
765.20
879.98
25031
380.58
361.55
415.78
25316
959.38
911.41
1,048.12
25035
608.69
578.26
665.00
25320
1,016.95
966.10
1,111.02
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
16
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------25332
879.89
835.90
961.29
25607
766.44
728.12
837.34
25335
988.67
939.24
1,080.13
25608
859.36
816.39
938.85
25337
919.11
873.15
1,004.12
25609
1,092.04
1,037.44
1,193.06
25350
701.06
666.01
765.91
25622
313.58
297.90
342.59
25355
800.55
760.52
874.60
#
25622
289.99
275.49
316.81
25360
680.15
646.14
743.06
25624
503.32
478.15
549.87
25365
960.05
912.05
1,048.86
#
25624
458.10
435.20
500.48
25370
1,057.32
1,004.45
1,155.12
25628
748.60
711.17
817.85
25375
999.71
949.72
1,092.18
25630
314.30
298.59
343.38
25390
800.42
760.40
874.46
#
25630
292.67
278.04
319.75
25391
1,044.31
992.09
1,140.90
25635
479.37
455.40
523.71
25392
1,062.70
1,009.57
1,161.01
#
25635
437.10
415.25
477.54
25393
1,185.23
1,125.97
1,294.87
25645
595.94
566.14
651.06
25394
820.29
779.28
896.17
25650
338.70
321.77
370.04
25400
837.53
795.65
915.00
#
25650
314.78
299.04
343.90
25405
1,081.48
1,027.41
1,181.52
25651
506.51
481.18
553.36
25415
1,014.69
963.96
1,108.55
25652
646.49
614.17
706.30
25420
1,224.20
1,162.99
1,337.44
25660
462.69
439.56
505.49
25425
1,010.09
959.59
1,103.53
25670
635.47
603.70
694.26
25426
1,178.43
1,119.51
1,287.44
25671
552.24
524.63
603.32
25430
762.44
724.32
832.97
25675
460.83
437.79
503.46
25431
824.15
782.94
900.38
#
25675
418.56
397.63
457.27
25440
799.37
759.40
873.31
25676
657.03
624.18
717.81
25441
982.21
933.10
1,073.07
25680
548.32
520.90
599.04
25442
839.53
797.55
917.18
25685
768.22
729.81
839.28
25443
819.85
778.86
895.69
25690
508.48
483.06
555.52
25444
861.90
818.81
941.63
25695
664.34
631.12
725.79
25445
750.26
712.75
819.66
25800
762.31
724.19
832.82
25446
1,222.01
1,160.91
1,335.05
25805
885.87
841.58
967.82
25447
860.38
817.36
939.96
25810
899.45
854.48
982.65
25449
1,076.38
1,022.56
1,175.94
25820
667.45
634.08
729.19
25450
644.61
612.38
704.24
25825
815.62
774.84
891.07
25455
761.79
723.70
832.26
25830
1,041.02
988.97
1,137.32
25490
750.69
713.16
820.13
25900
746.62
709.29
815.68
25491
772.12
733.51
843.54
25905
734.49
697.77
802.44
25492
948.50
901.08
1,036.24
25907
642.23
610.12
701.64
25500
289.72
275.23
316.51
25909
716.30
680.49
782.56
25500
263.18
250.02
287.52
25915
1,226.45
1,165.13
1,339.90
25505
520.24
494.23
568.36
25920
756.12
718.31
826.06
25505
475.03
451.28
518.97
25922
667.08
633.73
728.79
25515
696.39
661.57
760.81
25924
738.91
701.96
807.25
25520
597.92
568.02
653.22
25927
891.26
846.70
973.71
25520
565.16
536.90
617.44
25929
624.89
593.65
682.70
25525
819.66
778.68
895.48
25931
822.81
781.67
898.92
25526
997.78
947.89
1,090.07
26010
334.88
318.14
365.86
25530
270.07
256.57
295.06
#
26010
142.87
135.73
156.09
25530
248.12
235.71
271.07
26011
478.10
454.20
522.33
25535
512.84
487.20
560.28
#
26011
191.41
181.84
209.12
25535
474.51
450.78
518.40
26020
574.52
545.79
627.66
25545
647.54
615.16
707.43
26025
436.99
415.14
477.41
25560
294.94
280.19
322.22
26030
507.97
482.57
554.96
25560
264.47
251.25
288.94
26034
567.81
539.42
620.33
25565
536.27
509.46
585.88
26035
896.69
851.86
979.64
25565
483.85
459.66
528.61
26037
586.72
557.38
640.99
25574
701.96
666.86
766.89
26040
324.44
308.22
354.45
25575
941.84
894.75
1,028.96
26045
488.76
464.32
533.97
25600
342.89
325.75
374.61
26055
589.71
560.22
644.25
25600
327.49
311.12
357.79
#
26055
299.09
284.14
326.76
25605
561.62
533.54
613.57
26060
262.97
249.82
287.29
25605
531.80
505.21
580.99
26070
332.92
316.27
363.71
25606
691.19
656.63
755.12
26075
347.93
330.53
380.11
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
17
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------26080
408.50
388.08
446.29
26445
621.58
590.50
679.08
26100
349.83
332.34
382.19
26449
719.41
683.44
785.96
26105
352.38
334.76
384.97
26450
462.49
439.37
505.28
26110
333.71
317.02
364.57
26455
458.80
435.86
501.24
26111
431.54
409.96
471.45
26460
450.53
428.00
492.20
26113
566.15
537.84
618.52
26471
672.90
639.26
735.15
26115
559.37
531.40
611.11
26474
665.05
631.80
726.57
26115
341.15
324.09
372.70
26476
656.37
623.55
717.08
26116
543.47
516.30
593.75
26477
636.53
604.70
695.41
26117
769.02
730.57
840.16
26478
677.36
643.49
740.01
26118
1,096.63
1,041.80
1,198.07
26479
690.92
656.37
754.83
26121
621.77
590.68
679.28
26480
806.77
766.43
881.39
26123
864.21
821.00
944.15
26483
898.68
853.75
981.81
26125
283.48
269.31
309.71
26485
862.80
819.66
942.61
26130
486.38
462.06
531.37
26489
1,001.46
951.39
1,094.10
26135
574.01
545.31
627.11
26490
865.55
822.27
945.61
26140
525.18
498.92
573.76
26492
956.86
909.02
1,045.37
26145
533.40
506.73
582.74
26494
869.13
825.67
949.52
26160
614.34
583.62
671.16
26496
937.23
890.37
1,023.93
26160
324.70
308.47
354.74
26497
936.20
889.39
1,022.80
26170
421.13
400.07
460.08
26498
1,226.80
1,165.46
1,340.28
26180
463.25
440.09
506.10
26499
900.78
855.74
984.10
26185
575.53
546.75
628.76
26500
676.89
643.05
739.51
26200
467.26
443.90
510.49
26502
777.38
738.51
849.29
26205
632.52
600.89
691.02
26508
689.78
655.29
753.58
26210
460.74
437.70
503.36
26510
654.39
621.67
714.92
26215
591.84
562.25
646.59
26516
763.20
725.04
833.80
26230
519.11
493.15
567.12
26517
895.00
850.25
977.79
26235
510.91
485.36
558.16
26518
906.40
861.08
990.24
26236
457.16
434.30
499.45
26520
699.45
664.48
764.15
26250
1,114.78
1,059.04
1,217.90
26525
701.33
666.26
766.20
26260
833.78
792.09
910.90
26530
559.86
531.87
611.65
26262
656.76
623.92
717.51
26531
652.65
620.02
713.02
26320
360.65
342.62
394.01
26535
451.76
429.17
493.55
26340
351.42
333.85
383.93
26536
768.31
729.89
839.37
26341
114.14
108.43
124.69
26540
716.15
680.34
782.39
26341
79.41
75.44
86.76
26541
858.83
815.89
938.27
26350
763.10
724.95
833.69
26542
740.38
703.36
808.86
26352
860.31
817.29
939.88
26545
751.40
713.83
820.90
26356
822.55
781.42
898.63
26546
1,058.72
1,005.78
1,156.65
26357
928.61
882.18
1,014.51
26548
820.79
779.75
896.71
26358
1,027.66
976.28
1,122.72
26550
1,738.02
1,651.12
1,898.79
26370
810.62
770.09
885.60
26551
3,472.32
3,298.70
3,793.51
26372
950.37
902.85
1,038.28
26553
3,449.16
3,276.70
3,768.21
26373
912.77
867.13
997.20
26554
4,018.73
3,817.79
4,390.46
26390
908.59
863.16
992.63
26555
1,454.62
1,381.89
1,589.17
26392
1,042.62
990.49
1,139.06
26556
3,582.89
3,403.75
3,914.31
26410
613.16
582.50
669.88
26560
650.69
618.16
710.88
26412
736.03
699.23
804.11
26561
1,019.76
968.77
1,114.09
26415
881.90
837.81
963.48
26562
1,429.45
1,357.98
1,561.68
26416
954.43
906.71
1,042.72
26565
754.03
716.33
823.78
26418
630.16
598.65
688.45
26567
738.83
701.89
807.17
26420
764.11
725.90
834.79
26568
965.71
917.42
1,055.03
26426
521.72
495.63
569.97
26580
1,608.24
1,527.83
1,757.00
26428
820.99
779.94
896.93
26587
1,089.70
1,035.22
1,190.50
26432
550.48
522.96
601.40
26590
1,498.76
1,423.82
1,637.39
26433
582.87
553.73
636.79
26591
490.54
466.01
535.91
26434
712.53
676.90
778.44
26593
657.27
624.41
718.07
26437
680.53
646.50
743.48
26596
839.44
797.47
917.09
26440
667.61
634.23
729.36
26600
305.77
290.48
334.05
26442
1,015.92
965.12
1,109.89
#
26600
290.70
276.17
317.60
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
---#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
18
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------26605
337.25
320.39
368.45
26990
699.27
664.31
763.96
26605
305.14
289.88
333.36
26991
738.95
702.00
807.30
26607
521.19
495.13
569.40
#
26991
548.92
521.47
599.69
26608
498.17
473.26
544.25
26992
1,048.70
996.27
1,145.71
26615
596.03
566.23
651.16
27000
417.14
396.28
455.72
26641
430.40
408.88
470.21
27001
565.99
537.69
618.34
26641
393.38
373.71
429.77
27003
624.54
593.31
682.31
26645
449.16
426.70
490.71
27005
750.08
712.58
819.47
26645
410.83
390.29
448.83
27006
745.50
708.23
814.46
26650
497.06
472.21
543.04
27025
963.65
915.47
1,052.79
26665
648.62
616.19
708.62
27027
922.52
876.39
1,007.85
26670
360.07
342.07
393.38
27030
982.88
933.74
1,073.80
26670
324.36
308.14
354.36
27033
1,019.99
968.99
1,114.34
26675
477.25
453.39
521.40
27035
1,155.52
1,097.74
1,262.40
26675
437.61
415.73
478.09
27036
1,061.72
1,008.63
1,159.92
26676
524.79
498.55
573.33
27040
352.62
334.99
385.24
26685
595.51
565.73
650.59
#
27040
205.18
194.92
224.16
26686
651.75
619.16
712.03
27041
735.09
698.34
803.09
26700
346.97
329.62
379.06
27043
494.95
470.20
540.73
26700
321.74
305.65
351.50
27045
775.16
736.40
846.86
26705
435.83
414.04
476.15
27047
508.34
482.92
555.36
26705
397.17
377.31
433.91
#
27047
375.65
356.87
410.40
26706
461.41
438.34
504.09
27048
643.95
611.75
703.51
26715
592.65
563.02
647.47
27049
1,429.20
1,357.74
1,561.40
26720
203.42
193.25
222.24
27050
419.05
398.10
457.82
26720
191.30
181.74
209.00
27052
601.51
571.43
657.14
26725
350.72
333.18
383.16
27054
717.71
681.82
784.09
26725
314.02
298.32
343.07
27057
1,061.16
1,008.10
1,159.32
26727
489.67
465.19
534.97
27059
1,908.14
1,812.73
2,084.64
26735
616.16
585.35
673.15
27060
484.90
460.66
529.76
26740
236.56
224.73
258.44
27062
473.46
449.79
517.26
26740
224.43
213.21
245.19
27065
546.43
519.11
596.98
26742
386.95
367.60
422.74
27066
853.20
810.54
932.12
26742
349.27
331.81
381.58
27067
1,082.83
1,028.69
1,182.99
26746
770.18
731.67
841.42
27070
922.12
876.01
1,007.41
26750
191.23
181.67
208.92
27071
1,006.19
955.88
1,099.26
26750
192.21
182.60
209.99
27075
2,193.38
2,083.71
2,396.27
26755
330.03
313.53
360.56
27076
2,657.33
2,524.46
2,903.13
26755
285.79
271.50
312.23
27077
2,965.58
2,817.30
3,239.90
26756
435.46
413.69
475.74
27078
2,163.74
2,055.55
2,363.88
26765
516.70
490.87
564.50
27080
536.76
509.92
586.41
26770
293.80
279.11
320.98
27086
318.82
302.88
348.31
26770
269.22
255.76
294.12
#
27086
173.68
165.00
189.75
26775
402.30
382.19
439.52
27087
645.68
613.40
705.41
26775
362.32
344.20
395.83
27090
866.77
823.43
946.94
26776
463.62
440.44
506.51
27091
1,672.91
1,589.26
1,827.65
26785
564.62
536.39
616.85
27093
235.85
224.06
257.67
26820
855.52
812.74
934.65
#
27093
71.05
67.50
77.63
26841
790.67
751.14
863.81
27095
319.25
303.29
348.78
26842
858.57
815.64
937.99
#
27095
86.62
82.29
94.63
26843
806.65
766.32
881.27
27096
165.46
157.19
180.77
26844
888.87
844.43
971.09
#
27096
85.19
80.93
93.07
26850
752.12
714.51
821.69
27097
713.42
677.75
779.41
26852
855.96
813.16
935.13
27098
725.17
688.91
792.25
26860
619.47
588.50
676.78
27100
866.66
823.33
946.83
26861
107.86
102.47
117.84
27105
909.54
864.06
993.67
26862
784.68
745.45
857.27
27110
1,016.09
965.29
1,110.08
26863
238.99
227.04
261.10
27111
945.09
897.84
1,032.52
26910
782.66
743.53
855.06
27120
1,362.64
1,294.51
1,488.69
26951
710.16
674.65
775.85
27122
1,155.46
1,097.69
1,262.34
26952
698.18
663.27
762.76
27125
1,185.89
1,126.60
1,295.59
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
19
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------27130
1,350.99
1,283.44
1,475.96
27280
1,451.08
1,378.53
1,585.31
27132
1,756.62
1,668.79
1,919.11
27282
897.63
852.75
980.66
27134
2,008.20
1,907.79
2,193.96
27284
1,689.47
1,605.00
1,845.75
27137
1,542.63
1,465.50
1,685.33
27286
1,726.24
1,639.93
1,885.92
27138
1,602.92
1,522.77
1,751.19
27290
1,706.16
1,620.85
1,863.98
27140
933.80
887.11
1,020.18
27295
1,316.77
1,250.93
1,438.57
27146
1,341.40
1,274.33
1,465.48
27301
702.49
667.37
767.48
27147
1,535.61
1,458.83
1,677.65
#
27301
529.49
503.02
578.47
27151
1,661.90
1,578.81
1,815.63
27303
672.63
639.00
734.85
27156
1,791.44
1,701.87
1,957.15
27305
501.65
476.57
548.06
27158
1,470.17
1,396.66
1,606.16
27306
341.26
324.20
372.83
27161
1,274.92
1,211.17
1,392.85
27307
500.08
475.08
546.34
27165
1,444.83
1,372.59
1,578.48
27310
763.91
725.71
834.57
27170
1,230.25
1,168.74
1,344.05
27323
279.51
265.53
305.36
27175
697.64
662.76
762.17
#
27323
178.60
169.67
195.12
27176
964.51
916.28
1,053.72
27324
425.27
404.01
464.61
27177
1,168.26
1,109.85
1,276.33
27325
588.24
558.83
642.65
27178
964.51
916.28
1,053.72
27326
542.81
515.67
593.02
27179
1,024.75
973.51
1,119.54
27327
512.45
486.83
559.85
27181
1,173.06
1,114.41
1,281.57
#
27327
324.71
308.47
354.74
27185
749.83
712.34
819.19
27328
653.92
621.22
714.40
27187
1,041.72
989.63
1,138.07
27329
1,096.23
1,041.42
1,197.63
27197
136.23
129.42
148.83
27330
435.12
413.36
475.36
27198
331.34
314.77
361.99
27331
495.72
470.93
541.57
27200
190.52
180.99
208.14
27332
673.06
639.41
735.32
27200
191.83
182.24
209.58
27333
613.29
582.63
670.02
27202
552.94
525.29
604.08
27334
715.35
679.58
781.52
27220
436.37
414.55
476.73
27335
800.92
760.87
875.00
27220
430.80
409.26
470.65
27337
441.72
419.63
482.57
27222
1,023.39
972.22
1,118.05
27339
793.93
754.23
867.36
27226
1,107.74
1,052.35
1,210.20
27340
386.61
367.28
422.37
27227
1,735.97
1,649.17
1,896.55
27345
503.90
478.71
550.52
27228
1,974.25
1,875.54
2,156.87
27347
549.30
521.84
600.12
27230
503.75
478.56
550.34
27350
681.87
647.78
744.95
27230
495.23
470.47
541.04
27355
632.00
600.40
690.46
27232
781.66
742.58
853.97
27356
772.48
733.86
843.94
27235
948.91
901.46
1,036.68
27357
853.77
811.08
932.74
27236
1,250.20
1,187.69
1,365.84
27358
291.90
277.31
318.91
27238
484.78
460.54
529.62
27360
933.08
886.43
1,019.39
27240
1,005.04
954.79
1,098.01
27364
1,649.62
1,567.14
1,802.21
27244
1,287.41
1,223.04
1,406.50
27365
2,163.28
2,055.12
2,363.39
27245
1,285.75
1,221.46
1,404.68
27369
170.14
161.63
185.87
27246
405.81
385.52
443.35
#
27369
41.70
39.62
45.56
27246
401.88
381.79
439.06
27372
614.59
583.86
671.44
27248
781.11
742.05
853.36
#
27372
417.02
396.17
455.60
27250
194.76
185.02
212.77
27380
643.34
611.17
702.85
27252
794.01
754.31
867.46
27381
854.62
811.89
933.67
27253
986.66
937.33
1,077.93
27385
623.95
592.75
681.66
27254
1,335.39
1,268.62
1,458.91
27386
893.33
848.66
975.96
27256
318.39
302.47
347.84
27390
467.23
443.87
510.45
27256
252.86
240.22
276.25
27391
572.41
543.79
625.36
27257
379.91
360.91
415.05
27392
744.73
707.49
813.61
27258
1,165.52
1,107.24
1,273.33
27393
523.85
497.66
572.31
27259
1,619.27
1,538.31
1,769.06
27394
684.80
650.56
748.14
27265
422.81
401.67
461.92
27395
921.80
875.71
1,007.07
27266
609.54
579.06
665.92
27396
644.98
612.73
704.64
27267
453.83
431.14
495.81
27397
955.71
907.92
1,044.11
27268
567.59
539.21
620.09
27400
727.35
690.98
794.63
27269
1,304.12
1,238.91
1,424.75
27403
673.09
639.44
735.36
27275
190.79
181.25
208.44
27405
705.08
669.83
770.30
27279
912.29
866.68
996.68
27407
832.08
790.48
909.05
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
20
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------27409
1,013.02
962.37
1,106.73
#
27516
500.80
475.76
547.12
27412
1,728.53
1,642.10
1,888.42
27517
718.33
682.41
784.77
27415
1,437.95
1,366.05
1,570.96
27519
936.08
889.28
1,022.67
27416
1,026.00
974.70
1,120.91
27520
333.52
316.84
364.37
27418
867.81
824.42
948.08
#
27520
308.61
293.18
337.16
27420
775.94
737.14
847.71
27524
786.72
747.38
859.49
27422
776.67
737.84
848.52
27530
313.28
297.62
342.26
27424
782.18
743.07
854.53
#
27530
294.28
279.57
321.51
27425
469.69
446.21
513.14
27532
642.11
610.00
701.50
27427
743.73
706.54
812.52
#
27532
601.48
571.41
657.12
27428
1,165.93
1,107.63
1,273.77
27535
942.82
895.68
1,030.03
27429
1,312.67
1,247.04
1,434.10
27536
1,241.17
1,179.11
1,355.98
27430
775.42
736.65
847.15
27538
497.64
472.76
543.67
27435
845.25
802.99
923.44
#
27538
463.89
440.70
506.81
27437
690.34
655.82
754.19
27540
850.46
807.94
929.13
27438
878.50
834.58
959.77
27550
545.43
518.16
595.88
27440
834.94
793.19
912.17
#
27550
505.79
480.50
552.58
27441
861.69
818.61
941.40
27552
659.78
626.79
720.81
27442
911.26
865.70
995.56
27556
921.10
875.05
1,006.31
27443
854.18
811.47
933.19
27557
1,099.65
1,044.67
1,201.37
27445
1,316.22
1,250.41
1,437.97
27558
1,254.51
1,191.78
1,370.55
27446
1,211.72
1,151.13
1,323.80
27560
387.97
368.57
423.86
27447
1,349.01
1,281.56
1,473.79
#
27560
356.85
339.01
389.86
27448
845.24
802.98
923.43
27562
508.08
482.68
555.08
27450
1,064.40
1,011.18
1,162.86
27566
934.84
888.10
1,021.32
27454
1,357.39
1,289.52
1,482.95
27570
155.82
148.03
170.23
27455
1,002.37
952.25
1,095.09
27580
1,536.64
1,459.81
1,678.78
27457
1,008.18
957.77
1,101.44
27590
841.82
799.73
919.69
27465
1,311.19
1,245.63
1,432.47
27591
1,011.25
960.69
1,104.79
27466
1,241.11
1,179.05
1,355.91
27592
713.93
678.23
779.96
27468
1,408.23
1,337.82
1,538.49
27594
534.04
507.34
583.44
27470
1,234.90
1,173.16
1,349.13
27596
757.55
719.67
827.62
27472
1,325.87
1,259.58
1,448.52
27598
749.19
711.73
818.49
27475
692.48
657.86
756.54
27600
424.70
403.47
463.99
27477
766.53
728.20
837.43
27601
462.52
439.39
505.30
27479
962.59
914.46
1,051.63
27602
512.40
486.78
559.80
27485
702.62
667.49
767.61
27603
553.33
525.66
604.51
27486
1,474.60
1,400.87
1,611.00
#
27603
407.20
386.84
444.87
27487
1,843.94
1,751.74
2,014.50
27604
478.93
454.98
523.23
27488
1,257.75
1,194.86
1,374.09
#
27604
339.03
322.08
370.39
27495
1,184.19
1,124.98
1,293.73
27605
342.79
325.65
374.50
27496
569.41
540.94
622.08
#
27605
187.49
178.12
204.84
27497
607.13
576.77
663.29
27606
284.38
270.16
310.68
27498
684.99
650.74
748.35
27607
623.53
592.35
681.20
27499
732.98
696.33
800.78
27610
674.72
640.98
737.13
27500
543.22
516.06
593.47
27612
574.92
546.17
628.10
27500
501.94
476.84
548.37
27613
256.62
243.79
280.36
27501
527.99
501.59
576.83
#
27613
162.58
154.45
177.62
27501
518.16
492.25
566.09
27614
599.37
569.40
654.81
27502
794.56
754.83
868.05
#
27614
423.43
402.26
462.60
27503
840.28
798.27
918.01
27615
1,076.37
1,022.55
1,175.93
27506
1,400.73
1,330.69
1,530.29
27616
1,339.81
1,272.82
1,463.74
27507
1,017.23
966.37
1,111.33
27618
495.67
470.89
541.52
27508
545.27
518.01
595.71
#
27618
315.13
299.37
344.28
27508
517.74
491.85
565.63
27619
477.71
453.82
521.89
27509
697.84
662.95
762.39
27620
464.47
441.25
507.44
27510
713.64
677.96
779.65
27625
591.79
562.20
646.53
27511
1,047.67
995.29
1,144.58
27626
621.96
590.86
679.49
27513
1,302.99
1,237.84
1,423.52
27630
560.47
532.45
612.32
27514
1,016.02
965.22
1,110.00
#
27630
370.11
351.60
404.34
27516
534.22
507.51
583.64
27632
433.29
411.63
473.37
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
21
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------27634
709.60
674.12
775.24
27759
1,045.00
992.75
1,141.66
27635
605.05
574.80
661.02
27760
340.57
323.54
372.07
27637
773.05
734.40
844.56
#
27760
315.01
299.26
344.15
27638
789.41
749.94
862.43
27762
494.40
469.68
540.13
27640
866.65
823.32
946.82
#
27762
449.84
427.35
491.45
27641
682.13
648.02
745.22
27766
628.55
597.12
686.69
27645
1,860.10
1,767.10
2,032.17
27767
297.67
282.79
325.21
27646
1,610.30
1,529.79
1,759.26
#
27767
295.05
280.30
322.35
27647
1,028.00
976.60
1,123.09
27768
462.57
439.44
505.36
27648
217.76
206.87
237.90
27769
763.55
725.37
834.18
27648
54.60
51.87
59.65
27780
315.98
300.18
345.21
27650
681.14
647.08
744.14
#
27780
291.73
277.14
318.71
27652
684.03
649.83
747.30
27781
447.49
425.12
488.89
27654
734.31
697.59
802.23
#
27781
413.09
392.44
451.31
27656
566.34
538.02
618.72
27784
734.19
697.48
802.10
27656
362.55
344.42
396.08
27786
321.95
305.85
351.73
27658
380.18
361.17
415.35
#
27786
295.74
280.95
323.09
27659
483.69
459.51
528.44
27788
438.25
416.34
478.79
27664
372.47
353.85
406.93
#
27788
398.93
378.98
435.83
27665
433.35
411.68
473.43
27792
671.29
637.73
733.39
27675
506.05
480.75
552.86
27808
343.13
325.97
374.87
27676
620.26
589.25
677.64
#
27808
313.32
297.65
342.30
27680
432.04
410.44
472.01
27810
487.53
463.15
532.62
27681
534.43
507.71
583.87
#
27810
441.98
419.88
482.86
27685
674.30
640.59
736.68
27814
797.68
757.80
871.47
27685
476.73
452.89
520.82
27816
337.67
320.79
368.91
27686
555.10
527.35
606.45
#
27816
301.95
286.85
329.88
27687
467.47
444.10
510.72
27818
506.24
480.93
553.07
27690
662.46
629.34
723.74
#
27818
455.12
432.36
497.21
27691
771.12
732.56
842.44
27822
908.48
863.06
992.52
27692
108.14
102.73
118.14
27823
1,025.35
974.08
1,120.19
27695
489.25
464.79
534.51
27824
328.38
311.96
358.75
27696
569.61
541.13
622.30
#
27824
315.28
299.52
344.45
27698
661.37
628.30
722.55
27825
565.21
536.95
617.49
27700
626.51
595.18
684.46
#
27825
513.45
487.78
560.95
27702
1,005.69
955.41
1,098.72
27826
884.70
840.47
966.54
27703
1,165.51
1,107.23
1,273.31
27827
1,164.14
1,105.93
1,271.82
27704
592.24
562.63
647.02
27828
1,385.68
1,316.40
1,513.86
27705
788.86
749.42
861.83
27829
734.17
697.46
802.08
27707
411.01
390.46
449.03
27830
401.34
381.27
438.46
27709
1,208.45
1,148.03
1,320.23
#
27830
371.20
352.64
405.54
27712
1,153.32
1,095.65
1,260.00
27831
422.63
401.50
461.73
27715
1,123.64
1,067.46
1,227.58
27832
790.38
750.86
863.49
27720
913.46
867.79
997.96
27840
394.20
374.49
430.66
27722
935.06
888.31
1,021.56
27842
515.02
489.27
562.66
27724
1,321.14
1,255.08
1,443.34
27846
745.50
708.23
814.46
27725
1,270.74
1,207.20
1,388.28
27848
832.16
790.55
909.13
27726
1,004.34
954.12
1,097.24
27860
173.17
164.51
189.19
27727
1,086.55
1,032.22
1,187.05
27870
1,057.17
1,004.31
1,154.96
27730
613.63
582.95
670.39
27871
716.87
681.03
783.18
27732
470.69
447.16
514.23
27880
963.71
915.52
1,052.85
27734
687.18
652.82
750.74
27881
903.24
858.08
986.79
27740
740.10
703.10
808.57
27882
630.58
599.05
688.91
27742
812.25
771.64
887.39
27884
605.96
575.66
662.01
27745
795.70
755.92
869.31
27886
689.85
655.36
753.66
27750
356.71
338.87
389.70
27888
685.52
651.24
748.93
27750
331.48
314.91
362.15
27889
675.17
641.41
737.62
27752
557.25
529.39
608.80
27892
561.04
532.99
612.94
27752
512.69
487.06
560.12
27893
638.51
606.58
697.57
27756
599.74
569.75
655.21
27894
871.73
828.14
952.36
27758
936.06
889.26
1,022.65
28001
276.29
262.48
301.85
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
---#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
22
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------28001
170.79
162.25
186.59
28107
576.98
548.13
630.35
28002
443.05
420.90
484.04
#
28107
389.23
369.77
425.24
28002
322.80
306.66
352.66
28108
440.20
418.19
480.92
28003
714.18
678.47
780.24
#
28108
290.14
275.63
316.97
28003
574.60
545.87
627.75
28110
465.95
442.65
509.05
28005
584.94
555.69
639.04
#
28110
293.61
278.93
320.77
28008
438.24
416.33
478.78
28111
493.12
468.46
538.73
28008
299.97
284.97
327.72
#
28111
329.30
312.84
359.77
28010
233.45
221.78
255.05
28112
490.30
465.79
535.66
28010
208.22
197.81
227.48
#
28112
315.99
300.19
345.22
28011
318.62
302.69
348.09
28113
593.67
563.99
648.59
28011
283.89
269.70
310.16
#
28113
429.52
408.04
469.25
28020
557.80
529.91
609.40
28114
1,086.46
1,032.14
1,186.96
28020
375.30
356.54
410.02
#
28114
853.17
810.51
932.09
28022
494.65
469.92
540.41
28116
781.40
742.33
853.68
28022
331.16
314.60
361.79
#
28116
593.33
563.66
648.21
28024
462.01
438.91
504.75
28118
614.34
583.62
671.16
28024
307.03
291.68
335.43
#
28118
428.90
407.46
468.58
28035
537.42
510.55
587.13
28119
530.01
503.51
579.04
28035
364.10
345.90
397.79
#
28119
366.85
348.51
400.79
28039
506.97
481.62
553.86
28120
689.76
655.27
753.56
28039
357.23
339.37
390.28
#
28120
509.55
484.07
556.68
28041
460.38
437.36
502.96
28122
602.35
572.23
658.06
28043
393.76
374.07
430.18
#
28122
445.08
422.83
486.25
28043
263.69
250.51
288.09
28124
482.38
458.26
527.00
28045
491.25
466.69
536.69
#
28124
336.25
319.44
367.36
28045
351.68
334.10
384.22
28126
393.70
374.02
430.12
28046
735.00
698.25
802.99
#
28126
248.88
236.44
271.91
28047
1,073.42
1,019.75
1,172.71
28130
637.84
605.95
696.84
28050
421.84
400.75
460.86
28140
595.50
565.73
650.59
28050
280.62
266.59
306.58
#
28140
445.44
423.17
486.65
28052
450.08
427.58
491.72
28150
426.49
405.17
465.95
28052
288.22
273.81
314.88
#
28150
282.65
268.52
308.80
28054
372.03
353.43
406.44
28153
413.06
392.41
451.27
28054
235.07
223.32
256.82
#
28153
266.61
253.28
291.27
28055
394.03
374.33
430.48
28160
416.84
396.00
455.40
28060
530.37
503.85
579.43
#
28160
269.40
255.93
294.32
28060
367.20
348.84
401.17
28171
1,162.12
1,104.01
1,269.61
28062
587.54
558.16
641.88
28173
745.10
707.85
814.03
28062
413.23
392.57
451.46
28175
477.27
453.41
521.42
28070
533.49
506.82
582.84
28190
251.51
238.93
274.77
28070
359.51
341.53
392.76
#
28190
135.19
128.43
147.69
28072
492.96
468.31
538.56
28192
470.11
446.60
513.59
28072
325.53
309.25
355.64
#
28192
315.79
300.00
345.00
28080
533.88
507.19
583.27
28193
532.69
506.06
581.97
28080
375.30
356.54
410.02
#
28193
372.79
354.15
407.27
28086
548.40
520.98
599.13
28200
500.40
475.38
546.69
28086
363.61
345.43
397.24
#
28200
330.02
313.52
360.55
28088
450.87
428.33
492.58
28202
609.04
578.59
665.38
28088
286.07
271.77
312.54
#
28202
438.01
416.11
478.53
28090
470.94
447.39
514.50
28208
490.41
465.89
535.77
28090
310.72
295.18
339.46
#
28208
323.31
307.14
353.21
28092
423.83
402.64
463.04
28210
609.26
578.80
665.62
28092
270.82
257.28
295.87
#
28210
434.95
413.20
475.18
28100
625.64
594.36
683.51
28220
455.77
432.98
497.93
28100
426.10
404.80
465.52
#
28220
307.02
291.67
335.42
28102
635.93
604.13
694.75
28222
527.82
501.43
576.64
28103
393.59
373.91
430.00
#
28222
364.65
346.42
398.38
28104
536.49
509.67
586.12
28225
423.23
402.07
462.38
28104
361.52
343.44
394.96
#
28225
268.91
255.46
293.78
28106
433.27
411.61
473.35
28226
635.79
604.00
694.60
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
---#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
23
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------28226
410.69
390.16
448.68
28310
555.99
528.19
607.42
28230
440.04
418.04
480.75
#
28310
368.58
350.15
402.67
28230
288.34
273.92
315.01
28312
514.85
489.11
562.48
28232
385.04
365.79
420.66
#
28312
326.12
309.81
356.28
28232
242.84
230.70
265.31
28313
539.24
512.28
589.12
28234
413.48
392.81
451.73
#
28313
366.90
348.56
400.84
28234
268.00
254.60
292.79
28315
488.99
464.54
534.22
28238
676.46
642.64
739.04
#
28315
332.37
315.75
363.11
28238
494.95
470.20
540.73
28320
637.18
605.32
696.12
28240
453.42
430.75
495.36
28322
805.83
765.54
880.37
28240
298.77
283.83
326.40
#
28322
594.49
564.77
649.49
28250
587.95
558.55
642.33
28340
575.01
546.26
628.20
28250
411.67
391.09
449.75
#
28340
415.12
394.36
453.51
28260
717.09
681.24
783.43
28341
668.26
634.85
730.08
28260
534.26
507.55
583.68
#
28341
495.91
471.11
541.78
28261
1,247.03
1,184.68
1,362.38
28344
424.81
403.57
464.11
28261
979.67
930.69
1,070.29
#
28344
281.30
267.24
307.33
28262
1,438.24
1,366.33
1,571.28
28345
520.10
494.10
568.22
28262
1,166.95
1,108.60
1,274.89
#
28345
367.09
348.74
401.05
28264
933.85
887.16
1,020.23
28360
1,144.40
1,087.18
1,250.26
28264
719.24
683.28
785.77
28400
249.66
237.18
272.76
28270
495.20
470.44
541.01
#
28400
231.31
219.74
252.70
28270
338.26
321.35
369.55
28405
402.56
382.43
439.79
28272
389.85
370.36
425.91
#
28405
364.88
346.64
398.64
28272
252.89
240.25
276.29
28406
572.71
544.07
625.68
28280
516.42
490.60
564.19
28415
1,165.47
1,107.20
1,273.28
28280
351.61
334.03
384.13
28420
1,353.58
1,285.90
1,478.79
28285
542.94
515.79
593.16
28430
243.24
231.08
265.74
28285
386.32
367.00
422.05
#
28430
214.41
203.69
234.24
28286
447.11
424.75
488.46
28435
340.15
323.14
371.61
28286
299.01
284.06
326.67
#
28435
302.80
287.66
330.81
28288
615.46
584.69
672.39
28436
500.84
475.80
547.17
28288
439.19
417.23
479.81
28445
1,066.65
1,013.32
1,165.32
28289
710.15
674.64
775.84
28446
1,282.42
1,218.30
1,401.05
28289
465.73
442.44
508.81
28450
212.94
202.29
232.63
28291
735.97
699.17
804.05
#
28450
192.63
183.00
210.45
28291
502.03
476.93
548.47
28455
293.11
278.45
320.22
28292
716.51
680.68
782.78
#
28455
261.98
248.88
286.21
28292
487.81
463.42
532.93
28456
366.71
348.37
400.63
28295
1,130.16
1,073.65
1,234.70
28465
646.63
614.30
706.45
28295
635.75
603.96
694.55
28470
220.50
209.48
240.90
28296
910.10
864.60
994.29
#
28470
206.74
196.40
225.86
28296
519.54
493.56
567.59
28475
259.99
246.99
284.04
28297
1,062.38
1,009.26
1,160.65
#
28475
230.18
218.67
251.47
28297
616.45
585.63
673.47
28476
389.25
369.79
425.26
28298
852.79
810.15
931.67
28485
570.91
542.36
623.71
28298
510.07
484.57
557.26
28490
141.06
134.01
154.11
28299
1,025.74
974.45
1,120.62
#
28490
123.69
117.51
135.14
28299
597.18
567.32
652.42
28495
177.55
168.67
193.97
28300
673.30
639.64
735.59
#
28495
148.06
140.66
161.76
28302
747.43
710.06
816.57
28496
459.42
436.45
501.92
28304
844.26
802.05
922.36
#
28496
247.11
234.75
269.96
28304
625.72
594.43
683.59
28505
673.77
640.08
736.09
28305
698.40
663.48
763.00
#
28505
508.31
482.89
555.32
28306
613.05
582.40
669.76
28510
121.56
115.48
132.80
28306
408.60
388.17
446.40
#
28510
119.59
113.61
130.65
28307
621.57
590.49
679.06
28515
162.38
154.26
177.40
28307
420.40
399.38
459.29
#
28515
141.74
134.65
154.85
28308
579.41
550.44
633.01
28525
580.40
551.38
634.09
28308
390.36
370.84
426.47
#
28525
411.34
390.77
449.39
28309
919.29
873.33
1,004.33
28530
114.03
108.33
124.58
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
---#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
24
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------28530
99.61
94.63
108.82
#
28890
220.40
209.38
240.79
28531
334.78
318.04
365.75
29000
351.21
333.65
383.70
28531
181.77
172.68
198.58
#
29000
206.07
195.77
225.14
28540
193.71
184.02
211.62
29010
270.34
256.82
295.34
28540
174.38
165.66
190.51
#
29010
165.17
156.91
180.45
28545
312.69
297.06
341.62
29015
290.95
276.40
317.86
28545
275.34
261.57
300.81
#
29015
185.78
176.49
202.96
28546
600.58
570.55
656.13
29035
252.13
239.52
275.45
28546
357.14
339.28
390.17
#
29035
146.63
139.30
160.20
28555
881.94
837.84
963.52
29040
289.37
274.90
316.14
28555
675.85
642.06
738.37
#
29040
177.65
168.77
194.09
28570
236.03
224.23
257.86
29044
283.25
269.09
309.45
28570
198.35
188.43
216.69
#
29044
171.52
162.94
187.38
28575
385.20
365.94
420.83
29046
310.28
294.77
338.99
28575
346.53
329.20
378.58
#
29046
192.00
182.40
209.76
28576
399.40
379.43
436.34
29049
98.87
93.93
108.02
28585
889.82
845.33
972.13
#
29049
71.02
67.47
77.59
28585
703.06
667.91
768.10
29055
215.76
204.97
235.72
28600
218.82
207.88
239.06
#
29055
138.77
131.83
151.60
28600
187.04
177.69
204.34
29058
125.24
118.98
136.83
28605
346.63
329.30
378.70
#
29058
97.39
92.52
106.40
28605
309.93
294.43
338.59
29065
95.71
90.92
104.56
28606
391.14
371.58
427.32
#
29065
69.49
66.02
75.92
28615
847.26
804.90
925.64
29075
87.46
83.09
95.55
28630
157.46
149.59
172.03
#
29075
63.87
60.68
69.78
28630
113.88
108.19
124.42
29085
95.21
90.45
104.02
28635
180.17
171.16
196.83
#
29085
68.34
64.92
74.66
28635
137.25
130.39
149.95
29086
72.80
69.16
79.53
28636
317.55
301.67
346.92
#
29086
48.23
45.82
52.69
28636
204.18
193.97
223.07
29105
82.93
78.78
90.60
28645
666.66
633.33
728.33
#
29105
44.93
42.68
49.08
28645
495.96
471.16
541.83
29125
64.55
61.32
70.52
28660
123.50
117.33
134.93
#
29125
40.63
38.60
44.39
28660
95.32
90.55
104.13
29126
75.59
71.81
82.58
28665
150.99
143.44
164.96
#
29126
49.38
46.91
53.95
28665
128.06
121.66
139.91
29130
41.94
39.84
45.82
28666
175.74
166.95
191.99
#
29130
30.47
28.95
33.29
28675
579.76
550.77
633.39
29131
52.53
49.90
57.39
28675
412.67
392.04
450.85
#
29131
35.49
33.72
38.78
28705
1,269.03
1,205.58
1,386.42
29200
32.96
31.31
36.01
28715
975.59
926.81
1,065.83
#
29200
18.87
17.93
20.62
28725
804.53
764.30
878.95
29240
30.66
29.13
33.50
28730
758.05
720.15
828.17
#
29240
18.87
17.93
20.62
28735
806.61
766.28
881.22
29260
30.36
28.84
33.17
28737
702.94
667.79
767.96
#
29260
20.20
19.19
22.07
28740
851.35
808.78
930.10
29280
29.70
28.22
32.45
28740
635.10
603.35
693.85
#
29280
20.20
19.19
22.07
28750
809.60
769.12
884.49
29305
246.51
234.18
269.31
28750
596.95
567.10
652.17
#
29305
162.96
154.81
178.03
28755
516.44
490.62
564.21
29325
272.07
258.47
297.24
28755
339.52
322.54
370.92
#
29325
181.96
172.86
198.79
28760
780.98
741.93
853.22
29345
136.24
129.43
148.84
28760
580.46
551.44
634.16
#
29345
102.82
97.68
112.33
28800
546.91
519.56
597.49
29355
145.08
137.83
158.50
28805
739.58
702.60
807.99
#
29355
111.33
105.76
121.62
28810
440.21
418.20
480.93
29358
159.92
151.92
174.71
28820
313.57
297.89
342.57
#
29358
106.51
101.18
116.36
28820
188.41
178.99
205.84
29365
122.31
116.19
133.62
28825
306.79
291.45
335.17
#
29365
89.21
84.75
97.46
28825
182.61
173.48
199.50
29405
80.29
76.28
87.72
28890
313.45
297.78
342.45
#
29405
59.98
56.98
65.53
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
---#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
25
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------29425
75.52
71.74
82.50
29837
550.22
522.71
601.12
29425
55.53
52.75
60.66
29838
617.58
586.70
674.71
29435
114.60
108.87
125.20
29840
467.48
444.11
510.73
29435
83.80
79.61
91.55
29843
506.86
481.52
553.75
29440
42.71
40.57
46.66
29844
518.37
492.45
566.32
29440
28.95
27.50
31.63
29845
607.25
576.89
663.42
29445
130.95
124.40
143.06
29846
542.84
515.70
593.06
29445
103.42
98.25
112.99
29847
568.30
539.89
620.87
29450
145.04
137.79
158.46
29848
527.77
501.38
576.59
29450
115.88
110.09
126.60
29850
649.84
617.35
709.95
29505
86.94
82.59
94.98
29851
972.98
924.33
1,062.98
29505
53.19
50.53
58.11
29855
815.13
774.37
890.53
29515
70.95
67.40
77.51
29856
1,032.60
980.97
1,128.12
29515
50.31
47.79
54.96
29860
670.07
636.57
732.06
29520
35.58
33.80
38.87
29861
755.12
717.36
824.96
29520
18.87
17.93
20.62
29862
847.82
805.43
926.24
29530
30.34
28.82
33.14
29863
846.68
804.35
925.00
29530
18.54
17.61
20.25
29866
1,097.62
1,042.74
1,199.15
29540
28.39
26.97
31.02
29867
1,338.39
1,271.47
1,462.19
29540
18.56
17.63
20.27
29868
1,750.82
1,663.28
1,912.77
29550
18.90
17.96
20.65
29870
576.31
547.49
629.61
29550
11.69
11.11
12.78
#
29870
421.34
400.27
460.31
29580
63.48
60.31
69.36
29871
535.26
508.50
584.78
29580
27.44
26.07
29.98
29873
553.91
526.21
605.14
29581
88.45
84.03
96.63
29874
560.66
532.63
612.52
29581
27.83
26.44
30.41
29875
516.85
491.01
564.66
29584
82.17
78.06
89.77
29876
681.51
647.43
744.54
29584
15.99
15.19
17.47
29877
647.59
615.21
707.49
29700
61.92
58.82
67.64
29879
690.14
655.63
753.97
29700
34.73
32.99
37.94
29880
585.70
556.42
639.88
29705
65.14
61.88
71.16
29881
564.56
536.33
616.78
29705
47.77
45.38
52.19
29882
721.00
684.95
787.69
29710
123.67
117.49
135.11
29883
875.61
831.83
956.60
29710
86.64
82.31
94.66
29884
645.08
612.83
704.75
29720
84.80
80.56
92.64
29885
788.34
748.92
861.26
29720
45.81
43.52
50.05
29886
663.62
630.44
725.01
29730
64.13
60.92
70.06
29887
785.44
746.17
858.10
29730
46.11
43.80
50.37
29888
1,022.10
971.00
1,116.65
29740
100.55
95.52
109.85
29889
1,279.59
1,215.61
1,397.95
29740
72.70
69.07
79.43
29891
694.16
659.45
758.37
29750
109.56
104.08
119.69
29892
665.09
631.84
726.62
29750
81.38
77.31
88.91
29893
659.40
626.43
720.39
29800
552.02
524.42
603.08
#
29893
434.30
412.59
474.48
29804
615.94
585.14
672.91
29894
515.86
490.07
563.58
29805
489.32
464.85
534.58
29895
482.48
458.36
527.11
29806
1,104.84
1,049.60
1,207.04
29897
514.50
488.78
562.10
29807
1,079.02
1,025.07
1,178.83
29898
579.82
550.83
633.45
29819
612.82
582.18
669.51
29899
1,067.59
1,014.21
1,166.34
29820
561.69
533.61
613.65
29900
518.99
493.04
567.00
29821
619.76
588.77
677.09
29901
560.47
532.45
612.32
29822
564.24
536.03
616.43
29902
595.19
565.43
650.24
29823
617.66
586.78
674.80
29904
666.29
632.98
727.93
29824
704.35
669.13
769.50
29905
523.30
497.14
571.71
29825
612.32
581.70
668.96
29906
680.46
646.44
743.41
29826
184.02
174.82
201.04
29907
915.76
869.97
1,000.47
29827
1,118.15
1,062.24
1,221.58
29914
1,042.60
990.47
1,139.04
29828
958.74
910.80
1,047.42
29915
1,069.64
1,016.16
1,168.58
29830
468.21
444.80
511.52
29916
1,069.12
1,015.66
1,168.01
29834
513.82
488.13
561.35
30000
265.30
252.04
289.85
29835
531.70
505.12
580.89
#
30000
120.81
114.77
131.99
29836
606.89
576.55
663.03
30020
267.59
254.21
292.34
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
---#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
26
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------30020
121.46
115.39
132.70
#
30906
140.87
133.83
153.90
30100
144.16
136.95
157.49
30915
613.27
582.61
670.00
30100
68.14
64.73
74.44
30920
890.93
846.38
973.34
30110
247.07
234.72
269.93
30930
118.11
112.20
129.03
30110
132.06
125.46
144.28
31000
183.56
174.38
200.54
30115
470.04
446.54
513.52
#
31000
107.55
102.17
117.50
30117
972.44
923.82
1,062.39
31002
196.55
186.72
214.73
30117
335.82
319.03
366.88
31020
489.87
465.38
535.19
30118
807.91
767.51
882.64
#
31020
389.94
370.44
426.01
30120
520.01
494.01
568.11
31030
647.38
615.01
707.26
30120
431.22
409.66
471.11
#
31030
519.92
493.92
568.01
30124
304.89
289.65
333.10
31032
601.97
571.87
657.65
30125
663.25
630.09
724.60
31040
823.36
782.19
899.52
30130
417.70
396.82
456.34
31050
522.26
496.15
570.57
30140
299.21
284.25
326.89
31051
702.12
667.01
767.06
30140
183.55
174.37
200.53
31070
478.15
454.24
522.38
30150
821.10
780.05
897.06
31075
840.08
798.08
917.79
30160
830.36
788.84
907.17
31080
1,106.70
1,051.37
1,209.08
30200
112.67
107.04
123.10
31081
1,186.78
1,127.44
1,296.56
30200
58.94
55.99
64.39
31084
1,231.45
1,169.88
1,345.36
30210
150.80
143.26
164.75
31085
1,268.86
1,205.42
1,386.23
30210
101.33
96.26
110.70
31086
1,196.83
1,136.99
1,307.54
30220
310.59
295.06
339.32
31087
1,140.94
1,083.89
1,246.47
30220
127.11
120.75
138.86
31090
1,122.41
1,066.29
1,226.23
30300
203.47
193.30
222.30
31200
623.89
592.70
681.61
30300
120.90
114.86
132.09
31201
810.23
769.72
885.18
30310
209.80
199.31
229.21
31205
949.95
902.45
1,037.82
30320
490.47
465.95
535.84
31225
1,871.73
1,778.14
2,044.86
30400
1,263.72
1,200.53
1,380.61
31230
2,080.79
1,976.75
2,273.26
30410
1,460.78
1,387.74
1,595.90
31231
194.64
184.91
212.65
30420
1,480.66
1,406.63
1,617.62
#
31231
65.88
62.59
71.98
30430
1,099.47
1,044.50
1,201.18
31233
271.62
258.04
296.75
30435
1,381.71
1,312.62
1,509.51
#
31233
137.61
130.73
150.34
30450
1,816.65
1,725.82
1,984.69
31235
307.64
292.26
336.10
30460
864.23
821.02
944.17
#
31235
159.87
151.88
174.66
30462
1,666.05
1,582.75
1,820.16
31237
258.15
245.24
282.03
30465
1,047.05
994.70
1,143.91
#
31237
162.81
154.67
177.87
30468
2,761.49
2,623.42
3,016.93
31238
253.88
241.19
277.37
30468
172.10
163.50
188.03
#
31238
170.66
162.13
186.45
30520
679.79
645.80
742.67
31239
617.56
586.68
674.68
30540
747.22
709.86
816.34
31240
162.18
154.07
177.18
30545
1,018.48
967.56
1,112.69
31241
458.07
435.17
500.45
30560
314.72
298.98
343.83
31253
516.20
490.39
563.95
30560
147.95
140.55
161.63
31254
441.64
419.56
482.49
30580
622.54
591.41
680.12
#
31254
250.29
237.78
273.45
30580
469.53
446.05
512.96
31255
332.74
316.10
363.52
30600
605.20
574.94
661.18
31256
185.09
175.84
202.22
30600
435.15
413.39
475.40
31257
459.71
436.72
502.23
30620
678.86
644.92
741.66
31259
486.85
462.51
531.89
30630
678.96
645.01
741.76
31267
272.67
259.04
297.90
30801
223.23
212.07
243.88
31276
389.24
369.78
425.25
30801
151.81
144.22
165.85
31287
206.45
196.13
225.55
30802
283.84
269.65
310.10
31288
241.24
229.18
263.56
30802
204.88
194.64
223.84
31290
1,179.66
1,120.68
1,288.78
30901
156.98
149.13
171.50
31291
1,253.67
1,190.99
1,369.64
30901
59.02
56.07
64.48
31292
1,021.44
970.37
1,115.93
30903
246.63
234.30
269.45
31293
1,106.22
1,050.91
1,208.55
30903
82.15
78.04
89.75
31294
1,265.47
1,202.20
1,382.53
30905
357.38
339.51
390.44
31295
1,826.33
1,735.01
1,995.26
30905
111.32
105.75
121.61
#
31295
161.88
153.79
176.86
30906
369.89
351.40
404.11
31296
1,852.79
1,760.15
2,024.17
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
---#
#
#
#
#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
27
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------31296
184.42
175.20
201.48
31575
127.45
121.08
139.24
31297
1,811.49
1,720.92
1,979.06
#
31575
67.81
64.42
74.08
31297
147.38
140.01
161.01
31576
269.81
256.32
294.77
31298
3,461.09
3,288.04
3,781.25
#
31576
120.40
114.38
131.54
31298
263.27
250.11
287.63
31577
281.49
267.42
307.53
31300
1,293.08
1,228.43
1,412.69
#
31577
136.67
129.84
149.32
31360
2,121.87
2,015.78
2,318.15
31578
303.30
288.14
331.36
31365
2,624.00
2,492.80
2,866.72
#
31578
149.63
142.15
163.47
31367
2,246.01
2,133.71
2,453.77
31579
197.71
187.82
215.99
31368
2,488.75
2,364.31
2,718.96
#
31579
121.04
114.99
132.24
31370
2,107.85
2,002.46
2,302.83
31580
1,308.61
1,243.18
1,429.66
31375
2,001.76
1,901.67
2,186.92
31584
1,449.85
1,377.36
1,583.96
31380
1,973.10
1,874.45
2,155.62
31587
1,223.47
1,162.30
1,336.65
31382
2,165.17
2,056.91
2,365.45
31590
919.74
873.75
1,004.81
31390
2,903.66
2,758.48
3,172.25
31591
1,112.82
1,057.18
1,215.76
31395
3,056.63
2,903.80
3,339.37
31592
1,769.81
1,681.32
1,933.52
31400
1,022.37
971.25
1,116.94
31600
323.56
307.38
353.49
31420
850.80
808.26
929.50
31601
462.99
439.84
505.82
31500
149.80
142.31
163.66
31603
337.60
320.72
368.83
31502
36.36
34.54
39.72
31605
354.34
336.62
387.11
31505
90.67
86.14
99.06
31610
987.17
937.81
1,078.48
31505
49.05
46.60
53.59
31611
545.63
518.35
596.10
31510
216.64
205.81
236.68
31612
92.82
88.18
101.41
31510
122.94
116.79
134.31
#
31612
50.56
48.03
55.23
31511
215.57
204.79
235.51
31613
445.82
423.53
487.06
31511
135.95
129.15
148.52
31614
742.48
705.36
811.16
31512
215.50
204.73
235.44
31615
175.67
166.89
191.92
31512
130.64
124.11
142.73
#
31615
117.35
111.48
128.20
31513
133.84
127.15
146.22
31622
249.57
237.09
272.65
31515
216.21
205.40
236.21
#
31622
135.55
128.77
148.09
31515
113.33
107.66
123.81
31623
277.90
264.01
303.61
31520
158.45
150.53
173.11
#
31623
135.38
128.61
147.90
31525
254.79
242.05
278.36
31624
258.09
245.19
281.97
31525
163.05
154.90
178.14
#
31624
136.86
130.02
149.52
31526
160.12
152.11
174.93
31625
356.13
338.32
389.07
31527
198.56
188.63
216.92
#
31625
159.87
151.88
174.66
31528
146.73
139.39
160.30
31626
846.35
804.03
924.63
31529
164.46
156.24
179.68
#
31626
204.49
194.27
223.41
31530
203.24
193.08
222.04
31627
1,236.06
1,174.26
1,350.40
31531
214.81
204.07
234.68
#
31627
100.11
95.10
109.37
31535
193.41
183.74
211.30
31628
378.36
359.44
413.36
31536
214.09
203.39
233.90
#
31628
179.48
170.51
196.09
31540
246.85
234.51
269.69
31629
466.81
443.47
509.99
31541
269.21
255.75
294.11
#
31629
190.93
181.38
208.59
31545
370.03
351.53
404.26
31630
205.10
194.85
224.08
31546
563.22
535.06
615.32
31631
235.35
223.58
257.12
31551
1,572.21
1,493.60
1,717.64
31632
65.68
62.40
71.76
31552
1,516.54
1,440.71
1,656.82
#
31632
50.93
48.38
55.64
31553
1,724.72
1,638.48
1,884.25
31633
82.04
77.94
89.63
31554
1,725.37
1,639.10
1,884.97
#
31633
65.33
62.06
71.37
31560
319.29
303.33
348.83
31634
1,693.71
1,609.02
1,850.37
31561
348.52
331.09
380.75
#
31634
195.38
185.61
213.45
31570
348.52
331.09
380.75
31635
294.94
280.19
322.22
31570
235.16
223.40
256.91
#
31635
180.26
171.25
196.94
31571
254.20
241.49
277.71
31636
225.65
214.37
246.53
31572
533.50
506.83
582.85
31637
79.68
75.70
87.06
31572
184.55
175.32
201.62
31638
256.10
243.30
279.80
31573
283.81
269.62
310.06
31640
256.02
243.22
279.70
31573
151.44
143.87
165.45
31641
262.95
249.80
287.27
31574
998.58
948.65
1,090.95
31643
177.72
168.83
194.15
31574
151.94
144.34
165.99
31645
274.06
260.36
299.41
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
---#
#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
28
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------31645
150.53
143.00
164.45
#
32408
156.74
148.90
171.24
31646
145.23
137.97
158.67
32440
1,671.30
1,587.74
1,825.90
31647
213.81
203.12
233.59
32442
3,269.24
3,105.78
3,571.65
31648
205.21
194.95
224.19
32445
3,767.29
3,578.93
4,115.77
31649
69.19
65.73
75.59
32480
1,575.64
1,496.86
1,721.39
31651
78.70
74.77
85.99
32482
1,686.60
1,602.27
1,842.61
31652
1,239.87
1,177.88
1,354.56
32484
1,528.74
1,452.30
1,670.15
31652
228.75
217.31
249.91
32486
2,504.85
2,379.61
2,736.55
31653
1,287.65
1,223.27
1,406.76
32488
2,551.59
2,424.01
2,787.61
31653
252.61
239.98
275.98
32491
1,564.45
1,486.23
1,709.16
31654
123.82
117.63
135.27
32501
262.11
249.00
286.35
31654
68.77
65.33
75.13
32503
1,913.04
1,817.39
2,090.00
31660
200.64
190.61
219.20
32504
2,181.15
2,072.09
2,382.90
31661
211.83
201.24
231.43
32505
988.84
939.40
1,080.31
31717
289.21
274.75
315.96
32506
168.06
159.66
183.61
31717
108.35
102.93
118.37
32507
168.06
159.66
183.61
31720
55.91
53.11
61.08
32540
1,838.03
1,746.13
2,008.05
31725
81.11
77.05
88.61
32550
824.51
783.28
900.77
31730
1,186.77
1,127.43
1,296.54
#
32550
213.78
203.09
233.55
31730
159.27
151.31
174.01
32551
165.20
156.94
180.48
31750
1,404.10
1,333.90
1,533.99
32552
188.87
179.43
206.34
31755
1,771.66
1,683.08
1,935.54
#
32552
163.32
155.15
178.42
31760
1,461.05
1,388.00
1,596.20
32553
533.72
507.03
583.08
31766
1,895.20
1,800.44
2,070.51
#
32553
181.18
172.12
197.94
31770
1,416.80
1,345.96
1,547.85
32554
239.14
227.18
261.26
31775
1,490.85
1,416.31
1,628.76
#
32554
92.68
88.05
101.26
31780
1,227.22
1,165.86
1,340.74
32555
323.16
307.00
353.05
31781
1,478.84
1,404.90
1,615.64
#
32555
113.80
108.11
124.33
31785
1,105.76
1,050.47
1,208.04
32556
734.94
698.19
802.92
31786
1,536.69
1,459.86
1,678.84
#
32556
128.47
122.05
140.36
31800
732.23
695.62
799.96
32557
660.54
627.51
721.64
31805
866.58
823.25
946.74
#
32557
153.99
146.29
168.23
31820
451.52
428.94
493.28
32560
267.08
253.73
291.79
31820
336.84
320.00
368.00
#
32560
80.98
76.93
88.47
31825
619.32
588.35
676.60
32561
95.98
91.18
104.86
31825
491.21
466.65
536.65
#
32561
70.43
66.91
76.95
31830
491.17
466.61
536.60
32562
85.99
81.69
93.94
31830
366.67
348.34
400.59
#
32562
63.06
59.91
68.90
32035
773.29
734.63
844.82
32601
327.89
311.50
358.23
32036
834.49
792.77
911.69
32604
510.83
485.29
558.08
32096
851.92
809.32
930.72
32606
492.60
467.97
538.17
32097
850.11
807.60
928.74
32607
327.57
311.19
357.87
32098
805.22
764.96
879.70
32608
404.28
384.07
441.68
32100
856.01
813.21
935.19
32609
271.60
258.02
296.72
32110
1,562.84
1,484.70
1,707.41
32650
704.17
668.96
769.30
32120
925.53
879.25
1,011.14
32651
1,164.02
1,105.82
1,271.69
32124
981.57
932.49
1,072.36
32652
1,768.66
1,680.23
1,932.26
32140
1,051.09
998.54
1,148.32
32653
1,125.66
1,069.38
1,229.79
32141
1,624.87
1,543.63
1,775.17
32654
1,220.00
1,159.00
1,332.85
32150
1,066.02
1,012.72
1,164.63
32655
1,016.05
965.25
1,110.04
32151
1,067.32
1,013.95
1,166.04
32656
850.98
808.43
929.69
32160
842.03
799.93
919.92
32658
756.26
718.45
826.22
32200
1,205.22
1,144.96
1,316.70
32659
774.98
736.23
846.66
32215
849.51
807.03
928.08
32661
846.71
804.37
925.03
32220
1,688.97
1,604.52
1,845.20
32662
947.08
899.73
1,034.69
32225
1,054.04
1,001.34
1,151.54
32663
1,491.30
1,416.74
1,629.25
32310
973.83
925.14
1,063.91
32664
900.05
855.05
983.31
32320
1,702.68
1,617.55
1,860.18
32665
1,309.85
1,244.36
1,431.01
32400
163.61
155.43
178.74
32666
922.53
876.40
1,007.86
32400
86.94
82.59
94.98
32667
168.06
159.66
183.61
32408
919.18
873.22
1,004.20
32668
168.39
159.97
183.97
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
29
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------32669
1,429.73
1,358.24
1,561.98
33228
375.77
356.98
410.53
32670
1,709.22
1,623.76
1,867.32
33229
396.87
377.03
433.58
32671
1,892.82
1,798.18
2,067.91
33230
406.87
386.53
444.51
32672
1,623.95
1,542.75
1,774.16
33231
425.19
403.93
464.52
32673
1,292.54
1,227.91
1,412.10
33233
243.74
231.55
266.28
32674
231.30
219.74
252.70
33234
515.26
489.50
562.93
32701
225.69
214.41
246.57
33235
674.81
641.07
737.23
32800
1,004.48
954.26
1,097.40
33236
827.25
785.89
903.77
32810
954.36
906.64
1,042.64
33237
887.65
843.27
969.76
32815
2,992.01
2,842.41
3,268.77
33238
999.76
949.77
1,092.24
32820
1,413.24
1,342.58
1,543.97
33240
387.24
367.88
423.06
32851
3,494.48
3,319.76
3,817.72
33241
226.14
214.83
247.05
32852
3,823.68
3,632.50
4,177.38
33243
1,456.47
1,383.65
1,591.20
32853
4,886.59
4,642.26
5,338.60
33244
918.55
872.62
1,003.51
32854
5,186.77
4,927.43
5,666.54
33249
973.88
925.19
1,063.97
32900
1,513.96
1,438.26
1,654.00
33250
1,551.03
1,473.48
1,694.50
32905
1,420.47
1,349.45
1,551.87
33251
1,735.41
1,648.64
1,895.94
32906
1,756.78
1,668.94
1,919.28
33254
1,443.21
1,371.05
1,576.71
32940
1,311.22
1,245.66
1,432.51
33255
1,732.67
1,646.04
1,892.95
32960
128.55
122.12
140.44
33256
2,070.96
1,967.41
2,262.52
32960
93.49
88.82
102.14
33257
616.73
585.89
673.77
32994
5,345.54
5,078.26
5,840.00
33258
689.21
654.75
752.96
32994
449.19
426.73
490.74
33259
894.42
849.70
977.16
32997
349.76
332.27
382.11
33261
1,717.30
1,631.44
1,876.16
32998
3,395.54
3,225.76
3,709.62
33262
395.60
375.82
432.19
32998
448.37
425.95
489.84
33263
411.63
391.05
449.71
33016
251.38
238.81
274.63
33264
430.30
408.79
470.11
33017
259.70
246.72
283.73
33265
1,447.47
1,375.10
1,581.37
33018
294.35
279.63
321.57
33266
1,966.33
1,868.01
2,148.21
33019
239.57
227.59
261.73
33270
597.55
567.67
652.82
33020
879.97
835.97
961.37
33271
481.33
457.26
525.85
33025
817.89
777.00
893.55
33272
366.68
348.35
400.60
33030
2,133.48
2,026.81
2,330.83
33273
422.78
401.64
461.89
33031
2,645.24
2,512.98
2,889.93
33274
512.96
487.31
560.41
33050
1,067.88
1,014.49
1,166.66
33275
556.55
528.72
608.03
33120
2,236.83
2,124.99
2,443.74
33285
4,892.05
4,647.45
5,344.57
33130
1,454.91
1,382.16
1,589.48
#
33285
93.67
88.99
102.34
33140
1,663.05
1,579.90
1,816.89
33286
141.45
134.38
154.54
33141
142.09
134.99
155.24
#
33286
92.63
88.00
101.20
33202
819.53
778.55
895.33
33289
355.09
337.34
387.94
33203
859.69
816.71
939.22
33300
2,613.97
2,483.27
2,855.76
33206
482.09
457.99
526.69
33305
4,380.21
4,161.20
4,785.38
33207
508.70
483.27
555.76
33310
1,241.64
1,179.56
1,356.49
33208
552.82
525.18
603.96
33315
2,045.30
1,943.04
2,234.50
33210
173.03
164.38
189.04
33320
1,125.42
1,069.15
1,229.52
33211
181.47
172.40
198.26
33321
1,262.57
1,199.44
1,379.36
33212
341.31
324.24
372.88
33322
1,480.30
1,406.29
1,617.23
33213
355.70
337.92
388.61
33330
1,516.16
1,440.35
1,656.40
33214
507.69
482.31
554.66
33335
1,992.71
1,893.07
2,177.03
33215
328.00
311.60
358.34
33340
839.00
797.05
916.61
33216
392.70
373.07
429.03
33361
1,293.30
1,228.64
1,412.94
33217
389.03
369.58
425.02
33362
1,409.38
1,338.91
1,539.75
33218
410.04
389.54
447.97
33363
1,462.19
1,389.08
1,597.44
33220
398.45
378.53
435.31
33364
1,465.99
1,392.69
1,601.59
33221
382.54
363.41
417.92
33365
1,523.24
1,447.08
1,664.14
33222
359.63
341.65
392.90
33366
1,680.94
1,596.89
1,836.42
33223
434.61
412.88
474.81
33367
673.59
639.91
735.90
33224
548.76
521.32
599.52
33368
796.90
757.06
870.62
33225
499.28
474.32
545.47
33369
1,052.28
999.67
1,149.62
33226
525.65
499.37
574.28
33390
2,051.54
1,948.96
2,241.30
33227
358.41
340.49
391.56
33391
2,446.38
2,324.06
2,672.67
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
30
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------33404
1,863.44
1,770.27
2,035.81
33548
3,165.18
3,006.92
3,457.96
33405
2,423.93
2,302.73
2,648.14
33572
247.61
235.23
270.51
33406
3,075.26
2,921.50
3,359.73
33600
1,831.72
1,740.13
2,001.15
33410
2,714.87
2,579.13
2,966.00
33602
1,776.86
1,688.02
1,941.22
33411
3,586.30
3,406.99
3,918.04
33606
1,895.85
1,801.06
2,071.22
33412
3,369.68
3,201.20
3,681.38
33608
1,919.27
1,823.31
2,096.81
33413
3,446.90
3,274.56
3,765.74
33610
1,891.93
1,797.33
2,066.93
33414
2,296.06
2,181.26
2,508.45
33611
2,083.03
1,978.88
2,275.71
33415
2,156.77
2,048.93
2,356.27
33612
2,139.45
2,032.48
2,337.35
33416
2,155.87
2,048.08
2,355.29
33615
2,131.80
2,025.21
2,328.99
33417
1,776.51
1,687.68
1,940.83
33617
2,309.98
2,194.48
2,523.65
33418
1,913.03
1,817.38
2,089.99
33619
2,924.17
2,777.96
3,194.65
33419
453.62
430.94
495.58
33620
1,761.03
1,672.98
1,923.93
33420
1,544.53
1,467.30
1,687.40
33621
990.52
940.99
1,082.14
33422
1,772.44
1,683.82
1,936.39
33622
3,672.82
3,489.18
4,012.56
33425
2,918.27
2,772.36
3,188.21
33641
1,749.57
1,662.09
1,911.40
33426
2,539.70
2,412.72
2,774.63
33645
1,847.95
1,755.55
2,018.88
33427
2,601.49
2,471.42
2,842.13
33647
1,940.07
1,843.07
2,119.53
33430
2,989.46
2,839.99
3,265.99
33660
1,874.92
1,781.17
2,048.35
33440
3,476.84
3,303.00
3,798.45
33665
2,043.35
1,941.18
2,232.36
33460
2,568.75
2,440.31
2,806.36
33670
2,111.24
2,005.68
2,306.53
33463
3,264.39
3,101.17
3,566.35
33675
2,105.89
2,000.60
2,300.69
33464
2,599.88
2,469.89
2,840.37
33676
2,161.80
2,053.71
2,361.77
33465
2,937.55
2,790.67
3,209.27
33677
2,244.75
2,132.51
2,452.39
33468
2,620.98
2,489.93
2,863.42
33681
1,963.44
1,865.27
2,145.06
33470
1,317.40
1,251.53
1,439.26
33684
2,017.00
1,916.15
2,203.57
33471
1,408.38
1,337.96
1,538.65
33688
2,014.61
1,913.88
2,200.96
33474
2,326.94
2,210.59
2,542.18
33690
1,275.51
1,211.73
1,393.49
33475
2,476.70
2,352.87
2,705.80
33692
2,092.92
1,988.27
2,286.51
33476
1,621.96
1,540.86
1,771.99
33694
2,083.03
1,978.88
2,275.71
33477
1,447.99
1,375.59
1,581.93
33697
2,194.86
2,085.12
2,397.89
33478
1,676.00
1,592.20
1,831.03
33702
1,648.92
1,566.47
1,801.44
33496
1,774.51
1,685.78
1,938.65
33710
2,191.26
2,081.70
2,393.96
33500
1,663.42
1,580.25
1,817.29
33720
1,650.45
1,567.93
1,803.12
33501
1,187.13
1,127.77
1,296.94
33722
1,736.90
1,650.06
1,897.57
33502
1,356.80
1,288.96
1,482.30
33724
1,641.98
1,559.88
1,793.86
33503
1,409.64
1,339.16
1,540.03
33726
2,171.87
2,063.28
2,372.77
33504
1,560.54
1,482.51
1,704.89
33730
2,141.39
2,034.32
2,339.47
33505
2,207.12
2,096.76
2,411.27
33732
1,755.99
1,668.19
1,918.42
33506
2,195.35
2,085.58
2,398.42
33735
1,379.11
1,310.15
1,506.67
33507
1,839.83
1,747.84
2,010.02
33736
1,496.93
1,422.08
1,635.39
33508
16.77
15.93
18.32
33737
1,382.19
1,313.08
1,510.04
33510
2,062.75
1,959.61
2,253.55
33741
807.89
767.50
882.63
33511
2,265.34
2,152.07
2,474.88
33745
1,133.36
1,076.69
1,238.19
33512
2,584.64
2,455.41
2,823.72
33746
446.11
423.80
487.37
33513
2,657.10
2,524.25
2,902.89
33750
1,347.37
1,280.00
1,472.00
33514
2,801.35
2,661.28
3,060.47
33755
1,400.50
1,330.48
1,530.05
33516
2,886.90
2,742.56
3,153.94
33762
1,367.74
1,299.35
1,494.25
33517
200.60
190.57
219.16
33764
1,400.50
1,330.48
1,530.05
33518
441.71
419.62
482.56
33766
1,421.77
1,350.68
1,553.28
33519
583.82
554.63
637.82
33767
1,518.05
1,442.15
1,658.47
33521
700.96
665.91
765.80
33768
446.96
424.61
488.30
33522
787.33
747.96
860.15
33770
2,263.41
2,150.24
2,472.78
33523
893.63
848.95
976.29
33771
2,332.44
2,215.82
2,548.19
33530
563.15
534.99
615.24
33774
1,917.61
1,821.73
2,094.99
33533
1,997.17
1,897.31
2,181.91
33775
1,977.07
1,878.22
2,159.95
33534
2,345.02
2,227.77
2,561.94
33776
2,088.99
1,984.54
2,282.22
33535
2,614.93
2,484.18
2,856.81
33777
2,021.28
1,920.22
2,208.25
33536
2,814.16
2,673.45
3,074.47
33778
2,510.72
2,385.18
2,742.96
33542
2,807.62
2,667.24
3,067.33
33779
2,489.25
2,364.79
2,719.51
33545
3,281.27
3,117.21
3,584.79
33780
2,533.90
2,407.21
2,768.29
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
31
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------33781
2,476.58
2,352.75
2,705.66
33965
196.92
187.07
215.13
33782
3,453.95
3,281.25
3,773.44
33966
252.77
240.13
276.15
33783
3,733.01
3,546.36
4,078.31
33967
277.52
263.64
303.19
33786
2,436.75
2,314.91
2,662.15
33968
36.22
34.41
39.57
33788
1,637.87
1,555.98
1,789.38
33969
292.34
277.72
319.38
33800
1,051.58
999.00
1,148.85
33970
377.28
358.42
412.18
33802
1,153.07
1,095.42
1,259.73
33971
744.73
707.49
813.61
33803
1,228.53
1,167.10
1,342.17
33973
540.16
513.15
590.12
33813
1,319.95
1,253.95
1,442.04
33974
944.37
897.15
1,031.72
33814
1,623.27
1,542.11
1,773.43
33975
1,393.89
1,324.20
1,522.83
33820
1,029.38
977.91
1,124.60
33976
1,701.93
1,616.83
1,859.35
33822
1,085.99
1,031.69
1,186.44
33977
1,195.70
1,135.92
1,306.31
33824
1,254.71
1,191.97
1,370.77
33978
1,423.09
1,351.94
1,554.73
33840
1,318.43
1,252.51
1,440.39
33979
2,086.68
1,982.35
2,279.70
33845
1,418.47
1,347.55
1,549.68
33980
1,901.36
1,806.29
2,077.23
33851
1,354.17
1,286.46
1,479.43
33981
891.17
846.61
973.60
33852
1,490.76
1,416.22
1,628.65
33982
2,095.18
1,990.42
2,288.98
33853
1,954.66
1,856.93
2,135.47
33983
2,479.29
2,355.33
2,708.63
33858
3,629.98
3,448.48
3,965.75
33984
304.87
289.63
333.07
33859
2,606.64
2,476.31
2,847.76
33985
550.63
523.10
601.57
33863
3,368.44
3,200.02
3,680.02
33986
561.06
533.01
612.96
33864
3,440.75
3,268.71
3,759.02
33987
224.56
213.33
245.33
33866
990.38
940.86
1,081.99
33988
834.37
792.65
911.55
33871
3,487.03
3,312.68
3,809.58
33989
528.41
501.99
577.29
33875
2,922.44
2,776.32
3,192.77
33990
386.32
367.00
422.05
33877
3,873.27
3,679.61
4,231.55
33991
504.04
478.84
550.67
33880
1,918.00
1,822.10
2,095.42
33992
200.93
190.88
219.51
33881
1,644.22
1,562.01
1,796.31
33993
175.93
167.13
192.20
33883
1,190.52
1,130.99
1,300.64
33995
386.58
367.25
422.34
33884
427.03
405.68
466.53
33997
171.94
163.34
187.84
33886
1,021.57
970.49
1,116.06
34001
984.21
935.00
1,075.25
33889
849.35
806.88
927.91
34051
1,054.61
1,001.88
1,152.16
33891
1,042.92
990.77
1,139.39
34101
638.37
606.45
697.42
33910
2,796.35
2,656.53
3,055.01
34111
641.14
609.08
700.44
33915
1,470.32
1,396.80
1,606.32
34151
1,489.16
1,414.70
1,626.91
33916
4,504.24
4,279.03
4,920.88
34201
1,098.33
1,043.41
1,199.92
33917
1,550.81
1,473.27
1,694.26
34203
1,016.72
965.88
1,110.76
33920
1,934.72
1,837.98
2,113.68
34401
1,562.60
1,484.47
1,707.14
33922
1,479.66
1,405.68
1,616.53
34421
785.41
746.14
858.06
33924
306.25
290.94
334.58
34451
1,546.56
1,469.23
1,689.61
33925
1,833.86
1,742.17
2,003.50
34471
1,160.87
1,102.83
1,268.25
33926
2,584.32
2,455.10
2,823.37
34490
687.30
652.94
750.88
33927
2,736.34
2,599.52
2,989.45
34501
956.39
908.57
1,044.86
33935
5,272.27
5,008.66
5,759.96
34502
1,646.61
1,564.28
1,798.92
33945
5,185.92
4,926.62
5,665.61
34510
1,097.58
1,042.70
1,199.11
33946
329.58
313.10
360.07
34520
1,061.11
1,008.05
1,159.26
33947
367.47
349.10
401.47
34530
1,008.56
958.13
1,101.85
33948
251.42
238.85
274.68
34701
1,329.40
1,262.93
1,452.37
33949
243.76
231.57
266.31
34702
1,988.34
1,888.92
2,172.26
33951
453.84
431.15
495.82
34703
1,474.30
1,400.59
1,610.68
33952
456.38
433.56
498.59
34704
2,468.76
2,345.32
2,697.12
33953
507.70
482.32
554.67
34705
1,640.04
1,558.04
1,791.75
33954
509.80
484.31
556.96
34706
2,472.10
2,348.50
2,700.78
33955
888.63
844.20
970.83
34707
1,248.89
1,186.45
1,364.42
33956
895.03
850.28
977.82
34708
1,991.49
1,891.92
2,175.71
33957
196.92
187.07
215.13
34709
348.28
330.87
380.50
33958
196.92
187.07
215.13
34710
852.41
809.79
931.26
33959
251.28
238.72
274.53
34711
321.74
305.65
351.50
33962
251.28
238.72
274.53
34712
700.87
665.83
765.70
33963
501.37
476.30
547.75
34713
134.14
127.43
146.54
33964
528.41
501.99
577.29
34714
289.65
275.17
316.45
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
32
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------34715
324.21
308.00
354.20
35286
999.73
949.74
1,092.20
34716
398.03
378.13
434.85
35301
1,214.40
1,153.68
1,326.73
34717
475.02
451.27
518.96
35302
1,203.65
1,143.47
1,314.99
34718
1,318.11
1,252.20
1,440.03
35303
1,327.68
1,261.30
1,450.50
34808
215.78
204.99
235.74
35304
1,368.09
1,299.69
1,494.64
34812
222.67
211.54
243.27
35305
1,322.28
1,256.17
1,444.60
34813
256.17
243.36
279.86
35306
481.76
457.67
526.32
34820
375.05
356.30
409.75
35311
1,663.64
1,580.46
1,817.53
34830
1,900.49
1,805.47
2,076.29
35321
957.90
910.01
1,046.51
34831
2,071.76
1,968.17
2,263.40
35331
1,557.74
1,479.85
1,701.83
34832
2,042.58
1,940.45
2,231.52
35341
1,470.28
1,396.77
1,606.29
34833
425.13
403.87
464.45
35351
1,380.53
1,311.50
1,508.23
34834
140.24
133.23
153.21
35355
1,108.27
1,052.86
1,210.79
35001
1,207.44
1,147.07
1,319.13
35361
1,638.90
1,556.96
1,790.50
35002
1,223.63
1,162.45
1,336.82
35363
1,749.38
1,661.91
1,911.20
35005
1,069.74
1,016.25
1,168.69
35371
875.57
831.79
956.56
35011
1,078.22
1,024.31
1,177.96
35372
1,047.56
995.18
1,144.46
35013
1,350.41
1,282.89
1,475.32
35390
170.97
162.42
186.78
35021
1,339.79
1,272.80
1,463.72
35400
159.89
151.90
174.69
35022
1,536.96
1,460.11
1,679.13
35500
343.59
326.41
375.37
35045
1,042.04
989.94
1,138.43
35501
1,572.48
1,493.86
1,717.94
35081
1,859.83
1,766.84
2,031.87
35506
1,371.30
1,302.74
1,498.15
35082
2,337.31
2,220.44
2,553.51
35508
1,427.49
1,356.12
1,559.54
35091
1,930.99
1,834.44
2,109.61
35509
1,521.64
1,445.56
1,662.39
35092
2,789.52
2,650.04
3,047.55
35510
1,324.05
1,257.85
1,446.53
35102
2,020.76
1,919.72
2,207.68
35511
1,207.18
1,146.82
1,318.84
35103
2,400.20
2,280.19
2,622.22
35512
1,297.80
1,232.91
1,417.85
35111
1,430.40
1,358.88
1,562.71
35515
1,427.49
1,356.12
1,559.54
35112
1,760.87
1,672.83
1,923.75
35516
1,313.63
1,247.95
1,435.14
35121
1,703.02
1,617.87
1,860.55
35518
1,230.18
1,168.67
1,343.97
35122
2,037.61
1,935.73
2,226.09
35521
1,320.32
1,254.30
1,442.45
35131
1,478.47
1,404.55
1,615.23
35522
1,311.48
1,245.91
1,432.80
35132
1,760.87
1,672.83
1,923.75
35523
1,368.25
1,299.84
1,494.82
35141
1,178.84
1,119.90
1,287.89
35525
1,218.86
1,157.92
1,331.61
35142
1,421.63
1,350.55
1,553.13
35526
1,847.63
1,755.25
2,018.54
35151
1,325.20
1,258.94
1,447.78
35531
2,101.43
1,996.36
2,295.81
35152
1,504.40
1,429.18
1,643.56
35533
1,623.09
1,541.94
1,773.23
35180
937.68
890.80
1,024.42
35535
2,051.96
1,949.36
2,241.76
35182
1,909.37
1,813.90
2,085.99
35536
1,821.26
1,730.20
1,989.73
35184
1,037.02
985.17
1,132.95
35537
2,248.86
2,136.42
2,456.88
35188
1,392.43
1,322.81
1,521.23
35538
2,519.63
2,393.65
2,752.70
35189
1,626.52
1,545.19
1,776.97
35539
2,363.35
2,245.18
2,581.96
35190
814.29
773.58
889.62
35540
2,636.27
2,504.46
2,880.13
35201
1,005.68
955.40
1,098.71
35556
1,503.36
1,428.19
1,642.42
35206
832.47
790.85
909.48
35558
1,315.14
1,249.38
1,436.79
35207
782.42
743.30
854.80
35560
1,837.37
1,745.50
2,007.33
35211
1,486.74
1,412.40
1,624.26
35563
1,424.78
1,353.54
1,556.57
35216
2,216.86
2,106.02
2,421.92
35565
1,409.09
1,338.64
1,539.44
35221
1,572.69
1,494.06
1,718.17
35566
1,794.55
1,704.82
1,960.54
35226
889.74
845.25
972.04
35570
1,586.56
1,507.23
1,733.31
35231
1,314.78
1,249.04
1,436.40
35571
1,424.64
1,353.41
1,556.42
35236
1,071.13
1,017.57
1,170.21
35572
371.97
353.37
406.38
35241
1,529.79
1,453.30
1,671.30
35583
1,550.13
1,472.62
1,693.51
35246
1,669.02
1,585.57
1,823.41
35585
1,799.80
1,709.81
1,966.28
35251
1,854.82
1,762.08
2,026.39
35587
1,459.39
1,386.42
1,594.38
35256
1,100.25
1,045.24
1,202.03
35600
275.15
261.39
300.60
35261
1,051.78
999.19
1,149.07
35601
1,502.02
1,426.92
1,640.96
35266
926.54
880.21
1,012.24
35606
1,257.33
1,194.46
1,373.63
35271
1,476.26
1,402.45
1,612.82
35612
1,122.20
1,066.09
1,226.00
35276
1,552.32
1,474.70
1,695.91
35616
1,185.45
1,126.18
1,295.11
35281
1,733.15
1,646.49
1,893.46
35621
1,177.85
1,118.96
1,286.80
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
33
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------35623
1,414.81
1,344.07
1,545.68
#
36013
128.03
121.63
139.87
35626
1,704.35
1,619.13
1,862.00
36014
843.16
801.00
921.15
35631
1,992.70
1,893.07
2,177.03
#
36014
158.71
150.77
173.39
35632
1,947.65
1,850.27
2,127.81
36015
906.73
861.39
990.60
35633
2,132.13
2,025.52
2,329.35
#
36015
176.73
167.89
193.07
35634
1,905.46
1,810.19
2,081.72
36100
599.63
569.65
655.10
35636
1,717.48
1,631.61
1,876.35
#
36100
168.45
160.03
184.03
35637
1,787.06
1,697.71
1,952.37
36140
516.85
491.01
564.66
35638
1,870.12
1,776.61
2,043.10
#
36140
95.49
90.72
104.33
35642
1,058.44
1,005.52
1,156.35
36160
573.47
544.80
626.52
35645
1,018.93
967.98
1,113.18
#
36160
128.20
121.79
140.06
35646
1,839.74
1,747.75
2,009.91
36200
619.96
588.96
677.30
35647
1,665.85
1,582.56
1,819.94
#
36200
148.80
141.36
162.56
35650
1,099.98
1,044.98
1,201.73
36215
1,091.26
1,036.70
1,192.21
35654
1,468.35
1,394.93
1,604.17
#
36215
219.72
208.73
240.04
35656
1,157.34
1,099.47
1,264.39
36216
1,147.88
1,090.49
1,254.06
35661
1,161.79
1,103.70
1,269.26
#
36216
285.84
271.55
312.28
35663
1,309.85
1,244.36
1,431.01
36217
1,893.10
1,798.45
2,068.22
35665
1,258.56
1,195.63
1,374.97
#
36217
346.94
329.59
379.03
35666
1,376.03
1,307.23
1,503.31
36218
218.04
207.14
238.21
35671
1,210.13
1,149.62
1,322.06
#
36218
52.58
49.95
57.44
35681
86.82
82.48
94.85
36221
1,065.12
1,011.86
1,163.64
35682
382.24
363.13
417.60
#
36221
214.23
203.52
234.05
35683
442.79
420.65
483.75
36222
1,278.87
1,214.93
1,397.17
35685
214.94
204.19
234.82
#
36222
302.82
287.68
330.83
35686
173.46
164.79
189.51
36223
1,671.91
1,588.31
1,826.56
35691
1,016.73
965.89
1,110.77
#
36223
342.32
325.20
373.98
35693
893.79
849.10
976.47
36224
2,121.89
2,015.80
2,318.17
35694
1,061.86
1,008.77
1,160.09
#
36224
387.01
367.66
422.81
35695
1,102.85
1,047.71
1,204.87
36225
1,587.39
1,508.02
1,734.22
35697
160.41
152.39
175.25
#
36225
341.02
323.97
372.57
35700
164.51
156.28
179.72
36226
2,029.46
1,927.99
2,217.19
35701
457.97
435.07
500.33
#
36226
382.71
363.57
418.11
35702
436.79
414.95
477.19
36227
251.65
239.07
274.93
35703
447.12
424.76
488.47
#
36227
126.16
119.85
137.83
35800
758.99
721.04
829.20
36228
1,331.15
1,264.59
1,454.28
35820
2,146.82
2,039.48
2,345.40
#
36228
260.40
247.38
284.49
35840
1,283.62
1,219.44
1,402.36
36245
1,337.89
1,271.00
1,461.65
35860
894.39
849.67
977.12
#
36245
247.16
234.80
270.02
35870
1,342.17
1,275.06
1,466.32
36246
883.96
839.76
965.72
35875
635.61
603.83
694.40
#
36246
268.97
255.52
293.85
35876
1,013.61
962.93
1,107.37
36247
1,523.11
1,446.95
1,663.99
35879
989.46
939.99
1,080.99
#
36247
316.39
300.57
345.66
35881
1,096.74
1,041.90
1,198.19
36248
130.54
124.01
142.61
35883
1,292.59
1,227.96
1,412.15
#
36248
50.93
48.38
55.64
35884
1,335.47
1,268.70
1,459.01
36251
1,389.40
1,319.93
1,517.92
35901
503.95
478.75
550.56
#
36251
270.49
256.97
295.52
35903
602.00
571.90
657.69
36252
1,510.24
1,434.73
1,649.94
35905
1,904.54
1,809.31
2,080.71
#
36252
381.83
362.74
417.15
35907
2,048.90
1,946.46
2,238.43
36253
2,167.78
2,059.39
2,368.30
36002
154.82
147.08
169.14
#
36253
365.72
347.43
399.54
36002
107.97
102.57
117.96
36254
2,143.89
2,036.70
2,342.21
36005
285.74
271.45
312.17
#
36254
436.20
414.39
476.55
36005
50.49
47.97
55.17
36260
697.30
662.44
761.81
36010
558.23
530.32
609.87
36261
433.47
411.80
473.57
36010
115.91
110.11
126.63
36262
329.47
313.00
359.95
36011
871.98
828.38
952.64
36400
27.71
26.32
30.27
36011
165.90
157.61
181.25
#
36400
19.85
18.86
21.69
36012
887.72
843.33
969.83
36405
23.29
22.13
25.45
36012
182.30
173.19
199.17
#
36405
15.42
14.65
16.85
36013
819.69
778.71
895.52
36406
16.94
16.09
18.50
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
---#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
34
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------36406
8.75
8.31
9.56
36563
1,220.73
1,159.69
1,333.64
36410
17.44
16.57
19.06
#
36563
387.52
368.14
423.36
36410
9.58
9.10
10.47
36565
893.70
849.02
976.37
36420
51.33
48.76
56.07
#
36565
356.03
338.23
388.96
36425
42.01
39.91
45.90
36566
4,552.24
4,324.63
4,973.32
36430
35.73
33.94
39.03
#
36566
378.69
359.76
413.72
36440
51.07
48.52
55.80
36568
95.28
90.52
104.10
36450
174.10
165.40
190.21
36569
96.80
91.96
105.75
36455
135.77
128.98
148.33
36570
1,557.70
1,479.82
1,701.79
36456
99.56
94.58
108.77
#
36570
352.95
335.30
385.60
36460
363.41
345.24
397.03
36571
1,357.56
1,289.68
1,483.13
36465
1,463.94
1,390.74
1,599.35
#
36571
329.07
312.62
359.51
36465
126.48
120.16
138.18
36572
443.90
421.71
484.97
36466
1,634.13
1,552.42
1,785.28
#
36572
93.31
88.64
101.94
36466
162.67
154.54
177.72
36573
405.32
385.05
442.81
36470
114.61
108.88
125.21
#
36573
87.18
82.82
95.24
36470
40.89
38.85
44.68
36575
160.25
152.24
175.08
36471
201.83
191.74
220.50
#
36575
35.75
33.96
39.05
36471
79.95
75.95
87.34
36576
361.05
343.00
394.45
36473
1,372.90
1,304.26
1,499.90
#
36576
192.31
182.69
210.09
36473
190.42
180.90
208.04
36578
470.68
447.15
514.22
36474
286.80
272.46
313.33
#
36578
211.18
200.62
230.71
36474
95.45
90.68
104.28
36580
210.16
199.65
229.60
36475
1,267.51
1,204.13
1,384.75
#
36580
67.96
64.56
74.24
36475
296.69
281.86
324.14
36581
823.24
782.08
899.39
36476
308.56
293.13
337.10
#
36581
188.59
179.16
206.03
36476
143.10
135.95
156.34
36582
976.12
927.31
1,066.41
36478
1,068.88
1,015.44
1,167.76
#
36582
300.52
285.49
328.31
36478
293.67
278.99
320.84
36583
1,277.09
1,213.24
1,395.23
36479
323.61
307.43
353.54
#
36583
349.85
332.36
382.21
36479
144.06
136.86
157.39
36584
350.14
332.63
382.52
36481
1,875.33
1,781.56
2,048.79
#
36584
61.81
58.72
67.53
36481
336.37
319.55
367.48
36585
1,152.84
1,095.20
1,259.48
36482
1,842.43
1,750.31
2,012.86
#
36585
283.92
269.72
310.18
36482
191.42
181.85
209.13
36589
172.42
163.80
188.37
36483
149.53
142.05
163.36
#
36589
142.61
135.48
155.80
36483
94.82
90.08
103.59
36590
234.64
222.91
256.35
36500
192.18
182.57
209.96
#
36590
197.61
187.73
215.89
36510
83.63
79.45
91.37
36591
25.40
24.13
27.75
36510
53.82
51.13
58.80
36592
28.68
27.25
31.34
36511
111.53
105.95
121.84
36593
31.80
30.21
34.74
36512
109.06
103.61
119.15
36595
632.66
601.03
691.18
36513
111.60
106.02
121.92
#
36595
188.04
178.64
205.44
36514
627.99
596.59
686.08
36596
118.66
112.73
129.64
36514
96.55
91.72
105.48
#
36596
44.94
42.69
49.09
36516
1,924.88
1,828.64
2,102.94
36597
124.26
118.05
135.76
36516
88.75
84.31
96.96
#
36597
62.66
59.53
68.46
36522
1,665.83
1,582.54
1,819.92
36598
122.53
116.40
133.86
36522
99.35
94.38
108.54
#
36598
36.69
34.86
40.09
36555
196.08
186.28
214.22
36600
29.88
28.39
32.65
36555
86.98
82.63
95.02
#
36600
16.45
15.63
17.97
36556
222.30
211.19
242.87
36620
45.95
43.65
50.20
36556
87.96
83.56
96.09
36625
111.29
105.73
121.59
36557
1,200.55
1,140.52
1,311.60
36640
118.48
112.56
129.44
36557
340.15
323.14
371.61
36660
69.74
66.25
76.19
36558
857.14
814.28
936.42
36680
63.04
59.89
68.87
36558
268.36
254.94
293.18
36800
127.51
121.13
139.30
36560
1,349.54
1,282.06
1,474.37
36810
221.19
210.13
241.65
36560
407.88
387.49
445.61
36815
145.42
138.15
158.87
36561
1,073.61
1,019.93
1,172.92
36818
737.63
700.75
805.86
36561
348.53
331.10
380.77
36819
782.52
743.39
854.90
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
35
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------36820
770.82
732.28
842.12
37214
129.04
122.59
140.98
36821
708.48
673.06
774.02
37215
1,063.46
1,010.29
1,161.83
36823
1,502.96
1,427.81
1,641.98
37217
1,152.79
1,095.15
1,259.42
36825
850.63
808.10
929.32
37218
871.22
827.66
951.81
36830
712.88
677.24
778.83
37220
2,793.59
2,653.91
3,052.00
36831
657.06
624.21
717.84
#
37220
428.64
407.21
468.29
36832
807.75
767.36
882.46
37221
3,618.96
3,438.01
3,953.71
36833
865.32
822.05
945.36
#
37221
528.27
501.86
577.14
36835
511.18
485.62
558.46
37222
699.53
664.55
764.23
36838
1,226.24
1,164.93
1,339.67
#
37222
198.23
188.32
216.57
36860
248.49
236.07
271.48
37223
1,638.32
1,556.40
1,789.86
36860
118.74
112.80
129.72
#
37223
228.13
216.72
249.23
36861
150.27
142.76
164.17
37224
3,299.14
3,134.18
3,604.31
36901
725.80
689.51
792.94
#
37224
475.48
451.71
519.47
36901
175.68
166.90
191.94
37225
10,357.54
9,839.66
11,315.61
36902
1,298.21
1,233.30
1,418.30
#
37225
642.83
610.69
702.29
36902
249.74
237.25
272.84
37226
9,421.76
8,950.67
10,293.27
36903
4,867.91
4,624.51
5,318.19
#
37226
556.64
528.81
608.13
36903
330.67
314.14
361.26
37227
13,270.70
12,607.17
14,498.25
36904
1,909.56
1,814.08
2,086.19
#
37227
770.67
732.14
841.96
36904
384.04
364.84
419.57
37228
4,713.45
4,477.78
5,149.45
36905
2,436.95
2,315.10
2,662.37
#
37228
578.56
549.63
632.07
36905
461.57
438.49
504.26
37229
10,427.04
9,905.69
11,391.54
36906
6,108.36
5,802.94
6,673.38
#
37229
742.80
705.66
811.51
36906
533.14
506.48
582.45
37230
9,924.97
9,428.72
10,843.03
36907
661.58
628.50
722.78
#
37230
743.34
706.17
812.10
36907
153.40
145.73
167.59
37231
13,313.29
12,647.63
14,544.77
36908
1,802.19
1,712.08
1,968.89
#
37231
796.87
757.03
870.58
36908
217.37
206.50
237.48
37232
950.74
903.20
1,038.68
36909
2,043.54
1,941.36
2,232.56
#
37232
212.22
201.61
231.85
36909
211.67
201.09
231.25
37233
1,182.81
1,123.67
1,292.22
37140
2,500.26
2,375.25
2,731.54
#
37233
346.98
329.63
379.07
37145
2,318.56
2,202.63
2,533.02
37234
3,911.79
3,716.20
4,273.63
37160
2,380.69
2,261.66
2,600.91
#
37234
304.08
288.88
332.21
37180
2,288.72
2,174.28
2,500.42
37235
4,163.95
3,955.75
4,549.11
37181
2,500.26
2,375.25
2,731.54
#
37235
416.66
395.83
455.20
37182
834.17
792.46
911.33
37236
3,165.21
3,006.95
3,457.99
37183
6,218.31
5,907.39
6,793.50
#
37236
471.96
448.36
515.61
37183
381.95
362.85
417.28
37237
1,612.72
1,532.08
1,761.89
37184
1,903.69
1,808.51
2,079.79
#
37237
225.47
214.20
246.33
37184
456.48
433.66
498.71
37238
3,767.62
3,579.24
4,116.13
37185
550.00
522.50
600.88
#
37238
325.69
309.41
355.82
37185
173.54
164.86
189.59
37239
1,885.95
1,791.65
2,060.40
37186
1,312.10
1,246.50
1,433.48
#
37239
161.87
153.78
176.85
37186
259.37
246.40
283.36
37241
4,885.70
4,641.42
5,337.63
37187
1,890.46
1,795.94
2,065.33
#
37241
452.32
429.70
494.16
37187
409.82
389.33
447.73
37242
7,622.74
7,241.60
8,327.84
37188
1,615.57
1,534.79
1,765.01
#
37242
497.09
472.24
543.08
37188
290.24
275.73
317.09
37243
9,370.42
8,901.90
10,237.19
37191
2,282.12
2,168.01
2,493.21
#
37243
571.81
543.22
624.70
37191
231.38
219.81
252.78
37244
7,041.41
6,689.34
7,692.74
37192
1,369.23
1,300.77
1,495.89
#
37244
678.52
644.59
741.28
37192
373.18
354.52
407.70
37246
1,986.97
1,887.62
2,170.76
37193
1,591.98
1,512.38
1,739.24
#
37246
366.11
347.80
399.97
37193
361.67
343.59
395.13
37247
627.02
595.67
685.02
37197
1,635.40
1,553.63
1,786.67
#
37247
181.09
172.04
197.85
37197
314.66
298.93
343.77
37248
1,472.87
1,399.23
1,609.11
37200
221.73
210.64
242.24
#
37248
309.07
293.62
337.66
37211
407.32
386.95
444.99
37249
498.89
473.95
545.04
37212
354.63
336.90
387.44
#
37249
152.57
144.94
166.68
37213
243.75
231.56
266.29
37252
1,091.29
1,036.73
1,192.24
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
---#
#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
36
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------37252
95.58
90.80
104.42
#
38500
269.67
256.19
294.62
37253
183.36
174.19
200.32
38505
122.61
116.48
133.95
37253
75.56
71.78
82.55
#
38505
70.51
66.98
77.03
37500
675.69
641.91
738.20
38510
547.76
520.37
598.43
37565
769.35
730.88
840.51
#
38510
438.00
416.10
478.52
37600
770.96
732.41
842.27
38520
489.43
464.96
534.70
37605
792.73
753.09
866.05
38525
465.78
442.49
508.86
37606
776.84
738.00
848.70
38530
590.87
561.33
645.53
37607
397.17
377.31
433.91
38531
469.16
445.70
512.56
37609
326.37
310.05
356.56
38542
535.80
509.01
585.36
37609
214.31
203.59
234.13
38550
549.17
521.71
599.97
37615
564.72
536.48
616.95
38555
1,090.75
1,036.21
1,191.64
37616
1,171.80
1,113.21
1,280.19
38562
736.81
699.97
804.97
37617
1,416.41
1,345.59
1,547.43
38564
747.92
710.52
817.10
37618
412.70
392.07
450.88
38570
538.07
511.17
587.85
37619
1,861.71
1,768.62
2,033.91
38571
685.65
651.37
749.08
37650
491.29
466.73
536.74
38572
947.57
900.19
1,035.22
37660
1,415.48
1,344.71
1,546.42
38573
1,216.94
1,156.09
1,329.50
37700
258.96
246.01
282.91
38700
825.96
784.66
902.36
37718
451.38
428.81
493.13
38720
1,386.94
1,317.59
1,515.23
37722
501.28
476.22
547.65
38724
1,492.39
1,417.77
1,630.44
37735
622.92
591.77
680.54
38740
743.98
706.78
812.80
37760
666.98
633.63
728.67
38745
938.52
891.59
1,025.33
37761
569.87
541.38
622.59
38746
230.97
219.42
252.33
37765
455.62
432.84
497.77
38747
286.99
272.64
313.54
37765
287.21
272.85
313.78
38760
886.25
841.94
968.23
37766
531.44
504.87
580.60
38765
1,378.94
1,309.99
1,506.49
37766
351.24
333.68
383.73
38770
835.32
793.55
912.58
37780
248.92
236.47
271.94
38780
1,084.08
1,029.88
1,184.36
37785
372.73
354.09
407.20
38790
84.36
80.14
92.16
37785
270.83
257.29
295.88
38792
83.54
79.36
91.26
37788
1,301.62
1,236.54
1,422.02
#
38792
34.72
32.98
37.93
37790
499.83
474.84
546.07
38794
295.39
280.62
322.71
38100
1,234.18
1,172.47
1,348.34
38900
148.23
140.82
161.94
38101
1,252.75
1,190.11
1,368.63
39000
521.70
495.62
569.96
38102
279.33
265.36
305.16
39010
835.53
793.75
912.81
38115
1,361.30
1,293.24
1,487.23
39200
927.17
880.81
1,012.93
38120
1,128.53
1,072.10
1,232.92
39220
1,199.64
1,139.66
1,310.61
38200
134.09
127.39
146.50
39401
327.77
311.38
358.09
38205
85.68
81.40
93.61
39402
429.63
408.15
469.37
38206
85.85
81.56
93.79
39501
909.79
864.30
993.95
38220
167.35
158.98
182.83
39503
6,241.51
5,929.43
6,818.84
38220
72.01
68.41
78.67
39540
921.50
875.43
1,006.74
38221
159.59
151.61
174.35
39541
1,002.83
952.69
1,095.59
38221
70.79
67.25
77.34
39545
949.62
902.14
1,037.46
38222
175.34
166.57
191.56
39560
847.04
804.69
925.39
38222
78.36
74.44
85.61
39561
1,320.65
1,254.62
1,442.81
38230
215.82
205.03
235.78
40490
125.75
119.46
137.38
38232
209.01
198.56
228.34
#
40490
71.36
67.79
77.96
38240
240.73
228.69
262.99
40500
526.27
499.96
574.95
38241
179.09
170.14
195.66
#
40500
369.65
351.17
403.85
38242
128.47
122.05
140.36
40510
496.75
471.91
542.70
38243
124.58
118.35
136.10
#
40510
355.53
337.75
388.41
38300
351.40
333.83
383.90
40520
509.02
483.57
556.11
38300
217.06
206.21
237.14
#
40520
362.89
344.75
396.46
38305
518.83
492.89
566.82
40525
567.64
539.26
620.15
38308
485.90
461.61
530.85
40527
637.50
605.63
696.47
38380
587.73
558.34
642.09
40530
563.00
534.85
615.08
38381
850.91
808.36
929.61
#
40530
411.62
391.04
449.70
38382
723.14
686.98
790.03
40650
485.92
461.62
530.86
38500
352.24
334.63
384.82
#
40650
318.16
302.25
347.59
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
---#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
37
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------40652
525.50
499.23
574.11
41010
218.91
207.96
239.15
40652
364.95
346.70
398.71
#
41010
109.48
104.01
119.61
40654
588.06
558.66
642.46
41015
404.80
384.56
442.24
40654
430.13
408.62
469.91
#
41015
304.86
289.62
333.06
40700
1,043.45
991.28
1,139.97
41016
474.76
451.02
518.67
40701
1,235.41
1,173.64
1,349.69
#
41016
352.54
334.91
385.15
40702
1,035.80
984.01
1,131.61
41017
470.48
446.96
514.00
40720
1,063.53
1,010.35
1,161.90
#
41017
348.92
331.47
381.19
40761
1,121.14
1,065.08
1,224.84
41018
526.65
500.32
575.37
40800
208.99
198.54
228.32
#
41018
404.11
383.90
441.49
40800
121.18
115.12
132.39
41019
490.56
466.03
535.93
40801
296.94
282.09
324.40
41100
186.83
177.49
204.11
40801
201.60
191.52
220.25
#
41100
108.52
103.09
118.55
40804
195.07
185.32
213.12
41105
187.26
177.90
204.59
40804
114.80
109.06
125.42
#
41105
111.25
105.69
121.54
40805
291.39
276.82
318.34
41108
166.79
158.45
182.22
40805
201.94
191.84
220.62
#
41108
92.09
87.49
100.61
40806
100.30
95.29
109.58
41110
230.74
219.20
252.08
40806
28.55
27.12
31.19
#
41110
131.46
124.89
143.62
40808
167.98
159.58
183.52
41112
341.17
324.11
372.73
40808
87.71
83.32
95.82
#
41112
244.85
232.61
267.50
40810
216.82
205.98
236.88
41113
369.89
351.40
404.11
40810
122.46
116.34
133.79
#
41113
269.95
256.45
294.92
40812
290.49
275.97
317.37
41114
625.61
594.33
683.48
40812
188.59
179.16
206.03
41115
264.68
251.45
289.17
40814
381.67
362.59
416.98
#
41115
148.04
140.64
161.74
40814
289.60
275.12
316.39
41116
339.36
322.39
370.75
40816
404.71
384.47
442.14
#
41116
216.82
205.98
236.88
40816
306.09
290.79
334.41
41120
1,090.80
1,036.26
1,191.70
40818
378.35
359.43
413.34
41130
1,348.71
1,281.27
1,473.46
40818
274.16
260.45
299.52
41135
2,226.98
2,115.63
2,432.97
40819
275.35
261.58
300.82
41140
2,241.66
2,129.58
2,449.02
40819
202.62
192.49
221.36
41145
2,832.85
2,691.21
3,094.89
40820
265.75
252.46
290.33
41150
2,254.71
2,141.97
2,463.27
40820
169.75
161.26
185.45
41153
2,454.79
2,332.05
2,681.86
40830
284.46
270.24
310.78
41155
3,086.51
2,932.18
3,372.01
40830
168.48
160.06
184.07
41250
289.56
275.08
316.34
40831
360.54
342.51
393.89
#
41250
158.83
150.89
173.52
40831
232.44
220.82
253.94
41251
319.75
303.76
349.32
40840
865.02
821.77
945.04
#
41251
188.04
178.64
205.44
40840
642.22
610.11
701.63
41252
334.52
317.79
365.46
40842
947.88
900.49
1,035.56
#
41252
215.25
204.49
235.16
40842
698.55
663.62
763.16
41510
459.41
436.44
501.91
40843
1,230.79
1,169.25
1,344.64
41512
681.75
647.66
744.81
40843
906.42
861.10
990.27
41520
368.27
349.86
402.34
40844
1,543.88
1,466.69
1,686.69
#
41520
251.96
239.36
275.26
40844
1,220.49
1,159.47
1,333.39
41530
972.97
924.32
1,062.97
40845
1,517.05
1,441.20
1,657.38
#
41530
388.77
369.33
424.73
40845
1,244.78
1,182.54
1,359.92
41800
302.68
287.55
330.68
41000
158.98
151.03
173.68
#
41800
157.54
149.66
172.11
41000
109.51
104.03
119.63
41805
318.99
303.04
348.50
41005
218.34
207.42
238.53
#
41805
202.35
192.23
221.06
41005
111.20
105.64
121.49
41806
422.29
401.18
461.36
41006
339.27
322.31
370.66
#
41806
286.64
272.31
313.16
41006
230.82
219.28
252.17
41822
359.55
341.57
392.81
41007
332.73
316.09
363.50
#
41822
203.92
193.72
222.78
41007
222.97
211.82
243.59
41823
530.25
503.74
579.30
41008
396.30
376.49
432.96
#
41823
366.42
348.10
400.32
41008
260.66
247.63
284.77
41825
222.17
211.06
242.72
41009
423.86
402.67
463.07
#
41825
119.95
113.95
131.04
41009
284.94
270.69
311.29
41826
316.44
300.62
345.71
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
---#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
38
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------41826
205.04
194.79
224.01
42405
306.83
291.49
335.21
41827
444.93
422.68
486.08
#
42405
230.82
219.28
252.17
41827
294.21
279.50
321.43
42408
547.01
519.66
597.61
41828
361.39
343.32
394.82
#
42408
352.06
334.46
384.63
41828
230.00
218.50
251.28
42409
389.76
370.27
425.81
41830
479.07
455.12
523.39
#
42409
230.19
218.68
251.48
41830
323.77
307.58
353.72
42410
645.56
613.28
705.27
41872
468.39
444.97
511.72
42415
1,085.59
1,031.31
1,186.01
41872
303.25
288.09
331.30
42420
1,219.22
1,158.26
1,332.00
41874
392.55
372.92
428.86
42425
860.58
817.55
940.18
41874
247.40
235.03
270.28
42426
1,389.85
1,320.36
1,518.41
42000
160.64
152.61
175.50
42440
423.09
401.94
462.23
42000
106.58
101.25
116.44
42450
476.59
452.76
520.67
42100
148.52
141.09
162.25
#
42450
370.11
351.60
404.34
42100
108.87
103.43
118.94
42500
454.08
431.38
496.09
42104
218.24
207.33
238.43
#
42500
351.20
333.64
383.69
42104
136.00
129.20
148.58
42505
579.76
550.77
633.39
42106
263.95
250.75
288.36
#
42505
466.40
443.08
509.54
42106
167.29
158.93
182.77
42507
510.48
484.96
557.70
42107
474.15
450.44
518.01
42509
848.27
805.86
926.74
42107
341.78
324.69
373.39
42510
628.75
597.31
686.91
42120
1,031.96
980.36
1,127.41
42550
159.21
151.25
173.94
42140
303.14
287.98
331.18
#
42550
63.21
60.05
69.06
42140
158.64
150.71
173.32
42600
540.62
513.59
590.63
42145
707.49
672.12
772.94
#
42600
359.10
341.15
392.32
42160
237.62
225.74
259.60
42650
78.25
74.34
85.49
42160
146.20
138.89
159.72
#
42650
58.59
55.66
64.01
42180
258.36
245.44
282.26
42660
122.41
116.29
133.73
42180
187.91
178.51
205.29
#
42660
89.97
85.47
98.29
42182
336.21
319.40
367.31
42665
368.64
350.21
402.74
42182
262.82
249.68
287.13
#
42665
213.99
203.29
233.78
42200
969.07
920.62
1,058.71
42700
195.29
185.53
213.36
42205
1,010.97
960.42
1,104.48
#
42700
136.97
130.12
149.64
42210
1,126.65
1,070.32
1,230.87
42720
459.79
436.80
502.32
42215
733.07
696.42
800.88
#
42720
396.22
376.41
432.87
42220
602.24
572.13
657.95
42725
822.06
780.96
898.10
42225
1,014.34
963.62
1,108.16
42800
160.19
152.18
175.01
42226
916.52
870.69
1,001.29
#
42800
115.63
109.85
126.33
42227
856.36
813.54
935.57
42804
207.85
197.46
227.08
42235
749.70
712.22
819.05
#
42804
118.40
112.48
129.35
42260
866.76
823.42
946.93
42806
233.03
221.38
254.59
42260
682.29
648.18
745.41
#
42806
138.01
131.11
150.78
42280
180.62
171.59
197.33
42808
233.01
221.36
254.56
42280
111.15
105.59
121.43
#
42808
166.83
158.49
182.26
42281
229.65
218.17
250.90
42809
204.24
194.03
223.13
42281
162.48
154.36
177.51
#
42809
128.55
122.12
140.44
42300
218.25
207.34
238.44
42810
394.24
374.53
430.71
42300
156.66
148.83
171.15
#
42810
285.79
271.50
312.23
42305
434.92
413.17
475.15
42815
556.15
528.34
607.59
42310
174.76
166.02
190.92
42820
295.73
280.94
323.08
42310
134.13
127.42
146.53
42821
308.82
293.38
337.39
42320
263.76
250.57
288.16
42825
269.05
255.60
293.94
42320
180.21
171.20
196.88
42826
256.95
244.10
280.72
42330
236.08
224.28
257.92
42830
212.24
201.63
231.87
42330
166.94
158.59
182.38
42831
230.29
218.78
251.60
42335
428.21
406.80
467.82
42835
196.88
187.04
215.10
42335
262.42
249.30
286.70
42836
246.37
234.05
269.16
42340
526.68
500.35
575.40
42842
1,036.60
984.77
1,132.49
42340
346.15
328.84
378.17
42844
1,416.85
1,346.01
1,547.91
42400
102.17
97.06
111.62
42845
2,289.90
2,175.41
2,501.72
42400
53.68
51.00
58.65
42860
192.61
182.98
210.43
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
39
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------42870
601.06
571.01
656.66
43216
421.25
400.19
460.22
42890
1,463.85
1,390.66
1,599.26
#
43216
136.85
130.01
149.51
42892
1,918.43
1,822.51
2,095.89
43217
431.19
409.63
471.07
42894
2,432.11
2,310.50
2,657.08
#
43217
163.83
155.64
178.99
42900
341.56
324.48
373.15
43220
998.90
948.96
1,091.30
42950
820.75
779.71
896.67
#
43220
121.47
115.40
132.71
42953
990.09
940.59
1,081.68
43226
388.91
369.46
424.88
42955
778.53
739.60
850.54
#
43226
134.98
128.23
147.46
42960
166.24
157.93
181.62
43227
637.99
606.09
697.00
42961
426.16
404.85
465.58
#
43227
169.13
160.67
184.77
42962
528.65
502.22
577.55
43229
740.76
703.72
809.28
42970
419.89
398.90
458.74
#
43229
202.77
192.63
221.52
42971
464.76
441.52
507.75
43231
162.51
154.38
177.54
42972
519.23
493.27
567.26
43232
203.75
193.56
222.59
43020
598.14
568.23
653.46
43233
238.07
226.17
260.10
43030
534.45
507.73
583.89
43235
301.36
286.29
329.23
43045
1,384.39
1,315.17
1,512.45
#
43235
125.74
119.45
137.37
43100
647.60
615.22
707.50
43236
405.38
385.11
442.88
43101
1,072.54
1,018.91
1,171.75
#
43236
141.30
134.24
154.38
43107
3,176.68
3,017.85
3,470.53
43237
200.22
190.21
218.74
43108
4,769.23
4,530.77
5,210.39
43238
238.13
226.22
260.15
43112
3,720.46
3,534.44
4,064.61
43239
386.05
366.75
421.76
43113
4,653.05
4,420.40
5,083.46
#
43239
141.30
134.24
154.38
43116
5,334.18
5,067.47
5,827.59
43240
401.56
381.48
438.70
43117
3,477.10
3,303.25
3,798.74
43241
145.46
138.19
158.92
43118
3,885.59
3,691.31
4,245.01
43242
268.54
255.11
293.38
43121
3,053.81
2,901.12
3,336.29
43243
243.14
230.98
265.63
43122
2,718.82
2,582.88
2,970.31
43244
250.61
238.08
273.79
43123
4,824.53
4,583.30
5,270.80
43245
621.28
590.22
678.75
43124
4,071.04
3,867.49
4,447.61
#
43245
182.23
173.12
199.09
43130
822.07
780.97
898.12
43246
207.08
196.73
226.24
43135
1,571.04
1,492.49
1,716.36
43247
393.09
373.44
429.46
43180
562.83
534.69
614.89
#
43247
181.76
172.67
198.57
43191
158.97
151.02
173.67
43248
418.34
397.42
457.03
43192
174.56
165.83
190.70
#
43248
169.99
161.49
185.71
43193
173.23
164.57
189.26
43249
1,139.79
1,082.80
1,245.22
43194
199.80
189.81
218.28
#
43249
157.51
149.63
172.07
43195
188.61
179.18
206.06
43250
467.23
443.87
510.45
43196
200.59
190.56
219.14
#
43250
176.93
168.08
193.29
43197
197.91
188.01
216.21
43251
510.19
484.68
557.38
43197
85.85
81.56
93.79
#
43251
200.89
190.85
219.48
43198
217.57
206.69
237.69
43252
345.07
327.82
376.99
43198
101.91
96.81
111.33
#
43252
172.73
164.09
188.70
43200
263.53
250.35
287.90
43253
268.54
255.11
293.38
43200
90.21
85.70
98.56
43254
276.57
262.74
302.15
43201
260.91
247.86
285.04
43255
671.91
638.31
734.06
43201
105.61
100.33
115.38
#
43255
205.34
195.07
224.33
43202
363.95
345.75
397.61
43257
238.47
226.55
260.53
43202
105.43
100.16
115.18
43259
231.30
219.74
252.70
43204
138.05
131.15
150.82
43260
330.69
314.16
361.28
43205
144.03
136.83
157.35
43261
346.74
329.40
378.81
43206
306.05
290.75
334.36
43262
366.37
348.05
400.26
43206
136.00
129.20
148.58
43263
367.07
348.72
401.03
43210
450.64
428.11
492.33
43264
373.38
354.71
407.92
43211
240.18
228.17
262.40
43265
444.75
422.51
485.89
43212
198.12
188.21
216.44
43266
224.05
212.85
244.78
43213
1,288.30
1,223.89
1,407.47
43270
758.60
720.67
828.77
43213
269.00
255.55
293.88
#
43270
230.10
218.60
251.39
43214
198.49
188.57
216.86
43273
123.44
117.27
134.86
43215
406.87
386.53
444.51
43274
475.31
451.54
519.27
43215
145.74
138.45
159.22
43275
386.18
366.87
421.90
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
40
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------43276
494.44
469.72
540.18
43632
2,183.36
2,074.19
2,385.32
43277
388.23
368.82
424.14
43633
2,065.64
1,962.36
2,256.71
43278
443.75
421.56
484.79
43634
2,292.31
2,177.69
2,504.34
43279
1,380.45
1,311.43
1,508.14
43635
120.82
114.78
132.00
43280
1,158.33
1,100.41
1,265.47
43640
1,266.48
1,203.16
1,383.63
43281
1,658.15
1,575.24
1,811.53
43641
1,294.32
1,229.60
1,414.04
43282
1,864.93
1,771.68
2,037.43
43644
1,867.28
1,773.92
2,040.01
43283
170.75
162.21
186.54
43645
1,973.28
1,874.62
2,155.81
43284
696.34
661.52
760.75
43651
701.25
666.19
766.12
43285
717.47
681.60
783.84
43652
820.32
779.30
896.20
43286
3,403.91
3,233.71
3,718.77
43653
614.44
583.72
671.28
43287
3,814.95
3,624.20
4,167.83
43752
41.94
39.84
45.82
43288
4,011.73
3,811.14
4,382.81
43753
23.81
22.62
26.01
43300
635.55
603.77
694.34
43754
213.69
203.01
233.46
43305
1,132.58
1,075.95
1,237.34
#
43754
37.09
35.24
40.53
43310
1,583.88
1,504.69
1,730.39
43755
195.73
185.94
213.83
43312
1,702.75
1,617.61
1,860.25
#
43755
60.41
57.39
66.00
43313
2,917.73
2,771.84
3,187.62
43756
277.11
263.25
302.74
43314
3,148.27
2,990.86
3,439.49
#
43756
51.69
49.11
56.48
43320
1,502.91
1,427.76
1,641.92
43757
374.36
355.64
408.99
43325
1,461.60
1,388.52
1,596.80
#
43757
78.17
74.26
85.40
43327
876.68
832.85
957.78
43761
128.41
121.99
140.29
43328
1,201.55
1,141.47
1,312.69
#
43761
109.07
103.62
119.16
43330
1,438.38
1,366.46
1,571.43
43762
236.80
224.96
258.70
43331
1,427.30
1,355.94
1,559.33
#
43762
40.21
38.20
43.93
43332
1,234.71
1,172.97
1,348.92
43763
357.25
339.39
390.30
43333
1,354.27
1,286.56
1,479.54
#
43763
88.26
83.85
96.43
43334
1,334.15
1,267.44
1,457.56
43770
1,207.14
1,146.78
1,318.80
43335
1,429.12
1,357.66
1,561.31
43771
1,374.28
1,305.57
1,501.41
43336
1,551.55
1,473.97
1,695.07
43772
1,017.00
966.15
1,111.07
43337
1,654.47
1,571.75
1,807.51
43773
1,374.28
1,305.57
1,501.41
43338
124.27
118.06
135.77
43774
1,031.16
979.60
1,126.54
43340
1,484.63
1,410.40
1,621.96
43775
1,203.86
1,143.67
1,315.22
43341
1,492.79
1,418.15
1,630.87
43800
999.54
949.56
1,091.99
43351
1,401.19
1,331.13
1,530.80
43810
1,093.60
1,038.92
1,194.76
43352
1,134.73
1,077.99
1,239.69
43820
1,441.44
1,369.37
1,574.78
43360
2,403.30
2,283.14
2,625.61
43825
1,409.81
1,339.32
1,540.22
43361
2,898.44
2,753.52
3,166.55
43830
749.54
712.06
818.87
43400
1,639.71
1,557.72
1,791.38
43831
646.30
613.99
706.09
43405
1,550.65
1,473.12
1,694.09
43832
1,118.98
1,063.03
1,222.48
43410
1,052.72
1,000.08
1,150.09
43840
1,457.86
1,384.97
1,592.72
43415
2,724.84
2,588.60
2,976.89
43843
1,380.51
1,311.48
1,508.20
43420
1,043.39
991.22
1,139.90
43845
2,084.29
1,980.08
2,277.09
43425
1,537.93
1,461.03
1,680.18
43846
1,775.33
1,686.56
1,939.54
43450
189.13
179.67
206.62
43847
1,945.93
1,848.63
2,125.92
43450
81.01
76.96
88.50
43848
2,075.56
1,971.78
2,267.55
43453
879.60
835.62
960.96
43850
1,754.93
1,667.18
1,917.26
43453
87.68
83.30
95.80
43855
1,821.45
1,730.38
1,989.94
43460
217.82
206.93
237.97
43860
1,752.37
1,664.75
1,914.46
43500
838.42
796.50
915.98
43865
1,842.77
1,750.63
2,013.22
43501
1,445.17
1,372.91
1,578.85
43870
757.89
720.00
828.00
43502
1,643.02
1,560.87
1,795.00
43880
1,699.64
1,614.66
1,856.86
43510
1,018.28
967.37
1,112.48
43886
387.40
368.03
423.23
43520
731.42
694.85
799.08
43887
347.96
330.56
380.14
43605
896.49
851.67
979.42
43888
493.86
469.17
539.55
43610
1,052.07
999.47
1,149.39
44005
1,169.85
1,111.36
1,278.06
43611
1,310.55
1,245.02
1,431.77
44010
907.55
862.17
991.50
43620
2,137.59
2,030.71
2,335.32
44015
153.44
145.77
167.64
43621
2,444.35
2,322.13
2,670.45
44020
1,045.59
993.31
1,142.31
43622
2,493.77
2,369.08
2,724.44
44021
1,043.76
991.57
1,140.31
43631
1,557.00
1,479.15
1,701.02
44025
1,044.19
991.98
1,140.78
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
41
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------44050
1,001.80
951.71
1,094.47
44372
246.19
233.88
268.96
44055
1,598.38
1,518.46
1,746.23
44373
197.81
187.92
216.11
44100
109.81
104.32
119.97
44376
290.44
275.92
317.31
44110
899.50
854.53
982.71
44377
306.47
291.15
334.82
44111
1,034.39
982.67
1,130.07
44378
394.06
374.36
430.51
44120
1,308.38
1,242.96
1,429.40
44379
418.41
397.49
457.11
44121
259.39
246.42
283.38
44380
197.55
187.67
215.82
44125
1,257.22
1,194.36
1,373.51
#
44380
57.32
54.45
62.62
44126
2,660.16
2,527.15
2,906.22
44381
1,021.91
970.81
1,116.43
44127
3,076.04
2,922.24
3,360.58
#
44381
85.50
81.23
93.41
44128
264.07
250.87
288.50
44382
305.69
290.41
333.97
44130
1,405.04
1,334.79
1,535.01
#
44382
75.03
71.28
81.97
44139
129.04
122.59
140.98
44384
159.06
151.11
173.78
44140
1,433.34
1,361.67
1,565.92
44385
216.15
205.34
236.14
44141
1,941.43
1,844.36
2,121.01
#
44385
73.63
69.95
80.44
44143
1,773.63
1,684.95
1,937.69
44386
318.71
302.77
348.19
44144
1,884.48
1,790.26
2,058.80
#
44386
90.67
86.14
99.06
44145
1,751.51
1,663.93
1,913.52
44388
323.80
307.61
353.75
44146
2,230.53
2,119.00
2,436.85
#
44388
161.95
153.85
176.93
44147
2,062.32
1,959.20
2,253.08
44388
53
161.82
153.73
176.79
44150
1,971.18
1,872.62
2,153.51
#
44388
53
80.56
76.53
88.01
44151
2,316.44
2,200.62
2,530.71
44389
423.55
402.37
462.73
44155
2,183.64
2,074.46
2,385.63
#
44389
177.16
168.30
193.55
44156
2,479.09
2,355.14
2,708.41
44390
414.78
394.04
453.15
44157
2,353.02
2,235.37
2,570.68
#
44390
215.58
204.80
235.52
44158
2,411.05
2,290.50
2,634.08
44391
687.09
652.74
750.65
44160
1,321.45
1,255.38
1,443.69
#
44391
236.25
224.44
258.11
44180
984.16
934.95
1,075.19
44392
396.06
376.26
432.70
44186
696.37
661.55
760.78
#
44392
205.37
195.10
224.37
44187
1,150.62
1,093.09
1,257.05
44394
450.86
428.32
492.57
44188
1,289.34
1,224.87
1,408.60
#
44394
231.67
220.09
253.10
44202
1,480.27
1,406.26
1,617.20
44401
2,711.43
2,575.86
2,962.24
44203
257.40
244.53
281.21
#
44401
247.86
235.47
270.79
44204
1,630.75
1,549.21
1,781.59
44402
267.17
253.81
291.88
44205
1,413.85
1,343.16
1,544.63
44403
311.56
295.98
340.38
44206
1,855.37
1,762.60
2,026.99
44404
425.99
404.69
465.39
44207
1,915.99
1,820.19
2,093.22
#
44404
176.65
167.82
192.99
44208
2,081.20
1,977.14
2,273.71
44405
580.24
551.23
633.91
44210
1,852.46
1,759.84
2,023.82
#
44405
187.07
177.72
204.38
44211
2,181.05
2,072.00
2,382.80
44406
234.88
223.14
256.61
44212
2,124.63
2,018.40
2,321.16
44407
281.85
267.76
307.92
44213
198.94
188.99
217.34
44408
237.43
225.56
259.39
44227
1,769.03
1,680.58
1,932.67
44500
20.20
19.19
22.07
44300
900.52
855.49
983.81
44602
1,510.44
1,434.92
1,650.16
44310
1,101.20
1,046.14
1,203.06
44603
1,728.63
1,642.20
1,888.53
44312
628.13
596.72
686.23
44604
1,128.85
1,072.41
1,233.27
44314
1,060.75
1,007.71
1,158.87
44605
1,382.83
1,313.69
1,510.74
44316
1,522.25
1,446.14
1,663.06
44615
1,142.09
1,084.99
1,247.74
44320
1,276.20
1,212.39
1,394.25
44620
916.15
870.34
1,000.89
44322
1,071.16
1,017.60
1,170.24
44625
1,067.54
1,014.16
1,166.28
44340
655.54
622.76
716.17
44626
1,702.55
1,617.42
1,860.03
44345
1,110.21
1,054.70
1,212.91
44640
1,488.13
1,413.72
1,625.78
44346
1,255.64
1,192.86
1,371.79
44650
1,532.60
1,455.97
1,674.37
44360
146.43
139.11
159.98
44660
1,407.30
1,336.94
1,537.48
44361
162.46
154.34
177.49
44661
1,643.38
1,561.21
1,795.39
44363
196.29
186.48
214.45
44680
1,159.07
1,101.12
1,266.29
44364
209.10
198.65
228.45
44700
1,045.07
992.82
1,141.74
44365
186.04
176.74
203.25
44701
182.90
173.76
199.82
44366
245.31
233.04
268.00
44720
297.17
282.31
324.66
44369
251.29
238.73
274.54
44721
415.24
394.48
453.65
44370
271.73
258.14
296.86
44800
818.91
777.96
894.65
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
#
#
#
#
#
#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
42
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------44820
897.44
852.57
980.46
#
45334
119.79
113.80
130.87
44850
796.31
756.49
869.96
45335
292.64
278.01
319.71
44900
841.84
799.75
919.71
#
45335
68.20
64.79
74.51
44950
689.01
654.56
752.74
45337
118.73
112.79
129.71
44955
89.07
84.62
97.31
45338
305.87
290.58
334.17
44960
940.99
893.94
1,028.03
#
45338
123.37
117.20
134.78
44970
642.75
610.61
702.20
45340
476.91
453.06
521.02
45000
442.99
420.84
483.97
#
45340
79.48
75.51
86.84
45005
315.14
299.38
344.29
45341
126.45
120.13
138.15
45005
169.99
161.49
185.71
45342
173.74
165.05
189.81
45020
604.04
573.84
659.92
45346
2,631.71
2,500.12
2,875.14
45100
311.70
296.12
340.54
#
45346
164.53
156.30
179.75
45108
394.58
374.85
431.08
45347
158.09
150.19
172.72
45110
1,920.52
1,824.49
2,098.16
45349
203.29
193.13
222.10
45111
1,146.95
1,089.60
1,253.04
45350
680.52
646.49
743.46
45112
1,951.56
1,853.98
2,132.08
#
45350
103.21
98.05
112.76
45113
1,931.57
1,834.99
2,110.24
45378
349.22
331.76
381.52
45114
1,957.63
1,859.75
2,138.71
#
45378
190.96
181.41
208.62
45116
1,594.02
1,514.32
1,741.47
45378
53
174.36
165.64
190.49
45119
1,944.92
1,847.67
2,124.82
#
45378
53
95.07
90.32
103.87
45120
1,718.74
1,632.80
1,877.72
45379
446.48
424.16
487.78
45121
1,877.57
1,783.69
2,051.24
#
45379
244.98
232.73
267.64
45123
1,163.92
1,105.72
1,271.58
45380
448.32
425.90
489.79
45126
2,866.18
2,722.87
3,131.30
#
45380
206.52
196.19
225.62
45130
1,128.61
1,072.18
1,233.01
45381
451.93
429.33
493.73
45135
1,332.47
1,265.85
1,455.73
#
45381
206.52
196.19
225.62
45136
1,845.59
1,753.31
2,016.31
45382
714.67
678.94
780.78
45150
447.26
424.90
488.64
#
45382
265.46
252.19
290.02
45160
1,099.55
1,044.57
1,201.26
45384
505.24
479.98
551.98
45171
644.00
611.80
703.57
#
45384
235.91
224.11
257.73
45172
859.44
816.47
938.94
45385
467.43
444.06
510.67
45190
732.70
696.07
800.48
#
45385
260.68
247.65
284.80
45300
132.39
125.77
144.64
45386
638.01
606.11
697.03
45300
50.15
47.64
54.79
#
45386
217.64
206.76
237.77
45303
991.85
942.26
1,083.60
45388
2,802.64
2,662.51
3,061.89
45303
87.22
82.86
95.29
#
45388
278.78
264.84
304.57
45305
183.17
174.01
200.11
45389
297.57
282.69
325.09
45305
75.70
71.92
82.71
45390
340.44
323.42
371.93
45307
205.92
195.62
224.96
45391
263.26
250.10
287.62
45307
98.45
93.53
107.56
45392
313.23
297.57
342.21
45308
210.14
199.63
229.57
45393
261.65
248.57
285.86
45308
89.23
84.77
97.49
45395
2,052.34
1,949.72
2,242.18
45309
216.92
206.07
236.98
45397
2,217.84
2,106.95
2,422.99
45309
95.04
90.29
103.83
45398
845.80
803.51
924.04
45315
236.48
224.66
258.36
#
45398
243.59
231.41
266.12
45315
113.61
107.93
124.12
45400
1,180.04
1,121.04
1,289.20
45317
223.15
211.99
243.79
45402
1,583.83
1,504.64
1,730.34
45317
113.72
108.03
124.23
45500
603.21
573.05
659.01
45320
232.33
220.71
253.82
45505
624.31
593.09
682.05
45320
112.09
106.49
122.46
45520
165.38
157.11
180.68
45321
110.71
105.17
120.95
#
45520
39.89
37.90
43.59
45327
124.39
118.17
135.90
45540
1,104.24
1,049.03
1,206.38
45330
187.17
177.81
204.48
45541
993.58
943.90
1,085.49
45330
56.77
53.93
62.02
45550
1,536.52
1,459.69
1,678.64
45331
292.52
277.89
319.57
45560
721.18
685.12
787.89
45331
73.33
69.66
80.11
45562
1,192.64
1,133.01
1,302.96
45332
282.12
268.01
308.21
45563
1,781.26
1,692.20
1,946.03
45332
107.49
102.12
117.44
45800
1,363.97
1,295.77
1,490.14
45333
337.20
320.34
368.39
45805
1,579.12
1,500.16
1,725.18
45333
96.38
91.56
105.29
45820
1,367.22
1,298.86
1,493.69
45334
533.94
507.24
583.33
45825
1,651.57
1,568.99
1,804.34
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
43
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------45900
225.59
214.31
246.46
#
46607
132.76
126.12
145.04
45905
175.44
166.67
191.67
46608
303.19
288.03
331.23
45910
198.82
188.88
217.21
#
46608
89.23
84.77
97.49
45915
365.10
346.85
398.88
46610
284.55
270.32
310.87
45915
240.26
228.25
262.49
#
46610
83.37
79.20
91.08
45990
109.94
104.44
120.11
46611
228.20
216.79
249.31
46020
292.42
277.80
319.47
#
46611
82.72
78.58
90.37
46020
245.89
233.60
268.64
46612
348.38
330.96
380.60
46030
155.72
147.93
170.12
#
46612
101.34
96.27
110.71
46030
92.81
88.17
101.40
46614
168.88
160.44
184.51
46040
577.00
548.15
630.37
#
46614
65.67
62.39
71.75
46040
442.01
419.91
482.90
46615
182.10
173.00
198.95
46045
459.98
436.98
502.53
#
46615
93.63
88.95
102.29
46050
237.63
225.75
259.61
46700
682.01
647.91
745.10
46050
103.62
98.44
113.21
46705
603.00
572.85
658.78
46060
503.31
478.14
549.86
46706
188.75
179.31
206.21
46070
282.29
268.18
308.41
46707
530.93
504.38
580.04
46080
292.50
277.88
319.56
46710
1,191.39
1,131.82
1,301.59
46080
166.03
157.73
181.39
46712
2,395.08
2,275.33
2,616.63
46083
211.38
200.81
230.93
46715
590.36
560.84
644.97
46083
113.09
107.44
123.56
46716
1,306.52
1,241.19
1,427.37
46200
485.60
461.32
530.52
46730
2,118.98
2,013.03
2,314.98
46200
343.72
326.53
375.51
46735
2,444.48
2,322.26
2,670.60
46220
250.08
237.58
273.22
46740
2,314.36
2,198.64
2,528.44
46220
124.26
118.05
135.76
46742
2,681.11
2,547.05
2,929.11
46221
292.51
277.88
319.56
46744
3,798.90
3,608.96
4,150.30
46221
198.15
188.24
216.48
46746
4,189.55
3,980.07
4,577.08
46230
315.28
299.52
344.45
46748
4,544.05
4,316.85
4,964.38
46230
179.64
170.66
196.26
46750
784.79
745.55
857.38
46250
496.46
471.64
542.39
46751
710.11
674.60
775.79
46250
331.65
315.07
362.33
46753
660.66
627.63
721.77
46255
542.35
515.23
592.51
46754
343.75
326.56
375.54
46255
372.63
354.00
407.10
#
46754
241.20
229.14
263.51
46257
444.89
422.65
486.05
46760
1,128.62
1,072.19
1,233.02
46258
505.75
480.46
552.53
46761
961.38
913.31
1,050.31
46260
503.70
478.52
550.30
46900
242.66
230.53
265.11
46261
547.04
519.69
597.64
#
46900
138.47
131.55
151.28
46262
582.96
553.81
636.88
46910
271.05
257.50
296.13
46270
552.61
524.98
603.73
#
46910
138.68
131.75
151.51
46270
413.69
393.01
451.96
46916
257.35
244.48
281.15
46275
580.37
551.35
634.05
#
46916
142.02
134.92
155.16
46275
434.57
412.84
474.77
46917
437.82
415.93
478.32
46280
495.76
470.97
541.62
#
46917
131.80
125.21
143.99
46285
577.90
549.01
631.36
46922
316.30
300.49
345.56
46285
434.40
412.68
474.58
#
46922
141.34
134.27
154.41
46288
576.79
547.95
630.14
46924
560.92
532.87
612.80
46320
215.08
204.33
234.98
#
46924
186.42
177.10
203.67
46320
117.12
111.26
127.95
46930
222.00
210.90
242.54
46500
320.12
304.11
349.73
#
46930
154.83
147.09
169.15
46500
189.39
179.92
206.91
46940
267.43
254.06
292.17
46505
321.13
305.07
350.83
#
46940
150.14
142.63
164.02
46505
257.90
245.01
281.76
46942
253.35
240.68
276.78
46600
119.70
113.72
130.78
#
46942
133.76
127.07
146.13
46600
41.39
39.32
45.22
46945
348.35
330.93
380.57
46601
154.00
146.30
168.25
46946
393.09
373.44
429.46
46601
98.30
93.39
107.40
46947
406.10
385.80
443.67
46604
697.93
663.03
762.48
46948
465.02
441.77
508.04
46604
67.54
64.16
73.78
47000
311.15
295.59
339.93
46606
286.65
272.32
313.17
#
47000
89.99
85.49
98.31
46606
78.60
74.67
85.87
47001
111.76
106.17
122.10
46607
215.33
204.56
235.24
47010
1,297.46
1,232.59
1,417.48
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
44
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------47015
1,251.76
1,189.17
1,367.55
47553
286.19
271.88
312.66
47100
904.95
859.70
988.66
47554
555.05
527.30
606.40
47120
2,503.36
2,378.19
2,734.92
47555
340.47
323.45
371.97
47122
3,676.64
3,492.81
4,016.73
47556
385.61
366.33
421.28
47125
3,304.85
3,139.61
3,610.55
47562
706.29
670.98
771.63
47130
3,554.62
3,376.89
3,883.42
47563
768.58
730.15
839.67
47135
5,753.44
5,465.77
6,285.64
47564
1,197.95
1,138.05
1,308.76
47140
3,824.89
3,633.65
4,178.70
47570
833.63
791.95
910.74
47141
4,576.00
4,347.20
4,999.28
47600
1,145.53
1,088.25
1,251.49
47142
5,047.52
4,795.14
5,514.41
47605
1,208.53
1,148.10
1,320.32
47146
354.20
336.49
386.96
47610
1,346.80
1,279.46
1,471.38
47147
411.58
391.00
449.65
47612
1,373.30
1,304.64
1,500.34
47300
1,215.75
1,154.96
1,328.20
47620
1,483.67
1,409.49
1,620.91
47350
1,466.37
1,393.05
1,602.01
47700
1,136.30
1,079.49
1,241.41
47360
2,021.41
1,920.34
2,208.39
47701
1,872.49
1,778.87
2,045.70
47361
3,243.82
3,081.63
3,543.87
47711
1,671.19
1,587.63
1,825.77
47362
1,523.19
1,447.03
1,664.08
47712
2,153.89
2,046.20
2,353.13
47370
1,341.25
1,274.19
1,465.32
47715
1,431.26
1,359.70
1,563.66
47371
1,352.67
1,285.04
1,477.80
47720
1,242.21
1,180.10
1,357.12
47380
1,546.09
1,468.79
1,689.11
47721
1,458.37
1,385.45
1,593.27
47381
1,595.08
1,515.33
1,742.63
47740
1,413.16
1,342.50
1,543.88
47382
4,137.85
3,930.96
4,520.60
47741
1,590.56
1,511.03
1,737.68
47382
754.58
716.85
824.38
47760
2,418.49
2,297.57
2,642.21
47383
6,494.07
6,169.37
7,094.78
47765
3,274.69
3,110.96
3,577.60
47383
455.22
432.46
497.33
47780
2,661.32
2,528.25
2,907.49
47400
2,321.31
2,205.24
2,536.03
47785
3,482.08
3,307.98
3,804.18
47420
1,431.07
1,359.52
1,563.45
47800
1,671.21
1,587.65
1,825.80
47425
1,472.73
1,399.09
1,608.95
47801
1,199.03
1,139.08
1,309.94
47460
1,365.44
1,297.17
1,491.75
47802
1,643.53
1,561.35
1,795.55
47480
937.01
890.16
1,023.68
47900
1,455.40
1,382.63
1,590.02
47490
336.20
319.39
367.30
48000
2,029.80
1,928.31
2,217.56
47531
420.80
399.76
459.72
48001
2,489.87
2,365.38
2,720.19
47531
72.18
68.57
78.86
48020
1,267.89
1,204.50
1,385.18
47532
869.51
826.03
949.93
48100
942.37
895.25
1,029.54
47532
218.15
207.24
238.33
48102
540.85
513.81
590.88
47533
1,244.50
1,182.28
1,359.62
#
48102
242.37
230.25
264.79
47533
270.41
256.89
295.42
48105
3,044.87
2,892.63
3,326.52
47534
1,384.86
1,315.62
1,512.96
48120
1,188.20
1,128.79
1,298.11
47534
377.02
358.17
411.90
48140
1,677.40
1,593.53
1,832.56
47535
960.86
912.82
1,049.74
48145
1,759.24
1,671.28
1,921.97
47535
199.08
189.13
217.50
48146
2,028.42
1,927.00
2,216.05
47536
685.47
651.20
748.88
48148
1,344.50
1,277.28
1,468.87
47536
134.04
127.34
146.44
48150
3,347.50
3,180.13
3,657.15
47537
488.65
464.22
533.85
48152
3,115.62
2,959.84
3,403.82
47537
97.44
92.57
106.46
48153
3,338.91
3,171.96
3,647.75
47538
4,146.88
3,939.54
4,530.47
48154
3,129.77
2,973.28
3,419.27
47538
240.35
228.33
262.58
48155
1,948.77
1,851.33
2,129.03
47539
4,562.85
4,334.71
4,984.92
48400
115.49
109.72
126.18
47539
429.92
408.42
469.68
48500
1,235.55
1,173.77
1,349.84
47540
4,664.67
4,431.44
5,096.16
48510
1,178.89
1,119.95
1,287.94
47540
448.19
425.78
489.65
48520
1,185.07
1,125.82
1,294.69
47541
1,224.30
1,163.09
1,337.55
48540
1,411.08
1,340.53
1,541.61
47541
340.31
323.29
371.78
48545
1,450.43
1,377.91
1,584.60
47542
522.18
496.07
570.48
48547
1,932.90
1,836.26
2,111.70
47542
138.83
131.89
151.67
48548
1,801.52
1,711.44
1,968.16
47543
435.51
413.73
475.79
48552
254.54
241.81
278.08
47543
146.86
139.52
160.45
48554
2,736.89
2,600.05
2,990.06
47544
937.45
890.58
1,024.17
48556
1,364.62
1,296.39
1,490.85
47544
159.94
151.94
174.73
49000
818.93
777.98
894.68
47550
177.95
169.05
194.41
49002
1,116.90
1,061.06
1,220.22
47552
283.20
269.04
309.40
49010
986.32
937.00
1,077.55
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
#
#
#
#
#
#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
45
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------49013
459.62
436.64
502.14
49442
861.78
818.69
941.49
49014
379.24
360.28
414.32
#
49442
208.78
198.34
228.09
49020
1,701.68
1,616.60
1,859.09
49446
869.12
825.66
949.51
49040
1,075.06
1,021.31
1,174.51
#
49446
150.26
142.75
164.16
49060
1,170.28
1,111.77
1,278.54
49450
644.38
612.16
703.98
49062
822.98
781.83
899.10
#
49450
67.73
64.34
73.99
49082
217.57
206.69
237.69
49451
694.92
660.17
759.20
49082
75.37
71.60
82.34
#
49451
91.06
86.51
99.49
49083
304.37
289.15
332.52
49452
847.22
804.86
925.59
49083
108.11
102.70
118.11
#
49452
140.49
133.47
153.49
49084
115.39
109.62
126.06
49460
718.54
682.61
785.00
49180
174.69
165.96
190.85
#
49460
50.47
47.95
55.14
49180
85.90
81.61
93.85
49465
145.04
137.79
158.46
49185
1,264.02
1,200.82
1,380.94
#
49465
31.35
29.78
34.25
49185
121.52
115.44
132.76
49491
854.69
811.96
933.75
49203
1,267.89
1,204.50
1,385.18
49492
1,029.26
977.80
1,124.47
49204
1,613.42
1,532.75
1,762.66
49495
436.76
414.92
477.16
49205
1,852.91
1,760.26
2,024.30
49496
656.65
623.82
717.39
49215
2,357.99
2,240.09
2,576.10
49500
440.68
418.65
481.45
49250
623.22
592.06
680.87
49501
648.66
616.23
708.66
49255
834.65
792.92
911.86
49505
557.37
529.50
608.93
49320
348.99
331.54
381.27
49507
625.85
594.56
683.74
49321
365.87
347.58
399.72
49520
676.81
642.97
739.42
49322
399.02
379.07
435.93
49521
767.12
728.76
838.07
49323
673.55
639.87
735.85
49525
612.37
581.75
669.01
49324
416.38
395.56
454.89
49540
728.20
691.79
795.56
49325
444.75
422.51
485.89
49550
616.29
585.48
673.30
49326
204.16
193.95
223.04
49553
675.31
641.54
737.77
49327
141.75
134.66
154.86
49555
644.78
612.54
704.42
49400
151.63
144.05
165.66
49557
772.99
734.34
844.49
49400
94.29
89.58
103.02
49560
788.58
749.15
861.52
49402
913.70
868.02
998.22
49561
995.78
945.99
1,087.89
49405
909.53
864.05
993.66
49565
821.26
780.20
897.23
49405
199.85
189.86
218.34
49566
1,004.98
954.73
1,097.94
49406
909.86
864.37
994.03
49568
287.49
273.12
314.09
49406
199.85
189.86
218.34
49570
445.74
423.45
486.97
49407
760.07
722.07
830.38
49572
553.23
525.57
604.41
49407
213.89
203.20
233.68
49580
355.87
338.08
388.79
49411
496.07
471.27
541.96
49582
516.12
490.31
563.86
49411
187.10
177.75
204.41
49585
475.16
451.40
519.11
49412
89.21
84.75
97.46
49587
507.61
482.23
554.56
49418
1,118.04
1,062.14
1,221.46
49590
613.63
582.95
670.39
49418
206.85
196.51
225.99
49600
786.50
747.18
859.26
49419
450.89
428.35
492.60
49605
5,318.16
5,052.25
5,810.09
49421
245.10
232.85
267.78
49606
1,220.64
1,159.61
1,333.55
49422
238.22
226.31
260.26
49610
741.92
704.82
810.54
49423
615.43
584.66
672.36
49611
652.71
620.07
713.08
49423
72.52
68.89
79.22
49650
458.90
435.96
501.35
49424
182.21
173.10
199.07
49651
597.81
567.92
653.11
49424
38.04
36.14
41.56
49652
796.50
756.68
870.18
49425
739.66
702.68
808.08
49653
997.10
947.25
1,089.34
49426
716.17
680.36
782.41
49654
904.84
859.60
988.54
49427
40.15
38.14
43.86
49655
1,108.19
1,052.78
1,210.70
49428
461.93
438.83
504.65
49656
983.15
933.99
1,074.09
49429
492.28
467.67
537.82
49657
1,417.09
1,346.24
1,548.18
49435
129.14
122.68
141.08
49900
865.81
822.52
945.90
49436
199.21
189.25
217.64
49904
1,470.69
1,397.16
1,606.73
49440
905.97
860.67
989.77
49905
378.44
359.52
413.45
49440
207.75
197.36
226.96
50010
771.64
733.06
843.02
49441
1,030.74
979.20
1,126.08
50020
1,043.35
991.18
1,139.86
49441
246.35
234.03
269.13
50040
950.26
902.75
1,038.16
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
#
#
#
#
#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
46
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------50045
958.76
910.82
1,047.44
50435
601.48
571.41
657.12
50060
1,173.28
1,114.62
1,281.81
#
50435
100.18
95.17
109.45
50065
1,244.49
1,182.27
1,359.61
50436
153.44
145.77
167.64
50070
1,220.35
1,159.33
1,333.23
50437
255.00
242.25
278.59
50075
1,500.05
1,425.05
1,638.81
50500
1,311.04
1,245.49
1,432.31
50080
894.27
849.56
976.99
50520
1,243.12
1,180.96
1,358.10
50081
1,315.11
1,249.35
1,436.75
50525
1,581.65
1,502.57
1,727.96
50100
1,159.84
1,101.85
1,267.13
50526
1,694.77
1,610.03
1,851.53
50120
976.34
927.52
1,066.65
50540
1,180.15
1,121.14
1,289.31
50125
1,010.80
960.26
1,104.30
50541
946.95
899.60
1,034.54
50130
1,062.02
1,008.92
1,160.26
50542
1,203.75
1,143.56
1,315.09
50135
1,153.78
1,096.09
1,260.50
50543
1,534.40
1,457.68
1,676.33
50200
542.76
515.62
592.96
50544
1,281.41
1,217.34
1,399.94
50200
129.60
123.12
141.59
50545
1,378.11
1,309.20
1,505.58
50205
799.95
759.95
873.94
50546
1,244.37
1,182.15
1,359.47
50220
1,092.71
1,038.07
1,193.78
50547
1,708.72
1,623.28
1,866.77
50225
1,242.87
1,180.73
1,357.84
50548
1,388.81
1,319.37
1,517.28
50230
1,323.55
1,257.37
1,445.98
50551
370.61
352.08
404.89
50234
1,345.68
1,278.40
1,470.16
#
50551
302.13
287.02
330.07
50236
1,510.10
1,434.60
1,649.79
50553
397.05
377.20
433.78
50240
1,365.09
1,296.84
1,491.37
#
50553
323.33
307.16
353.23
50250
1,252.62
1,189.99
1,368.49
50555
423.14
401.98
462.28
50280
1,003.03
952.88
1,095.81
#
50555
349.74
332.25
382.09
50290
925.35
879.08
1,010.94
50557
430.38
408.86
470.19
50320
1,605.37
1,525.10
1,753.87
#
50557
354.70
336.97
387.52
50327
233.47
221.80
255.07
50561
488.26
463.85
533.43
50328
203.12
192.96
221.90
#
50561
405.36
385.09
442.85
50329
193.57
183.89
211.47
50562
594.62
564.89
649.62
50340
1,012.38
961.76
1,106.02
50570
505.56
480.28
552.32
50360
2,585.54
2,456.26
2,824.70
50572
546.83
519.49
597.41
50365
3,057.73
2,904.84
3,340.57
50574
581.25
552.19
635.02
50370
1,285.30
1,221.04
1,404.20
50575
735.15
698.39
803.15
50380
2,150.62
2,043.09
2,349.55
50576
579.87
550.88
633.51
50382
1,085.31
1,031.04
1,185.70
50580
625.57
594.29
683.43
50382
260.63
247.60
284.74
50590
759.38
721.41
829.62
50384
909.91
864.41
994.07
#
50590
585.40
556.13
639.55
50384
234.63
222.90
256.34
50592
3,110.58
2,955.05
3,398.31
50385
1,083.19
1,029.03
1,183.38
#
50592
349.18
331.72
381.48
50385
224.11
212.90
244.84
50593
4,176.62
3,967.79
4,562.96
50386
771.53
732.95
842.89
#
50593
465.70
442.42
508.78
50386
165.71
157.42
181.03
50600
965.44
917.17
1,054.75
50387
573.15
544.49
626.16
50605
1,058.63
1,005.70
1,156.56
50387
85.28
81.02
93.17
50606
582.16
553.05
636.01
50389
413.63
392.95
451.89
#
50606
153.60
145.92
167.81
50389
54.86
52.12
59.94
50610
972.01
923.41
1,061.92
50390
97.54
92.66
106.56
50620
930.22
883.71
1,016.27
50391
129.21
122.75
141.16
50630
918.92
872.97
1,003.92
50391
101.36
96.29
110.73
50650
1,069.16
1,015.70
1,168.06
50396
116.98
111.13
127.80
50660
1,176.70
1,117.87
1,285.55
50400
1,189.05
1,129.60
1,299.04
50684
124.73
118.49
136.26
50405
1,436.36
1,364.54
1,569.22
#
50684
51.01
48.46
55.73
50430
619.61
588.63
676.92
50686
144.10
136.90
157.44
50430
156.65
148.82
171.14
#
50686
89.71
85.22
98.00
50431
302.89
287.75
330.91
50688
77.52
73.64
84.69
50431
66.00
62.70
72.11
50690
115.44
109.67
126.12
50432
922.96
876.81
1,008.33
#
50690
70.23
66.72
76.73
50432
208.04
197.64
227.29
50693
1,045.42
993.15
1,142.12
50433
1,171.85
1,113.26
1,280.25
#
50693
206.97
196.62
226.11
50433
259.36
246.39
283.35
50694
1,165.72
1,107.43
1,273.54
50434
937.66
890.78
1,024.40
#
50694
270.92
257.37
295.98
50434
194.88
185.14
212.91
50695
1,408.33
1,337.91
1,538.60
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
---#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
47
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------50695
349.38
331.91
381.70
#
51101
53.57
50.89
58.52
50700
952.42
904.80
1,040.52
51102
246.17
233.86
268.94
50705
1,917.00
1,821.15
2,094.32
#
51102
148.53
141.10
162.27
50705
182.45
173.33
199.33
51500
655.09
622.34
715.69
50706
912.71
867.07
997.13
51520
611.60
581.02
668.17
50706
185.99
176.69
203.19
51525
885.90
841.61
967.85
50715
1,255.73
1,192.94
1,371.88
51530
792.42
752.80
865.72
50722
1,073.25
1,019.59
1,172.53
51535
802.85
762.71
877.12
50725
1,133.91
1,077.21
1,238.79
51550
994.47
944.75
1,086.46
50727
523.64
497.46
572.08
51555
1,304.25
1,239.04
1,424.90
50728
762.61
724.48
833.15
51565
1,326.48
1,260.16
1,449.18
50740
1,314.58
1,248.85
1,436.18
51570
1,514.50
1,438.78
1,654.60
50750
1,186.98
1,127.63
1,296.77
51575
1,876.21
1,782.40
2,049.76
50760
1,187.20
1,127.84
1,297.02
51580
1,953.69
1,856.01
2,134.41
50770
1,186.98
1,127.63
1,296.77
51585
2,174.23
2,065.52
2,375.35
50780
1,150.80
1,093.26
1,257.25
51590
1,994.62
1,894.89
2,179.12
50782
1,105.84
1,050.55
1,208.13
51595
2,254.72
2,141.98
2,463.28
50783
1,159.93
1,101.93
1,267.22
51596
2,428.42
2,307.00
2,653.05
50785
1,252.48
1,189.86
1,368.34
51597
2,365.78
2,247.49
2,584.61
50800
951.86
904.27
1,039.91
51600
215.42
204.65
235.35
50810
1,505.20
1,429.94
1,644.43
#
51600
45.37
43.10
49.57
50815
1,259.59
1,196.61
1,376.10
51605
39.62
37.64
43.29
50820
1,354.84
1,287.10
1,480.17
51610
127.33
120.96
139.10
50825
1,709.61
1,624.13
1,867.75
#
51610
64.75
61.51
70.74
50830
1,856.57
1,763.74
2,028.30
51700
78.85
74.91
86.15
50840
1,266.77
1,203.43
1,383.94
#
51700
32.32
30.70
35.31
50845
1,288.21
1,223.80
1,407.37
51701
46.01
43.71
50.27
50860
972.29
923.68
1,062.23
#
51701
26.35
25.03
28.78
50900
866.65
823.32
946.82
51702
63.20
60.04
69.05
50920
906.55
861.22
990.40
#
51702
25.85
24.56
28.24
50930
1,133.23
1,076.57
1,238.06
51703
149.25
141.79
163.06
50940
913.37
867.70
997.86
#
51703
78.81
74.87
86.10
50945
1,000.33
950.31
1,092.86
51705
97.53
92.65
106.55
50947
1,429.38
1,357.91
1,561.60
#
51705
52.97
50.32
57.87
50948
1,320.06
1,254.06
1,442.17
51710
136.53
129.70
149.16
50951
389.35
369.88
425.36
#
51710
80.83
76.79
88.31
50951
315.63
299.85
344.83
51715
369.78
351.29
403.98
50953
410.86
390.32
448.87
#
51715
206.94
196.59
226.08
50953
335.17
318.41
366.17
51720
89.10
84.65
97.35
50955
437.71
415.82
478.19
#
51720
45.19
42.93
49.37
50955
361.04
342.99
394.44
51725
226.01
214.71
246.92
50957
442.23
420.12
483.14
51725
TC
147.79
140.40
161.46
50957
363.27
345.11
396.88
51725
26
78.22
74.31
85.46
50961
399.47
379.50
436.43
51726
302.12
287.01
330.06
50961
325.75
309.46
355.88
51726
TC
215.28
204.52
235.20
50970
380.43
361.41
415.62
51726
26
86.84
82.50
94.88
50972
367.26
348.90
401.24
51727
363.79
345.60
397.44
50974
485.39
461.12
530.29
51727
TC
254.93
242.18
278.51
50976
479.04
455.09
523.35
51727
26
108.87
103.43
118.94
50980
365.53
347.25
399.34
51728
366.55
348.22
400.45
51020
481.80
457.71
526.37
51728
TC
260.50
247.48
284.60
51030
485.51
461.23
530.41
51728
26
106.05
100.75
115.86
51040
296.73
281.89
324.17
51729
390.74
371.20
426.88
51045
523.09
496.94
571.48
51729
TC
260.82
247.78
284.95
51050
484.88
460.64
529.74
51729
26
129.92
123.42
141.93
51060
598.08
568.18
653.41
51736
13.49
12.82
14.74
51065
595.79
566.00
650.90
51736
TC
5.09
4.84
5.57
51080
418.32
397.40
457.01
51736
26
8.40
7.98
9.18
51100
74.82
71.08
81.74
51741
14.31
13.59
15.63
51100
40.09
38.09
43.80
51741
TC
5.42
5.15
5.92
51101
153.50
145.83
167.70
51741
26
8.90
8.46
9.73
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
#
#
#
#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
48
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------51784
66.04
62.74
72.15
52283
352.22
334.61
384.80
51784
TC
28.02
26.62
30.61
#
52283
207.40
197.03
226.58
51784
26
38.02
36.12
41.54
52285
348.82
331.38
381.09
51785
432.59
410.96
472.60
#
52285
201.38
191.31
220.01
51785
TC
332.25
315.64
362.99
52287
387.41
368.04
423.25
51785
26
100.34
95.32
109.62
#
52287
174.44
165.72
190.58
51792
264.07
250.87
288.50
52290
250.24
237.73
273.39
51792
TC
208.40
197.98
227.68
52300
288.23
273.82
314.89
51792
26
55.67
52.89
60.82
52301
298.01
283.11
325.58
51797
183.60
174.42
200.58
52305
286.09
271.79
312.56
51797
TC
143.51
136.33
156.78
52310
312.80
297.16
341.73
51797
26
40.09
38.09
43.80
#
52310
155.20
147.44
169.56
51798
10.00
9.50
10.93
52315
482.14
458.03
526.73
51800
1,074.56
1,020.83
1,173.95
#
52315
282.60
268.47
308.74
51820
1,116.50
1,060.68
1,219.78
52317
911.10
865.55
995.38
51840
713.59
677.91
779.60
#
52317
356.39
338.57
389.36
51841
824.14
782.93
900.37
52318
487.59
463.21
532.69
51845
599.18
569.22
654.60
52320
252.94
240.29
276.33
51860
773.59
734.91
845.15
52325
329.11
312.65
359.55
51865
929.72
883.23
1,015.71
52327
272.42
258.80
297.62
51880
481.49
457.42
526.03
52330
613.63
582.95
670.39
51900
846.72
804.38
925.04
#
52330
270.91
257.36
295.96
51920
785.04
745.79
857.66
52332
440.60
418.57
481.36
51925
1,122.41
1,066.29
1,226.23
#
52332
159.15
151.19
173.87
51940
1,691.04
1,606.49
1,847.46
52334
187.58
178.20
204.93
51960
1,424.51
1,353.28
1,556.27
52341
291.62
277.04
318.60
51980
734.51
697.78
802.45
52342
317.14
301.28
346.47
51990
768.91
730.46
840.03
52343
352.43
334.81
385.03
51992
871.06
827.51
951.64
52344
378.45
359.53
413.46
52000
232.60
220.97
254.12
52345
404.80
384.56
442.24
52000
82.54
78.41
90.17
52346
458.72
435.78
501.15
52001
442.70
420.57
483.66
52351
310.35
294.83
339.05
52001
295.26
280.50
322.58
52352
363.20
345.04
396.80
52005
307.88
292.49
336.36
52353
402.40
382.28
439.62
52005
135.53
128.75
148.06
52354
428.92
407.47
468.59
52007
477.59
453.71
521.77
52355
479.96
455.96
524.35
52007
169.93
161.43
185.64
52356
427.61
406.23
467.16
52010
400.90
380.86
437.99
52400
490.58
466.05
535.96
52010
168.93
160.48
184.55
52402
275.22
261.46
300.68
52204
393.72
374.03
430.13
52441
1,362.45
1,294.33
1,488.48
52204
144.71
137.47
158.09
#
52441
215.68
204.90
235.64
52214
767.65
729.27
838.66
52442
963.09
914.94
1,052.18
52214
182.47
173.35
199.35
#
52442
53.22
50.56
58.14
52224
800.31
760.29
874.33
52450
484.46
460.24
529.28
52224
209.89
199.40
229.31
52500
502.78
477.64
549.29
52234
251.96
239.36
275.26
52601
749.74
712.25
819.09
52235
296.24
281.43
323.64
52630
412.39
391.77
450.54
52240
402.40
382.28
439.62
52640
324.58
308.35
354.60
52250
245.29
233.03
267.98
52647
1,645.50
1,563.23
1,797.71
52260
216.32
205.50
236.33
#
52647
667.81
634.42
729.58
52265
389.96
370.46
426.03
52648
1,698.50
1,613.58
1,855.62
52265
167.48
159.11
182.98
#
52648
711.30
675.74
777.10
52270
426.75
405.41
466.22
52649
848.87
806.43
927.39
52270
187.24
177.88
204.56
52700
452.51
429.88
494.36
52275
552.41
524.79
603.51
53000
151.33
143.76
165.32
52275
254.58
241.85
278.13
53010
301.06
286.01
328.91
52276
271.81
258.22
296.95
53020
99.47
94.50
108.68
52277
331.75
315.16
362.43
53025
69.20
65.74
75.60
52281
334.45
317.73
365.39
53040
401.90
381.81
439.08
52281
155.56
147.78
169.95
53060
195.65
185.87
213.75
52282
344.55
327.32
376.42
#
53060
172.71
164.07
188.68
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
#
#
#
#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
49
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------53080
430.42
408.90
470.24
#
53854
386.61
367.28
422.37
53085
667.34
633.97
729.07
53855
723.01
686.86
789.89
53200
162.10
154.00
177.10
#
53855
85.09
80.84
92.97
53200
146.04
138.74
159.55
53860
2,345.48
2,228.21
2,562.44
53210
792.61
752.98
865.93
#
53860
228.23
216.82
249.34
53215
954.09
906.39
1,042.35
54000
162.96
154.81
178.03
53220
463.14
439.98
505.98
#
54000
111.85
106.26
122.20
53230
628.43
597.01
686.56
54001
199.63
189.65
218.10
53235
651.02
618.47
711.24
#
54001
142.95
135.80
156.17
53240
434.87
413.13
475.10
54015
314.24
298.53
343.31
53250
405.12
384.86
442.59
54050
140.16
133.15
153.12
53260
212.75
202.11
232.43
#
54050
105.76
100.47
115.54
53260
187.20
177.84
204.52
54055
133.85
127.16
146.23
53265
234.70
222.97
256.42
#
54055
95.51
90.73
104.34
53265
194.72
184.98
212.73
54056
142.28
135.17
155.45
53270
215.40
204.63
235.32
#
54056
109.19
103.73
119.29
53270
188.86
179.42
206.33
54057
141.64
134.56
154.74
53275
270.72
257.18
295.76
#
54057
97.08
92.23
106.06
53400
822.36
781.24
898.43
54060
195.61
185.83
213.70
53405
898.84
853.90
981.99
#
54060
132.70
126.07
144.98
53410
1,008.87
958.43
1,102.19
54065
223.21
212.05
243.86
53415
1,164.86
1,106.62
1,272.61
#
54065
171.77
163.18
187.66
53420
866.79
823.45
946.97
54100
203.92
193.72
222.78
53425
964.40
916.18
1,053.61
#
54100
122.66
116.53
134.01
53430
1,008.06
957.66
1,101.31
54105
281.35
267.28
307.37
53431
1,187.22
1,127.86
1,297.04
#
54105
218.77
207.83
239.00
53440
775.10
736.35
846.80
54110
643.16
611.00
702.65
53442
805.69
765.41
880.22
54111
822.66
781.53
898.76
53444
816.26
775.45
891.77
54112
963.69
915.51
1,052.84
53445
776.09
737.29
847.88
54115
465.22
441.96
508.25
53446
660.27
627.26
721.35
#
54115
435.40
413.63
475.67
53447
830.06
788.56
906.84
54120
649.11
616.65
709.15
53448
1,315.14
1,249.38
1,436.79
54125
841.23
799.17
919.05
53449
630.75
599.21
689.09
54130
1,229.17
1,167.71
1,342.87
53450
418.95
398.00
457.70
54135
1,557.04
1,479.19
1,701.07
53460
470.13
446.62
513.61
54150
155.48
147.71
169.87
53500
776.66
737.83
848.50
#
54150
101.42
96.35
110.80
53502
498.95
474.00
545.10
54160
225.17
213.91
246.00
53505
498.63
473.70
544.76
#
54160
148.83
141.39
162.60
53510
649.64
617.16
709.73
54161
202.21
192.10
220.92
53515
818.29
777.38
893.99
54162
265.12
251.86
289.64
53520
573.28
544.62
626.31
#
54162
204.83
194.59
223.78
53600
89.86
85.37
98.18
54163
222.20
211.09
242.75
53600
65.61
62.33
71.68
54164
195.85
186.06
213.97
53601
86.25
81.94
94.23
54200
114.37
108.65
124.95
53601
55.45
52.68
60.58
#
54200
86.20
81.89
94.17
53605
66.59
63.26
72.75
54205
546.08
518.78
596.60
53620
164.99
156.74
180.25
54220
223.04
211.89
243.67
53620
89.63
85.15
97.92
#
54220
138.84
131.90
151.69
53621
155.86
148.07
170.28
54230
104.73
99.49
114.41
53621
73.62
69.94
80.43
#
54230
80.81
76.77
88.29
53660
75.48
71.71
82.47
54231
143.97
136.77
157.29
53660
42.71
40.57
46.66
#
54231
118.08
112.18
129.01
53661
74.52
70.79
81.41
54235
89.82
85.33
98.13
53661
41.42
39.35
45.25
#
54235
74.42
70.70
81.31
53665
40.04
38.04
43.75
54240
105.16
99.90
114.89
53850
1,537.65
1,460.77
1,679.89
54240
TC
37.52
35.64
40.99
53850
360.42
342.40
393.76
54240
26
67.64
64.26
73.90
53852
1,496.35
1,421.53
1,634.76
54250
123.83
117.64
135.29
53852
386.29
366.98
422.03
54250
TC
12.95
12.30
14.15
53854
1,797.46
1,707.59
1,963.73
54250
26
110.88
105.34
121.14
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
50
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------54300
664.97
631.72
726.48
54865
367.73
349.34
401.74
54304
769.82
731.33
841.03
54900
823.49
782.32
899.67
54308
736.91
700.06
805.07
54901
1,090.19
1,035.68
1,191.03
54312
841.38
799.31
919.21
55000
121.65
115.57
132.91
54316
1,025.09
973.84
1,119.92
#
55000
86.26
81.95
94.24
54318
731.90
695.31
799.61
55040
347.39
330.02
379.52
54322
804.83
764.59
879.28
55041
525.99
499.69
574.64
54324
996.26
946.45
1,088.42
55060
390.24
370.73
426.34
54326
970.17
921.66
1,059.91
55100
232.92
221.27
254.46
54328
964.15
915.94
1,053.33
#
55100
170.99
162.44
186.81
54332
1,041.36
989.29
1,137.68
55110
397.68
377.80
434.47
54336
1,224.25
1,163.04
1,337.50
55120
362.54
344.41
396.07
54340
585.43
556.16
639.58
55150
506.44
481.12
553.29
54344
971.90
923.31
1,061.81
55175
373.88
355.19
408.47
54348
1,041.08
989.03
1,137.38
55180
713.03
677.38
778.99
54352
1,458.11
1,385.20
1,592.98
55200
407.27
386.91
444.95
54360
742.01
704.91
810.65
#
55200
283.75
269.56
309.99
54380
822.14
781.03
898.18
55250
355.33
337.56
388.19
54385
957.21
909.35
1,045.75
#
55250
232.14
220.53
253.61
54390
1,278.41
1,214.49
1,396.66
55300
192.63
183.00
210.45
54400
545.70
518.42
596.18
55400
514.00
488.30
561.55
54401
675.35
641.58
737.82
55500
406.94
386.59
444.58
54405
832.22
790.61
909.20
55520
483.98
459.78
528.75
54406
752.59
714.96
822.20
55530
361.48
343.41
394.92
54408
813.52
772.84
888.77
55535
441.35
419.28
482.17
54410
887.13
842.77
969.19
55540
591.12
561.56
645.79
54411
1,064.68
1,011.45
1,163.17
55550
440.06
418.06
480.77
54415
544.25
517.04
594.60
55600
432.43
410.81
472.43
54416
734.26
697.55
802.18
55605
537.27
510.41
586.97
54417
924.39
878.17
1,009.90
55650
739.44
702.47
807.84
54420
724.28
688.07
791.28
55680
355.55
337.77
388.44
54430
657.08
624.23
717.86
55700
250.99
238.44
274.21
54435
424.27
403.06
463.52
#
55700
134.02
127.32
146.42
54437
695.10
660.35
759.40
55705
272.58
258.95
297.79
54438
1,375.98
1,307.18
1,503.26
55706
383.60
364.42
419.08
54450
70.34
66.82
76.84
55720
465.18
441.92
508.21
54450
59.52
56.54
65.02
55725
610.26
579.75
666.71
54500
75.83
72.04
82.85
55801
1,126.80
1,070.46
1,231.03
54505
215.89
205.10
235.87
55810
1,348.84
1,281.40
1,473.61
54512
556.46
528.64
607.94
55812
1,655.71
1,572.92
1,808.86
54520
337.26
320.40
368.46
55815
1,815.09
1,724.34
1,982.99
54522
605.46
575.19
661.47
55821
899.56
854.58
982.77
54530
522.21
496.10
570.52
55831
973.52
924.84
1,063.57
54535
765.53
727.25
836.34
55840
1,204.35
1,144.13
1,315.75
54550
505.52
480.24
552.28
55842
1,207.01
1,146.66
1,318.66
54560
708.07
672.67
773.57
55845
1,402.09
1,331.99
1,531.79
54600
464.47
441.25
507.44
55860
901.54
856.46
984.93
54620
307.68
292.30
336.15
55862
1,127.65
1,071.27
1,231.96
54640
448.71
426.27
490.21
55865
1,374.34
1,305.62
1,501.46
54650
732.47
695.85
800.23
55866
1,485.17
1,410.91
1,622.55
54660
365.86
347.57
399.71
55870
178.11
169.20
194.58
54670
417.69
396.81
456.33
#
55870
145.35
138.08
158.79
54680
810.85
770.31
885.86
55873
6,172.95
5,864.30
6,743.95
54690
675.38
641.61
737.85
#
55873
786.12
746.81
858.83
54692
779.88
740.89
852.02
55874
3,072.98
2,919.33
3,357.23
54700
219.63
208.65
239.95
#
55874
167.41
159.04
182.90
54800
128.39
121.97
140.27
55875
791.24
751.68
864.43
54830
381.39
362.32
416.67
55876
150.13
142.62
164.01
54840
330.92
314.37
361.53
#
55876
102.30
97.19
111.77
54860
429.50
408.03
469.23
55880
1,009.99
959.49
1,103.41
54861
583.77
554.58
637.77
55920
464.57
441.34
507.54
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
---#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
51
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------56405
144.45
137.23
157.81
#
57155
287.73
273.34
314.34
56405
127.74
121.35
139.55
57156
223.47
212.30
244.15
56420
177.77
168.88
194.21
#
57156
152.04
144.44
166.11
56420
112.57
106.94
122.98
57160
74.43
70.71
81.32
56440
188.57
179.14
206.01
#
57160
49.20
46.74
53.75
56441
181.18
172.12
197.94
57170
77.93
74.03
85.13
56441
156.28
148.47
170.74
#
57170
50.73
48.19
55.42
56442
48.24
45.83
52.70
57180
194.55
184.82
212.54
56501
184.27
175.06
201.32
#
57180
123.46
117.29
134.88
56501
132.50
125.88
144.76
57200
338.36
321.44
369.66
56515
275.50
261.73
300.99
57210
406.16
385.85
443.73
56515
217.83
206.94
237.98
57220
354.71
336.97
387.52
56605
96.52
91.69
105.44
57230
434.05
412.35
474.20
56605
62.12
59.01
67.86
57240
635.83
604.04
694.65
56606
40.08
38.08
43.79
57250
640.15
608.14
699.36
56606
30.91
29.36
33.76
57260
813.78
773.09
889.05
56620
591.50
561.93
646.22
57265
914.13
868.42
998.68
56625
684.66
650.43
747.99
57267
264.81
251.57
289.31
56630
991.88
942.29
1,083.63
57268
523.73
497.54
572.17
56631
1,228.14
1,166.73
1,341.74
57270
849.84
807.35
928.45
56632
1,474.95
1,401.20
1,611.38
57280
1,009.83
959.34
1,103.24
56633
1,275.27
1,211.51
1,393.24
57282
723.92
687.72
790.88
56634
1,341.36
1,274.29
1,465.43
57283
729.44
692.97
796.92
56637
1,561.38
1,483.31
1,705.81
57284
869.41
825.94
949.83
56640
1,584.05
1,504.85
1,730.58
57285
723.36
687.19
790.27
56700
208.45
198.03
227.73
57287
759.76
721.77
830.04
56740
326.63
310.30
356.85
57288
769.70
731.22
840.90
56800
261.05
248.00
285.20
57289
828.09
786.69
904.69
56805
1,222.43
1,161.31
1,335.51
57291
573.23
544.57
626.26
56810
280.53
266.50
306.48
57292
869.66
826.18
950.11
56820
125.78
119.49
137.41
57295
518.01
492.11
565.93
56820
88.10
83.70
96.26
57296
995.21
945.45
1,087.27
56821
169.14
160.68
184.78
57300
628.48
597.06
686.62
56821
118.68
112.75
129.66
57305
1,030.09
978.59
1,125.38
57000
207.87
197.48
227.10
57307
1,104.41
1,049.19
1,206.57
57010
473.95
450.25
517.79
57308
680.73
646.69
743.69
57020
124.49
118.27
136.01
57310
500.86
475.82
547.19
57020
84.84
80.60
92.69
57311
567.25
538.89
619.72
57022
187.73
178.34
205.09
57320
577.49
548.62
630.91
57023
333.03
316.38
363.84
57330
787.20
747.84
860.02
57061
160.40
152.38
175.24
57335
1,234.89
1,173.15
1,349.12
57061
114.85
109.11
125.48
57400
136.86
130.02
149.52
57065
245.08
232.83
267.75
57410
109.47
104.00
119.60
57065
191.34
181.77
209.04
57415
179.63
170.65
196.25
57100
103.81
98.62
113.41
57420
132.89
126.25
145.19
57100
69.08
65.63
75.47
#
57420
93.90
89.21
102.59
57105
173.99
165.29
190.08
57421
179.30
170.34
195.89
57105
146.14
138.83
159.65
#
57421
127.21
120.85
138.98
57106
547.98
520.58
598.67
57423
971.89
923.30
1,061.80
57107
1,507.42
1,432.05
1,646.86
57425
1,018.57
967.64
1,112.79
57109
1,797.53
1,707.65
1,963.80
57426
904.92
859.67
988.62
57110
949.15
901.69
1,036.94
57452
127.42
121.05
139.21
57111
1,797.53
1,707.65
1,963.80
#
57452
94.33
89.61
103.05
57120
550.06
522.56
600.94
57454
173.55
164.87
189.60
57130
228.23
216.82
249.34
#
57454
140.13
133.12
153.09
57130
177.45
168.58
193.87
57455
163.92
155.72
179.08
57135
245.49
233.22
268.20
#
57455
114.45
108.73
125.04
57135
192.74
183.10
210.57
57456
153.60
145.92
167.81
57150
58.98
56.03
64.43
#
57456
106.09
100.79
115.91
57150
28.18
26.77
30.79
57460
324.42
308.20
354.43
57155
391.27
371.71
427.47
#
57460
167.81
159.42
183.33
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
---#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
52
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------57461
362.31
344.19
395.82
#
58321
51.08
48.53
55.81
57461
194.23
184.52
212.20
58322
92.77
88.13
101.35
57465
58.36
55.44
63.76
#
58322
60.66
57.63
66.27
57465
45.59
43.31
49.81
58323
15.93
15.13
17.40
57500
155.09
147.34
169.44
#
58323
12.98
12.33
14.18
57500
78.10
74.20
85.33
58340
230.20
218.69
251.49
57505
147.69
140.31
161.36
#
58340
58.84
55.90
64.29
57505
108.37
102.95
118.39
58345
301.31
286.24
329.18
57510
165.85
157.56
181.19
58346
489.38
464.91
534.65
57510
118.01
112.11
128.93
58350
145.26
138.00
158.70
57511
194.96
185.21
212.99
#
58350
94.47
89.75
103.21
57511
149.42
141.95
163.24
58353
1,010.14
959.63
1,103.57
57513
199.88
189.89
218.37
#
58353
240.17
228.16
262.38
57513
149.09
141.64
162.89
58356
1,826.14
1,734.83
1,995.05
57520
356.97
339.12
389.99
#
58356
374.34
355.62
408.96
57520
302.58
287.45
330.57
58400
478.29
454.38
522.54
57522
307.99
292.59
336.48
58410
857.08
814.23
936.36
57522
263.10
249.95
287.44
58520
838.97
797.02
916.57
57530
382.87
363.73
418.29
58540
963.63
915.45
1,052.77
57531
1,969.32
1,870.85
2,151.48
58541
763.10
724.95
833.69
57540
830.51
788.98
907.33
58542
871.28
827.72
951.88
57545
874.44
830.72
955.33
58543
885.27
841.01
967.16
57550
446.28
423.97
487.57
58544
952.52
904.89
1,040.62
57555
646.46
614.14
706.26
58545
947.44
900.07
1,035.08
57556
612.19
581.58
668.82
58546
1,175.07
1,116.32
1,283.77
57558
156.58
148.75
171.06
58548
1,960.65
1,862.62
2,142.01
57558
130.37
123.85
142.43
58550
925.37
879.10
1,010.97
57700
360.31
342.29
393.63
58552
1,029.91
978.41
1,125.17
57720
343.71
326.52
375.50
58553
1,182.90
1,123.76
1,292.32
57800
77.28
73.42
84.43
58554
1,375.78
1,306.99
1,503.04
57800
50.09
47.59
54.73
58555
362.03
343.93
395.52
58100
104.66
99.43
114.34
#
58555
159.21
151.25
173.94
58100
67.63
64.25
73.89
58558
1,424.74
1,353.50
1,556.53
58110
52.71
50.07
57.58
#
58558
242.27
230.16
264.68
58110
43.21
41.05
47.21
58559
299.00
284.05
326.66
58120
302.08
286.98
330.03
58560
330.25
313.74
360.80
58120
241.13
229.07
263.43
58561
376.56
357.73
411.39
58140
980.29
931.28
1,070.97
58562
436.03
414.23
476.36
58145
593.18
563.52
648.05
#
58562
233.22
221.56
254.79
58146
1,217.78
1,156.89
1,330.42
58563
2,142.33
2,035.21
2,340.49
58150
1,059.84
1,006.85
1,157.88
#
58563
259.02
246.07
282.98
58152
1,305.27
1,240.01
1,426.01
58565
1,814.99
1,724.24
1,982.88
58180
1,006.61
956.28
1,099.72
#
58565
474.91
451.16
518.83
58200
1,415.27
1,344.51
1,546.19
58570
839.03
797.08
916.64
58210
1,903.06
1,807.91
2,079.10
58571
944.31
897.09
1,031.65
58240
3,054.84
2,902.10
3,337.42
58572
1,085.98
1,031.68
1,186.43
58260
879.14
835.18
960.46
58573
1,272.68
1,209.05
1,390.41
58262
972.63
924.00
1,062.60
58575
2,006.43
1,906.11
2,192.03
58263
1,044.54
992.31
1,141.16
58600
387.29
367.93
423.12
58267
1,122.82
1,066.68
1,226.68
58605
350.13
332.62
382.51
58270
938.78
891.84
1,025.62
58611
80.46
76.44
87.91
58275
1,038.80
986.86
1,134.89
58615
264.87
251.63
289.37
58280
1,114.08
1,058.38
1,217.14
58660
716.73
680.89
783.02
58285
1,476.50
1,402.68
1,613.08
58661
685.07
650.82
748.44
58290
1,213.85
1,153.16
1,326.13
58662
747.18
709.82
816.29
58291
1,313.44
1,247.77
1,434.94
58670
387.95
368.55
423.83
58292
1,385.02
1,315.77
1,513.14
58671
387.95
368.55
423.83
58294
1,284.58
1,220.35
1,403.40
58672
771.16
732.60
842.49
58301
110.68
105.15
120.92
58673
837.29
795.43
914.74
58301
70.38
66.86
76.89
58674
855.72
812.93
934.87
58321
83.19
79.03
90.88
58700
833.99
792.29
911.13
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
53
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------58720
787.54
748.16
860.38
#
59160
198.89
188.95
217.29
58740
946.79
899.45
1,034.37
59200
102.63
97.50
112.13
58750
956.75
908.91
1,045.25
#
59200
48.24
45.83
52.70
58752
954.46
906.74
1,042.75
59300
236.08
224.28
257.92
58760
862.94
819.79
942.76
#
59300
157.77
149.88
172.36
58770
905.78
860.49
989.56
59320
162.19
154.08
177.19
58800
370.60
352.07
404.88
59325
260.02
247.02
284.07
58800
326.70
310.37
356.93
59350
303.57
288.39
331.65
58805
443.50
421.33
484.53
59400
2,540.51
2,413.48
2,775.50
58820
348.16
330.75
380.36
59409
867.45
824.08
947.69
58822
749.01
711.56
818.29
59410
1,139.75
1,082.76
1,245.17
58825
744.03
706.83
812.85
59412
110.40
104.88
120.61
58900
452.22
429.61
494.05
59414
99.02
94.07
108.18
58920
749.65
712.17
819.00
59425
587.54
558.16
641.88
58925
802.01
761.91
876.20
#
59425
470.24
446.73
513.74
58940
576.35
547.53
629.66
59426
1,074.49
1,020.77
1,173.89
58943
1,227.64
1,166.26
1,341.20
#
59426
860.86
817.82
940.49
58950
1,193.67
1,133.99
1,304.09
59430
270.54
257.01
295.56
58951
1,502.57
1,427.44
1,641.56
#
59430
194.20
184.49
212.16
58952
1,712.49
1,626.87
1,870.90
59510
2,820.96
2,679.91
3,081.90
58953
2,091.41
1,986.84
2,284.87
59514
986.42
937.10
1,077.67
58954
2,264.01
2,150.81
2,473.43
59515
1,410.99
1,340.44
1,541.51
58956
1,419.18
1,348.22
1,550.45
59525
522.62
496.49
570.96
58957
1,658.54
1,575.61
1,811.95
59610
2,672.03
2,538.43
2,919.19
58958
1,744.98
1,657.73
1,906.39
59612
986.93
937.58
1,078.22
58960
1,022.03
970.93
1,116.57
59614
1,245.08
1,182.83
1,360.25
58970
247.85
235.46
270.78
59618
2,854.24
2,711.53
3,118.26
58970
206.56
196.23
225.66
59620
1,020.03
969.03
1,114.38
58976
267.87
254.48
292.65
59622
1,460.81
1,387.77
1,595.94
58976
223.64
212.46
244.33
59812
377.73
358.84
412.67
59000
123.00
116.85
134.38
#
59812
327.93
311.53
358.26
59000
84.99
80.74
92.85
59820
450.76
428.22
492.45
59001
191.61
182.03
209.33
#
59820
402.27
382.16
439.48
59012
217.58
206.70
237.71
59821
448.09
425.69
489.54
59015
166.13
157.82
181.49
#
59821
397.63
377.75
434.41
59015
141.88
134.79
155.01
59830
491.80
467.21
537.29
59020
71.84
68.25
78.49
59840
258.82
245.88
282.76
59020
TC
32.61
30.98
35.63
#
59840
233.91
222.21
255.54
59020
26
39.23
37.27
42.86
59841
446.46
424.14
487.76
59025
50.73
48.19
55.42
#
59841
397.64
377.76
434.42
59025
TC
18.85
17.91
20.60
59850
417.23
396.37
455.83
59025
26
31.88
30.29
34.83
59851
450.37
427.85
492.03
59030
121.38
115.31
132.61
59852
622.34
591.22
679.90
59050
54.71
51.97
59.77
59855
454.55
431.82
496.59
59051
45.51
43.23
49.71
59856
533.31
506.64
582.64
59070
425.34
404.07
464.68
59857
624.63
593.40
682.41
59070
332.94
316.29
363.73
59866
256.57
243.74
280.30
59072
564.05
535.85
616.23
59870
556.13
528.32
607.57
59074
408.63
388.20
446.43
59871
142.20
135.09
155.35
59074
332.94
316.29
363.73
60000
181.18
172.12
197.94
59076
564.05
535.85
616.23
#
60000
155.29
147.53
169.66
59100
918.68
872.75
1,003.66
60100
112.40
106.78
122.80
59120
874.89
831.15
955.82
#
60100
79.64
75.66
87.01
59121
876.05
832.25
957.09
60200
696.24
661.43
760.64
59130
1,020.73
969.69
1,115.14
60210
741.98
704.88
810.61
59135
1,007.88
957.49
1,101.11
60212
1,100.92
1,045.87
1,202.75
59136
967.80
919.41
1,057.32
60220
737.85
700.96
806.10
59140
443.70
421.52
484.75
60225
973.30
924.64
1,063.34
59150
849.09
806.64
927.64
60240
963.90
915.71
1,053.07
59151
827.80
786.41
904.37
60252
1,388.37
1,318.95
1,516.79
59160
274.25
260.54
299.62
60254
1,741.18
1,654.12
1,902.24
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
54
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------60260
1,141.34
1,084.27
1,246.91
61512
2,780.06
2,641.06
3,037.22
60270
1,439.16
1,367.20
1,572.28
61514
2,079.97
1,975.97
2,272.37
60271
1,106.85
1,051.51
1,209.24
61516
2,035.62
1,933.84
2,223.92
60280
459.72
436.73
502.24
61517
95.64
90.86
104.49
60281
605.56
575.28
661.57
61518
3,011.12
2,860.56
3,289.64
60300
111.92
106.32
122.27
61519
3,210.03
3,049.53
3,506.96
60300
50.65
48.12
55.34
61520
4,055.84
3,853.05
4,431.01
60500
1,022.92
971.77
1,117.54
61521
3,443.50
3,271.33
3,762.03
60502
1,372.70
1,304.07
1,499.68
61522
2,382.61
2,263.48
2,603.00
60505
1,464.48
1,391.26
1,599.95
61524
2,268.79
2,155.35
2,478.65
60512
257.33
244.46
281.13
61526
3,582.70
3,403.57
3,914.11
60520
1,112.46
1,056.84
1,215.37
61530
3,352.02
3,184.42
3,662.08
60521
1,192.95
1,133.30
1,303.30
61531
1,325.27
1,259.01
1,447.86
60522
1,454.45
1,381.73
1,588.99
61533
1,658.49
1,575.57
1,811.91
60540
1,137.01
1,080.16
1,242.18
61534
1,792.09
1,702.49
1,957.86
60545
1,319.75
1,253.76
1,441.82
61535
1,084.75
1,030.51
1,185.09
60600
1,451.55
1,378.97
1,585.82
61536
2,809.73
2,669.24
3,069.63
60605
1,782.70
1,693.57
1,947.61
61537
2,687.03
2,552.68
2,935.58
60650
1,264.21
1,201.00
1,381.15
61538
2,904.61
2,759.38
3,173.29
61000
122.68
116.55
134.03
61539
2,572.54
2,443.91
2,810.50
61001
115.40
109.63
126.07
61540
2,372.19
2,253.58
2,591.62
61020
112.11
106.50
122.48
61541
2,340.16
2,223.15
2,556.62
61026
111.05
105.50
121.33
61543
2,366.48
2,248.16
2,585.38
61050
84.45
80.23
92.26
61544
2,068.57
1,965.14
2,259.91
61055
125.03
118.78
136.60
61545
3,470.35
3,296.83
3,791.35
61070
58.22
55.31
63.61
61546
2,514.28
2,388.57
2,746.86
61105
494.11
469.40
539.81
61548
1,692.37
1,607.75
1,848.91
61107
343.23
326.07
374.98
61550
1,288.83
1,224.39
1,408.05
61108
968.43
920.01
1,058.01
61552
1,611.16
1,530.60
1,760.19
61120
808.28
767.87
883.05
61556
1,857.34
1,764.47
2,029.14
61140
1,377.08
1,308.23
1,504.46
61557
1,827.70
1,736.32
1,996.77
61150
1,467.88
1,394.49
1,603.66
61558
2,044.31
1,942.09
2,233.40
61151
1,076.72
1,022.88
1,176.31
61559
2,606.47
2,476.15
2,847.57
61154
1,379.61
1,310.63
1,507.22
61563
2,158.72
2,050.78
2,358.40
61156
1,351.25
1,283.69
1,476.24
61564
2,620.21
2,489.20
2,862.58
61210
402.32
382.20
439.53
61566
2,443.19
2,321.03
2,669.18
61215
542.92
515.77
593.14
61567
2,783.07
2,643.92
3,040.51
61250
939.10
892.15
1,025.97
61570
2,034.18
1,932.47
2,222.34
61253
1,076.72
1,022.88
1,176.31
61571
2,166.19
2,057.88
2,366.56
61304
1,784.75
1,695.51
1,949.84
61575
2,729.87
2,593.38
2,982.39
61305
2,183.29
2,074.13
2,385.25
61576
4,548.46
4,321.04
4,969.20
61312
2,257.61
2,144.73
2,466.44
61580
2,620.43
2,489.41
2,862.82
61313
2,153.99
2,046.29
2,353.23
61581
3,001.69
2,851.61
3,279.35
61314
1,988.54
1,889.11
2,172.48
61582
3,226.27
3,064.96
3,524.70
61315
2,247.95
2,135.55
2,455.88
61583
3,156.02
2,998.22
3,447.95
61316
95.99
91.19
104.87
61584
3,111.87
2,956.28
3,399.72
61320
2,064.65
1,961.42
2,255.63
61585
3,557.61
3,379.73
3,886.69
61321
2,313.60
2,197.92
2,527.61
61586
2,708.42
2,573.00
2,958.95
61322
2,588.48
2,459.06
2,827.92
61590
3,185.57
3,026.29
3,480.23
61323
2,604.05
2,473.85
2,844.93
61591
3,230.12
3,068.61
3,528.90
61330
1,948.94
1,851.49
2,129.21
61592
3,439.33
3,267.36
3,757.46
61333
2,198.77
2,088.83
2,402.15
61595
2,526.21
2,399.90
2,759.89
61340
1,565.57
1,487.29
1,710.38
61596
2,520.92
2,394.87
2,754.10
61343
2,387.08
2,267.73
2,607.89
61597
3,216.66
3,055.83
3,514.20
61345
2,222.75
2,111.61
2,428.35
61598
3,104.64
2,949.41
3,391.82
61450
2,090.33
1,985.81
2,283.68
61600
2,253.09
2,140.44
2,461.51
61458
2,191.60
2,082.02
2,394.32
61601
2,611.60
2,481.02
2,853.17
61460
2,292.08
2,177.48
2,504.10
61605
2,256.72
2,143.88
2,465.46
61500
1,396.29
1,326.48
1,525.45
61606
3,164.64
3,006.41
3,457.37
61501
1,193.33
1,133.66
1,303.71
61607
3,313.74
3,148.05
3,620.26
61510
2,385.72
2,266.43
2,606.39
61608
3,543.39
3,366.22
3,871.15
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
55
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------61611
512.40
486.78
559.80
62120
2,262.38
2,149.26
2,471.65
61613
3,588.11
3,408.70
3,920.01
62121
1,655.82
1,573.03
1,808.98
61615
3,060.98
2,907.93
3,344.12
62140
1,093.29
1,038.63
1,194.42
61616
3,611.97
3,431.37
3,946.08
62141
1,234.66
1,172.93
1,348.87
61618
1,387.01
1,317.66
1,515.31
62142
953.92
906.22
1,042.15
61619
1,473.34
1,399.67
1,609.62
62143
1,131.17
1,074.61
1,235.80
61623
612.69
582.06
669.37
62145
1,525.01
1,448.76
1,666.07
61624
1,237.08
1,175.23
1,351.51
62146
1,357.56
1,289.68
1,483.13
61626
938.35
891.43
1,025.14
62147
1,532.67
1,456.04
1,674.45
61630
1,468.86
1,395.42
1,604.73
62148
138.29
131.38
151.09
61635
1,545.11
1,467.85
1,688.03
62160
208.27
197.86
227.54
61645
895.44
850.67
978.27
62161
1,644.40
1,562.18
1,796.51
61650
612.64
582.01
669.31
62162
2,054.89
1,952.15
2,244.97
61651
263.22
250.06
287.57
62164
2,273.69
2,160.01
2,484.01
61680
2,468.67
2,345.24
2,697.03
62165
1,618.05
1,537.15
1,767.72
61682
4,540.98
4,313.93
4,961.02
62180
1,738.76
1,651.82
1,899.59
61684
3,097.44
2,942.57
3,383.96
62190
1,003.85
953.66
1,096.71
61686
4,903.45
4,658.28
5,357.02
62192
1,060.61
1,007.58
1,158.72
61690
2,373.44
2,254.77
2,592.99
62194
527.05
500.70
575.81
61692
3,982.96
3,783.81
4,351.38
62200
1,496.53
1,421.70
1,634.96
61697
4,581.92
4,352.82
5,005.74
62201
1,310.07
1,244.57
1,431.26
61698
5,050.42
4,797.90
5,517.59
62220
1,062.76
1,009.62
1,161.06
61700
3,711.50
3,525.93
4,054.82
62223
1,118.83
1,062.89
1,222.32
61702
4,387.83
4,168.44
4,793.71
62225
568.00
539.60
620.54
61703
1,475.16
1,401.40
1,611.61
62230
909.09
863.64
993.19
61705
2,836.90
2,695.06
3,099.32
62252
85.04
80.79
92.91
61708
2,774.38
2,635.66
3,031.01
62252
TC
34.90
33.16
38.13
61710
2,339.90
2,222.91
2,556.35
62252
26
50.13
47.62
54.76
61711
2,796.94
2,657.09
3,055.65
62256
651.54
618.96
711.80
61720
1,380.00
1,311.00
1,507.65
62258
1,209.38
1,148.91
1,321.25
61735
1,733.28
1,646.62
1,893.61
62263
636.04
604.24
694.88
61750
1,529.59
1,453.11
1,671.08
#
62263
314.62
298.89
343.72
61751
1,499.70
1,424.72
1,638.43
62264
458.86
435.92
501.31
61760
1,721.39
1,635.32
1,880.62
#
62264
253.43
240.76
276.87
61770
1,765.99
1,677.69
1,929.34
62267
272.35
258.73
297.54
61781
259.10
246.15
283.07
#
62267
158.65
150.72
173.33
61782
179.69
170.71
196.32
62268
266.79
253.45
291.47
61783
253.07
240.42
276.48
62269
267.60
254.22
292.35
61790
952.92
905.27
1,041.06
62270
132.49
125.87
144.75
61791
1,222.36
1,161.24
1,335.43
#
62270
64.01
60.81
69.93
61796
1,101.87
1,046.78
1,203.80
62272
180.61
171.58
197.32
61797
241.06
229.01
263.36
#
62272
93.45
88.78
102.10
61798
1,498.72
1,423.78
1,637.35
62273
172.84
164.20
188.83
61799
331.32
314.75
361.96
#
62273
115.83
110.04
126.55
61800
165.77
157.48
181.10
62280
377.47
358.60
412.39
61850
1,068.32
1,014.90
1,167.14
#
62280
177.61
168.73
194.04
61860
1,702.10
1,617.00
1,859.55
62281
246.88
234.54
269.72
61863
1,630.75
1,549.21
1,781.59
#
62281
163.00
154.85
178.08
61864
310.06
294.56
338.74
62282
331.65
315.07
362.33
61867
2,484.10
2,359.90
2,713.89
#
62282
147.52
140.14
161.16
61868
546.22
518.91
596.75
62284
199.20
189.24
217.63
61880
621.32
590.25
678.79
#
62284
87.48
83.11
95.58
61885
557.44
529.57
609.01
62287
593.10
563.45
647.97
61886
926.20
879.89
1,011.87
62290
368.85
350.41
402.97
61888
428.65
407.22
468.30
#
62290
167.67
159.29
183.18
62000
1,120.91
1,064.86
1,224.59
62291
346.20
328.89
378.22
62005
1,380.35
1,311.33
1,508.03
#
62291
159.12
151.16
173.83
62010
1,668.73
1,585.29
1,823.08
62292
595.77
565.98
650.88
62100
1,678.56
1,594.63
1,833.82
62294
1,029.82
978.33
1,125.08
62115
1,824.45
1,733.23
1,993.21
62302
263.57
250.39
287.95
62117
2,141.62
2,034.54
2,339.72
#
62302
122.68
116.55
134.03
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
---#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
56
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------62303
267.83
254.44
292.61
63056
1,603.24
1,523.08
1,751.54
62303
122.68
116.55
134.03
63057
347.66
330.28
379.82
62304
260.54
247.51
284.64
63064
1,932.44
1,835.82
2,111.19
62304
120.96
114.91
132.15
63066
225.78
214.49
246.66
62305
282.70
268.57
308.86
63075
1,455.34
1,382.57
1,589.96
62305
125.76
119.47
137.39
63076
263.75
250.56
288.14
62320
168.51
160.08
184.09
63077
1,601.89
1,521.80
1,750.07
62320
102.33
97.21
111.79
63078
228.31
216.89
249.42
62321
268.25
254.84
293.07
63081
1,887.41
1,793.04
2,062.00
62321
110.32
104.80
120.52
63082
287.17
272.81
313.73
62322
146.15
138.84
159.67
63085
2,065.91
1,962.61
2,257.00
62322
83.89
79.70
91.66
63086
203.85
193.66
222.71
62323
263.98
250.78
288.40
63087
2,590.02
2,460.52
2,829.60
62323
101.46
96.39
110.85
63088
279.67
265.69
305.54
62324
142.92
135.77
156.14
63090
2,091.48
1,986.91
2,284.95
62324
91.81
87.22
100.30
63091
190.46
180.94
208.08
62325
257.98
245.08
281.84
63101
2,511.38
2,385.81
2,743.68
62325
114.15
108.44
124.71
63102
2,436.55
2,314.72
2,661.93
62326
145.31
138.04
158.75
63103
318.79
302.85
348.28
62326
88.62
84.19
96.82
63170
1,730.48
1,643.96
1,890.55
62327
265.19
251.93
289.72
63172
1,535.03
1,458.28
1,677.02
62327
105.95
100.65
115.75
63173
1,875.90
1,782.11
2,049.43
62328
258.97
246.02
282.92
63185
1,207.37
1,147.00
1,319.05
62328
92.20
87.59
100.73
63190
1,305.29
1,240.03
1,426.03
62329
329.43
312.96
359.90
63191
1,497.58
1,422.70
1,636.11
62329
119.73
113.74
130.80
63194
1,733.31
1,646.64
1,893.64
62350
417.11
396.25
455.69
63195
1,666.00
1,582.70
1,820.11
62351
961.12
913.06
1,050.02
63196
1,937.08
1,840.23
2,116.26
62355
283.48
269.31
309.71
63197
1,860.26
1,767.25
2,032.34
62360
335.65
318.87
366.70
63198
2,273.72
2,160.03
2,484.03
62361
460.41
437.39
503.00
63199
2,382.95
2,263.80
2,603.37
62362
405.91
385.61
443.45
63200
1,643.78
1,561.59
1,795.83
62365
310.82
295.28
339.57
63250
3,235.29
3,073.53
3,534.56
62367
32.03
30.43
34.99
63251
3,305.71
3,140.42
3,611.48
62367
25.48
24.21
27.84
63252
3,304.86
3,139.62
3,610.56
62368
45.91
43.61
50.15
63265
1,803.93
1,713.73
1,970.79
62368
36.73
34.89
40.12
63266
1,864.05
1,770.85
2,036.48
62369
96.36
91.54
105.27
63267
1,474.46
1,400.74
1,610.85
62369
37.06
35.21
40.49
63268
1,531.00
1,454.45
1,672.62
62370
98.66
93.73
107.79
63270
2,261.33
2,148.26
2,470.50
62370
48.21
45.80
52.67
63271
2,252.17
2,139.56
2,460.49
63001
1,331.69
1,265.11
1,454.88
63272
2,015.30
1,914.54
2,201.72
63003
1,331.39
1,264.82
1,454.54
63273
2,031.63
1,930.05
2,219.56
63005
1,285.50
1,221.23
1,404.41
63275
1,958.23
1,860.32
2,139.37
63011
1,168.26
1,109.85
1,276.33
63276
1,944.87
1,847.63
2,124.77
63012
1,279.68
1,215.70
1,398.06
63277
1,683.45
1,599.28
1,839.17
63015
1,596.90
1,517.06
1,744.62
63278
1,730.42
1,643.90
1,890.49
63016
1,644.25
1,562.04
1,796.35
63280
2,307.70
2,192.32
2,521.17
63017
1,359.79
1,291.80
1,485.57
63281
2,282.17
2,168.06
2,493.27
63020
1,240.63
1,178.60
1,355.39
63282
2,151.27
2,043.71
2,350.27
63030
1,040.54
988.51
1,136.79
63283
2,067.74
1,964.35
2,259.00
63035
207.59
197.21
226.79
63285
2,849.22
2,706.76
3,112.77
63040
1,490.73
1,416.19
1,628.62
63286
2,811.49
2,670.92
3,071.56
63042
1,381.67
1,312.59
1,509.48
63287
2,990.22
2,840.71
3,266.82
63045
1,384.66
1,315.43
1,512.74
63290
3,041.35
2,889.28
3,322.67
63046
1,317.14
1,251.28
1,438.97
63295
359.04
341.09
392.25
63047
1,180.22
1,121.21
1,289.39
63300
1,971.45
1,872.88
2,153.81
63048
228.51
217.08
249.64
63301
2,400.54
2,280.51
2,622.59
63050
1,603.11
1,522.95
1,751.39
63302
2,370.50
2,251.98
2,589.78
63051
1,818.34
1,727.42
1,986.53
63303
2,521.58
2,395.50
2,754.83
63055
1,759.03
1,671.08
1,921.74
63304
2,559.38
2,431.41
2,796.12
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
57
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------63305
2,724.51
2,588.28
2,976.52
#
64450
43.78
41.59
47.83
63306
2,676.11
2,542.30
2,923.65
64451
221.42
210.35
241.90
63307
2,622.22
2,491.11
2,864.78
#
64451
81.19
77.13
88.70
63308
350.55
333.02
382.97
64454
220.77
209.73
241.19
63600
1,185.61
1,126.33
1,295.28
#
64454
83.81
79.62
91.56
63610
632.79
601.15
691.32
64455
48.99
46.54
53.52
63620
1,218.89
1,157.95
1,331.64
#
64455
34.57
32.84
37.77
63621
276.09
262.29
301.63
64461
135.74
128.95
148.29
63650
2,206.24
2,095.93
2,410.32
#
64461
80.04
76.04
87.45
63650
426.46
405.14
465.91
64462
75.33
71.56
82.29
63655
892.43
847.81
974.98
#
64462
50.75
48.21
55.44
63661
688.56
654.13
752.25
64463
224.20
212.99
244.94
63661
340.60
323.57
372.11
#
64463
85.28
81.02
93.17
63662
904.62
859.39
988.30
64479
266.69
253.36
291.36
63663
907.34
861.97
991.27
#
64479
133.67
126.99
146.04
63663
468.95
445.50
512.33
64480
135.53
128.75
148.06
63664
941.80
894.71
1,028.92
#
64480
64.44
61.22
70.40
63685
379.49
360.52
414.60
64483
247.15
234.79
270.01
63688
390.27
370.76
426.37
#
64483
113.47
107.80
123.97
63700
1,417.15
1,346.29
1,548.23
64484
111.65
106.07
121.98
63702
1,551.87
1,474.28
1,695.42
#
64484
53.66
50.98
58.63
63704
1,801.62
1,711.54
1,968.27
64486
114.70
108.97
125.32
63706
2,003.95
1,903.75
2,189.31
#
64486
58.01
55.11
63.38
63707
998.86
948.92
1,091.26
64487
207.89
197.50
227.13
63709
1,190.43
1,130.91
1,300.55
#
64487
67.00
63.65
73.20
63710
1,155.80
1,098.01
1,262.71
64488
141.30
134.24
154.38
63740
1,060.85
1,007.81
1,158.98
#
64488
71.84
68.25
78.49
63741
721.58
685.50
788.33
64489
329.81
313.32
360.32
63744
738.96
702.01
807.31
#
64489
80.80
76.76
88.27
63746
652.27
619.66
712.61
64490
194.58
184.85
212.58
64400
114.32
108.60
124.89
#
64490
108.40
102.98
118.43
64400
53.05
50.40
57.96
64491
99.41
94.44
108.61
64405
77.39
73.52
84.55
#
64491
62.38
59.26
68.15
64405
57.08
54.23
62.36
64492
99.74
94.75
108.96
64408
78.36
74.44
85.61
#
64492
63.37
60.20
69.23
64408
45.27
43.01
49.46
64493
177.85
168.96
194.30
64415
114.54
108.81
125.13
#
64493
92.33
87.71
100.87
64415
65.06
61.81
71.08
64494
92.00
87.40
100.51
64416
67.00
63.65
73.20
#
64494
53.33
50.66
58.26
64417
140.25
133.24
153.23
64495
92.00
87.40
100.51
64417
62.60
59.47
68.39
#
64495
53.99
51.29
58.98
64418
90.61
86.08
98.99
64505
139.47
132.50
152.38
64418
59.81
56.82
65.34
#
64505
104.74
99.50
114.43
64420
100.53
95.50
109.83
64510
147.37
140.00
161.00
64420
60.89
57.85
66.53
#
64510
78.57
74.64
85.84
64421
34.37
32.65
37.55
64517
196.04
186.24
214.18
64421
25.85
24.56
28.24
#
64517
128.54
122.11
140.43
64425
114.78
109.04
125.40
64520
229.08
217.63
250.27
64425
57.11
54.25
62.39
#
64520
85.90
81.61
93.85
64430
98.09
93.19
107.17
64530
231.05
219.50
252.43
64430
57.13
54.27
62.41
#
64530
96.06
91.26
104.95
64435
80.84
76.80
88.32
64553
2,371.99
2,253.39
2,591.40
64435
45.78
43.49
50.01
#
64553
374.01
355.31
408.61
64445
127.71
121.32
139.52
64555
2,161.18
2,053.12
2,361.09
64445
55.30
52.54
60.42
#
64555
351.59
334.01
384.11
64446
61.15
58.09
66.80
64561
771.54
732.96
842.90
64447
90.40
85.88
98.76
#
64561
314.14
298.43
343.19
64447
54.36
51.64
59.39
64566
125.37
119.10
136.97
64448
62.90
59.76
68.72
#
64566
32.32
30.70
35.31
64449
64.58
61.35
70.55
64568
653.89
621.20
714.38
64450
78.18
74.27
85.41
64569
816.90
776.06
892.47
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
58
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------64570
789.36
749.89
862.37
#
64653
54.29
51.58
59.32
64575
350.12
332.61
382.50
64680
351.42
333.85
383.93
64580
330.47
313.95
361.04
#
64680
164.33
156.11
179.53
64581
685.84
651.55
749.28
64681
478.55
454.62
522.81
64585
254.57
241.84
278.12
#
64681
229.87
218.38
251.14
64585
146.78
139.44
160.36
64702
524.64
498.41
573.17
64590
274.20
260.49
299.56
64704
330.59
314.06
361.17
64590
165.42
157.15
180.72
64708
526.28
499.97
574.97
64595
243.04
230.89
265.52
64712
619.40
588.43
676.69
64595
130.00
123.50
142.03
64713
824.99
783.74
901.30
64600
471.31
447.74
514.90
64714
795.03
755.28
868.57
64600
237.37
225.50
259.33
64716
529.99
503.49
579.01
64605
655.10
622.35
715.70
64718
620.14
589.13
677.50
64605
364.15
345.94
397.83
64719
419.02
398.07
457.78
64610
828.96
787.51
905.64
64721
454.77
432.03
496.83
64610
520.31
494.29
568.43
#
64721
447.56
425.18
488.96
64611
130.31
123.79
142.36
64722
369.92
351.42
404.13
64611
112.94
107.29
123.38
64726
272.21
258.60
297.39
64612
137.75
130.86
150.49
64727
190.13
180.62
207.71
64612
120.38
114.36
131.51
64732
478.66
454.73
522.94
64615
162.24
154.13
177.25
64734
540.75
513.71
590.77
64615
132.76
126.12
145.04
64736
338.70
321.77
370.04
64616
142.45
135.33
155.63
64738
456.24
433.43
498.44
64616
115.91
110.11
126.63
64740
473.96
450.26
517.80
64617
165.81
157.52
181.15
64742
491.29
466.73
536.74
64617
111.75
106.16
122.08
64744
535.75
508.96
585.30
64620
213.83
203.14
233.61
64746
457.85
434.96
500.20
64620
180.41
171.39
197.10
64755
990.87
941.33
1,082.53
64624
408.39
387.97
446.17
64760
551.77
524.18
602.81
64624
150.21
142.70
164.11
64763
546.61
519.28
597.17
64625
498.65
473.72
544.78
64766
675.61
641.83
738.10
64625
197.87
187.98
216.18
64771
626.31
594.99
684.24
64630
259.86
246.87
283.90
64772
584.36
555.14
638.41
64630
198.26
188.35
216.60
64774
419.96
398.96
458.80
64632
89.54
85.06
97.82
64776
403.21
383.05
440.51
64632
67.91
64.51
74.19
64778
192.49
182.87
210.30
64633
425.45
404.18
464.81
64782
471.55
447.97
515.17
64633
229.51
218.03
250.73
64783
228.76
217.32
249.92
64634
190.51
180.98
208.13
64784
760.45
722.43
830.79
64634
69.93
66.43
76.39
64786
1,079.37
1,025.40
1,179.21
64635
421.21
400.15
460.17
64787
251.91
239.31
275.21
64635
226.26
214.95
247.19
64788
418.40
397.48
457.10
64636
173.44
164.77
189.49
64790
879.32
835.35
960.65
64636
61.38
58.31
67.06
64792
1,129.22
1,072.76
1,233.67
64640
253.57
240.89
277.02
64795
202.70
192.57
221.46
64640
120.87
114.83
132.05
64802
904.22
859.01
987.86
64642
153.58
145.90
167.79
64804
1,287.32
1,222.95
1,406.39
64642
112.62
106.99
123.04
64809
1,180.02
1,121.02
1,289.17
64643
96.35
91.53
105.26
64818
816.18
775.37
891.68
64643
74.73
70.99
81.64
64820
754.79
717.05
824.61
64644
180.34
171.32
197.02
64821
727.67
691.29
794.98
64644
123.33
117.16
134.73
64822
727.67
691.29
794.98
64645
124.31
118.09
135.80
64823
827.07
785.72
903.58
64645
87.29
82.93
95.37
64831
714.62
678.89
780.72
64646
162.65
154.52
177.70
64832
350.44
332.92
382.86
64646
122.35
116.23
133.66
64834
771.80
733.21
843.19
64647
186.83
177.49
204.11
64835
854.09
811.39
933.10
64647
142.27
135.16
155.43
64836
854.09
811.39
933.10
64650
88.91
84.46
97.13
64837
385.85
366.56
421.54
64650
42.38
40.26
46.30
64840
1,007.33
956.96
1,100.50
64653
106.39
101.07
116.23
64856
1,055.70
1,002.92
1,153.36
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
59
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------64857
1,102.74
1,047.60
1,204.74
65273
377.82
358.93
412.77
64858
1,235.01
1,173.26
1,349.25
65275
587.37
558.00
641.70
64859
262.28
249.17
286.55
#
65275
458.60
435.67
501.02
64861
1,648.59
1,566.16
1,801.08
65280
666.12
632.81
727.73
64862
1,444.06
1,371.86
1,577.64
65285
1,100.08
1,045.08
1,201.84
64864
887.84
843.45
969.97
65286
703.92
668.72
769.03
64865
1,121.14
1,065.08
1,224.84
#
65286
491.28
466.72
536.73
64866
1,307.05
1,241.70
1,427.96
65290
486.48
462.16
531.48
64868
1,027.85
976.46
1,122.93
65400
687.50
653.13
751.10
64872
123.39
117.22
134.80
#
65400
595.43
565.66
650.51
64874
184.65
175.42
201.73
65410
142.64
135.51
155.84
64876
208.32
197.90
227.59
#
65410
101.69
96.61
111.10
64885
1,143.62
1,086.44
1,249.41
65420
537.91
511.01
587.66
64886
1,319.42
1,253.45
1,441.47
#
65420
373.44
354.77
407.99
64890
1,133.71
1,077.02
1,238.57
65426
670.72
637.18
732.76
64891
1,205.24
1,144.98
1,316.73
#
65426
472.82
449.18
516.56
64892
1,101.06
1,046.01
1,202.91
65430
114.79
109.05
125.41
64893
1,175.79
1,117.00
1,284.55
#
65430
101.03
95.98
110.38
64895
1,393.80
1,324.11
1,522.73
65435
81.30
77.24
88.83
64896
1,501.28
1,426.22
1,640.15
#
65435
67.87
64.48
74.15
64897
1,331.00
1,264.45
1,454.12
65436
383.78
364.59
419.28
64898
1,441.34
1,369.27
1,574.66
#
65436
365.43
347.16
399.23
64901
629.74
598.25
687.99
65450
323.48
307.31
353.41
64902
728.81
692.37
796.23
#
65450
316.27
300.46
345.53
64905
1,060.28
1,007.27
1,158.36
65600
425.50
404.23
464.86
64907
1,367.90
1,299.51
1,494.44
#
65600
335.40
318.63
366.42
64910
806.42
766.10
881.02
65710
1,128.89
1,072.45
1,233.32
64911
1,069.54
1,016.06
1,168.47
65730
1,242.67
1,180.54
1,357.62
64912
913.22
867.56
997.69
65750
1,250.56
1,188.03
1,366.23
64913
184.57
175.34
201.64
65755
1,244.76
1,182.52
1,359.90
65091
723.01
686.86
789.89
65756
1,168.53
1,110.10
1,276.62
65093
716.97
681.12
783.29
65770
1,389.82
1,320.33
1,518.38
65101
828.68
787.25
905.34
65772
454.16
431.45
496.17
65103
856.06
813.26
935.25
#
65772
399.45
379.48
436.40
65105
933.99
887.29
1,020.38
65775
564.15
535.94
616.33
65110
1,300.69
1,235.66
1,421.01
65778
1,405.97
1,335.67
1,536.02
65112
1,494.63
1,419.90
1,632.89
#
65778
53.78
51.09
58.75
65114
1,559.85
1,481.86
1,704.14
65779
1,214.02
1,153.32
1,326.32
65125
459.83
436.84
502.37
#
65779
149.50
142.03
163.33
65125
288.80
274.36
315.51
65780
660.50
627.48
721.60
65130
828.46
787.04
905.10
65781
1,318.02
1,252.12
1,439.94
65135
838.34
796.42
915.88
65782
1,136.93
1,080.08
1,242.09
65140
902.65
857.52
986.15
65785
2,316.20
2,200.39
2,530.45
65150
676.30
642.49
738.86
#
65785
438.13
416.22
478.65
65155
939.26
892.30
1,026.15
65800
119.53
113.55
130.58
65175
754.78
717.04
824.60
#
65800
91.02
86.47
99.44
65205
29.91
28.41
32.67
65810
459.05
436.10
501.52
65205
29.59
28.11
32.33
65815
645.71
613.42
705.43
65210
39.34
37.37
42.98
#
65815
471.07
447.52
514.65
65210
36.72
34.88
40.11
65820
804.94
764.69
879.39
65220
61.06
58.01
66.71
65850
837.76
795.87
915.25
65220
42.71
40.57
46.66
65855
245.44
233.17
268.15
65222
67.53
64.15
73.77
#
65855
204.49
194.27
223.41
65222
50.82
48.28
55.52
65860
306.69
291.36
335.06
65235
720.30
684.29
786.93
#
65860
246.74
234.40
269.56
65260
972.82
924.18
1,062.81
65865
473.03
449.38
516.79
65265
1,093.58
1,038.90
1,194.74
65870
588.30
558.89
642.72
65270
284.92
270.67
311.27
65875
628.39
596.97
686.52
65270
140.43
133.41
153.42
65880
661.23
628.17
722.40
65272
527.17
500.81
575.93
65900
982.91
933.76
1,073.82
65272
350.57
333.04
383.00
65920
784.38
745.16
856.93
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
#
#
#
#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
60
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------65930
636.72
604.88
695.61
66990
90.00
85.50
98.33
66020
196.10
186.30
214.25
67005
467.39
444.02
510.62
66020
129.59
123.11
141.58
67010
535.81
509.02
585.37
66030
175.86
167.07
192.13
67015
594.80
565.06
649.82
66030
109.34
103.87
119.45
67025
738.00
701.10
806.27
66130
708.05
672.65
773.55
#
67025
624.96
593.71
682.77
66130
560.94
532.89
612.82
67027
841.37
799.30
919.20
66150
867.63
824.25
947.89
67028
113.09
107.44
123.56
66155
867.28
823.92
947.51
#
67028
92.12
87.51
100.64
66160
978.22
929.31
1,068.71
67030
546.34
519.02
596.87
66170
1,082.20
1,028.09
1,182.30
67031
388.09
368.69
423.99
66172
1,180.35
1,121.33
1,289.53
#
67031
351.39
333.82
383.89
66174
933.85
887.16
1,020.23
67036
890.02
845.52
972.35
66175
980.39
931.37
1,071.08
67039
952.48
904.86
1,040.59
66179
1,069.23
1,015.77
1,168.14
67040
1,029.89
978.40
1,125.16
66180
1,129.11
1,072.65
1,233.55
67041
1,137.78
1,080.89
1,243.02
66183
1,020.30
969.29
1,114.68
67042
1,137.78
1,080.89
1,243.02
66184
780.37
741.35
852.55
67043
1,199.74
1,139.75
1,310.71
66185
839.41
797.44
917.06
67101
330.09
313.59
360.63
66225
926.68
880.35
1,012.40
#
67101
280.95
266.90
306.94
66250
756.25
718.44
826.21
67105
293.97
279.27
321.16
66250
550.16
522.65
601.05
#
67105
271.37
257.80
296.47
66500
383.57
364.39
419.05
67107
1,116.88
1,061.04
1,220.20
66505
417.85
396.96
456.50
67108
1,183.75
1,124.56
1,293.24
66600
886.88
842.54
968.92
67110
883.07
838.92
964.76
66605
1,081.85
1,027.76
1,181.92
#
67110
803.46
763.29
877.78
66625
424.66
403.43
463.94
67113
1,323.52
1,257.34
1,445.94
66630
561.20
533.14
613.11
67115
492.28
467.67
537.82
66635
566.30
537.99
618.69
67120
666.14
632.83
727.75
66680
515.83
490.04
563.55
#
67120
548.85
521.41
599.62
66682
694.33
659.61
758.55
67121
897.00
852.15
979.97
66700
448.87
426.43
490.39
67141
519.88
493.89
567.97
66700
387.60
368.22
423.45
#
67141
479.91
455.91
524.30
66710
440.68
418.65
481.45
67145
522.88
496.74
571.25
66710
387.60
368.22
423.45
#
67145
490.45
465.93
535.82
66711
498.75
473.81
544.88
67208
597.58
567.70
652.86
66720
459.65
436.67
502.17
#
67208
572.35
543.73
625.29
66720
403.29
383.13
440.60
67210
512.16
486.55
559.53
66740
436.75
414.91
477.15
#
67210
492.50
467.88
538.06
66740
387.60
368.22
423.45
67218
1,386.28
1,316.97
1,514.52
66761
297.87
282.98
325.43
67220
527.88
501.49
576.71
66761
233.65
221.97
255.27
#
67220
492.50
467.88
538.06
66762
474.80
451.06
518.72
67221
275.93
262.13
301.45
66762
420.41
399.39
459.30
#
67221
209.41
198.94
228.78
66770
525.41
499.14
574.01
67225
29.54
28.06
32.27
66770
475.61
451.83
519.60
#
67225
27.90
26.51
30.49
66820
452.77
430.13
494.65
67227
292.41
277.79
319.46
66821
330.41
313.89
360.97
#
67227
252.11
239.50
275.43
66821
307.47
292.10
335.92
67228
338.77
321.83
370.10
66825
814.33
773.61
889.65
#
67228
302.07
286.97
330.02
66830
704.45
669.23
769.61
67229
1,152.46
1,094.84
1,259.07
66840
687.43
653.06
751.02
67250
879.71
835.72
961.08
66850
781.18
742.12
853.44
67255
679.29
645.33
742.13
66852
832.23
790.62
909.21
67311
592.27
562.66
647.06
66920
742.41
705.29
811.08
67312
717.17
681.31
783.51
66930
849.54
807.06
928.12
67314
677.39
643.52
740.05
66940
775.71
736.92
847.46
67316
802.16
762.05
876.36
66982
739.72
702.73
808.14
67318
708.10
672.70
773.61
66984
539.55
512.57
589.46
67320
317.90
302.01
347.31
66985
760.44
722.42
830.78
67331
301.74
286.65
329.65
66986
896.85
852.01
979.81
67332
327.26
310.90
357.54
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
61
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------67334
297.14
282.28
324.62
67901
794.89
755.15
868.42
67335
146.20
138.89
159.72
#
67901
583.56
554.38
637.54
67340
353.45
335.78
386.15
67902
720.13
684.12
786.74
67343
659.53
626.55
720.53
67903
604.58
574.35
660.50
67345
244.96
232.71
267.62
#
67903
477.13
453.27
521.26
67345
217.76
206.87
237.90
67904
742.64
705.51
811.34
67346
188.97
179.52
206.45
#
67904
590.94
561.39
645.60
67400
1,016.09
965.29
1,110.08
67906
500.63
475.60
546.94
67405
879.22
835.26
960.55
67908
530.33
503.81
579.38
67412
967.11
918.75
1,056.56
#
67908
426.80
405.46
466.28
67413
941.26
894.20
1,028.33
67909
550.95
523.40
601.91
67414
1,437.16
1,365.30
1,570.10
#
67909
434.64
412.91
474.85
67415
103.81
98.62
113.41
67911
555.32
527.55
606.68
67420
1,720.89
1,634.85
1,880.08
67912
918.43
872.51
1,003.39
67430
1,359.10
1,291.15
1,484.82
#
67912
484.63
460.40
529.46
67440
1,318.96
1,253.01
1,440.96
67914
490.23
465.72
535.58
67445
1,511.00
1,435.45
1,650.77
#
67914
322.80
306.66
352.66
67450
1,365.91
1,297.61
1,492.25
67915
316.21
300.40
345.46
67500
75.50
71.73
82.49
#
67915
194.33
184.61
212.30
67500
62.72
59.58
68.52
67916
614.79
584.05
671.66
67505
86.96
82.61
95.00
#
67916
425.41
404.14
464.76
67505
72.55
68.92
79.26
67917
625.92
594.62
683.81
67515
51.28
48.72
56.03
#
67917
451.61
429.03
493.38
67515
47.02
44.67
51.37
67921
480.09
456.09
524.50
67550
1,062.96
1,009.81
1,161.28
#
67921
306.11
290.80
334.42
67560
1,087.63
1,033.25
1,188.24
67922
306.06
290.76
334.37
67570
1,340.27
1,273.26
1,464.25
#
67922
193.68
184.00
211.60
67700
288.63
274.20
315.33
67923
614.11
583.40
670.91
67700
114.65
108.92
125.26
#
67923
425.06
403.81
464.38
67710
245.31
233.04
268.00
67924
652.61
619.98
712.98
67710
96.56
91.73
105.49
#
67924
451.44
428.87
493.20
67715
267.09
253.74
291.80
67930
374.01
355.31
408.61
67715
107.52
102.14
117.46
#
67930
236.72
224.88
258.61
67800
127.77
121.38
139.59
67935
601.51
571.43
657.14
67800
102.22
97.11
111.68
#
67935
439.32
417.35
479.95
67801
162.29
154.18
177.31
67938
273.16
259.50
298.43
67801
131.49
124.92
143.66
#
67938
115.24
109.48
125.90
67805
201.09
191.04
219.70
67950
586.61
557.28
640.87
67805
162.10
154.00
177.10
#
67950
459.16
436.20
501.63
67808
363.00
344.85
396.58
67961
587.26
557.90
641.59
67810
185.60
176.32
202.77
#
67961
449.32
426.85
490.88
67810
69.62
66.14
76.06
67966
779.07
740.12
851.14
67820
21.01
19.96
22.95
#
67966
649.65
617.17
709.75
67820
22.32
21.20
24.38
67971
715.17
679.41
781.32
67825
134.04
127.34
146.44
67973
920.26
874.25
1,005.39
67825
119.95
113.95
131.04
67974
917.71
871.82
1,002.59
67830
274.82
261.08
300.24
67975
676.53
642.70
739.11
67830
135.90
129.11
148.48
68020
120.41
114.39
131.55
67835
436.01
414.21
476.34
#
68020
109.60
104.12
119.74
67840
284.73
270.49
311.06
68040
61.48
58.41
67.17
67840
155.64
147.86
170.04
#
68040
47.72
45.33
52.13
67850
219.75
208.76
240.07
68100
181.05
172.00
197.80
67850
129.98
123.48
142.00
#
68100
94.88
90.14
103.66
67875
185.00
175.75
202.11
68110
236.63
224.80
258.52
67875
95.88
91.09
104.75
#
68110
146.20
138.89
159.72
67880
467.85
444.46
511.13
68115
334.43
317.71
365.37
67880
363.65
345.47
397.29
#
68115
181.09
172.04
197.85
67882
571.05
542.50
623.88
68130
553.31
525.64
604.49
67882
465.22
441.96
508.25
#
68130
407.18
386.82
444.84
67900
652.53
619.90
712.89
68135
156.51
148.68
170.98
67900
505.09
479.84
551.82
#
68135
147.99
140.59
161.68
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
---#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
62
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------68200
41.38
39.31
45.21
#
69020
143.85
136.66
157.16
68200
34.17
32.46
37.33
69100
98.63
93.70
107.76
68320
742.80
705.66
811.51
#
69100
47.84
45.45
52.27
68320
532.45
505.83
581.70
69105
146.26
138.95
159.79
68325
648.37
615.95
708.34
#
69105
63.69
60.51
69.59
68326
636.78
604.94
695.68
69110
475.51
451.73
519.49
68328
701.70
666.62
766.61
#
69110
330.69
314.16
361.28
68330
623.44
592.27
681.11
69120
404.99
384.74
442.45
68330
454.38
431.66
496.41
69140
916.29
870.48
1,001.05
68335
639.16
607.20
698.28
69145
414.02
393.32
452.32
68340
597.57
567.69
652.84
#
69145
257.73
244.84
281.57
68340
392.79
373.15
429.12
69150
1,058.32
1,005.40
1,156.21
68360
543.95
516.75
594.26
69155
1,685.34
1,601.07
1,841.23
68360
404.70
384.47
442.14
69200
81.85
77.76
89.42
68362
647.84
615.45
707.77
#
69200
48.43
46.01
52.91
68371
407.96
387.56
445.69
69205
96.58
91.75
105.51
68400
300.35
285.33
328.13
69209
14.59
13.86
15.94
68400
129.65
123.17
141.65
69210
48.40
45.98
52.88
68420
336.59
319.76
367.72
#
69210
34.64
32.91
37.85
68420
165.56
157.28
180.87
69220
80.03
76.03
87.43
68440
102.61
97.48
112.10
#
69220
52.84
50.20
57.73
68440
98.03
93.13
107.10
69222
216.74
205.90
236.79
68500
1,037.22
985.36
1,133.16
#
69222
136.47
129.65
149.10
68505
1,032.29
980.68
1,127.78
69300
643.95
611.75
703.51
68510
464.47
441.25
507.44
#
69300
470.95
447.40
514.51
68510
290.49
275.97
317.37
69310
1,142.08
1,084.98
1,247.73
68520
722.29
686.18
789.11
69320
1,594.09
1,514.39
1,741.55
68525
261.72
248.63
285.92
69420
191.19
181.63
208.87
68530
438.49
416.57
479.06
#
69420
120.75
114.71
131.92
68530
251.73
239.14
275.01
69421
151.62
144.04
165.65
68540
967.12
918.76
1,056.57
69424
130.18
123.67
142.22
68550
1,200.40
1,140.38
1,311.44
#
69424
61.38
58.31
67.06
68700
597.09
567.24
652.33
69433
201.27
191.21
219.89
68705
259.88
246.89
283.92
#
69433
131.81
125.22
144.00
68705
163.22
155.06
178.32
69436
160.00
152.00
174.80
68720
794.99
755.24
868.53
69440
711.85
676.26
777.70
68745
797.95
758.05
871.76
69450
562.47
534.35
614.50
68750
838.40
796.48
915.95
69501
737.99
701.09
806.25
68760
219.18
208.22
239.45
69502
984.11
934.90
1,075.14
68760
143.82
136.63
157.12
69505
1,254.94
1,192.19
1,371.02
68761
147.74
140.35
161.40
69511
1,285.30
1,221.04
1,404.20
68761
115.96
110.16
126.68
69530
1,717.29
1,631.43
1,876.14
68770
621.26
590.20
678.73
69535
2,739.45
2,602.48
2,992.85
68801
93.70
89.02
102.37
69540
210.05
199.55
229.48
68801
76.66
72.83
83.75
#
69540
128.47
122.05
140.36
68810
160.83
152.79
175.71
69550
1,084.92
1,030.67
1,185.27
68810
126.43
120.11
138.13
69552
1,627.87
1,546.48
1,778.45
68811
133.58
126.90
145.94
69554
2,598.76
2,468.82
2,839.14
68815
386.83
367.49
422.61
69601
1,058.48
1,005.56
1,156.39
68815
219.07
208.12
239.34
69602
1,124.07
1,067.87
1,228.05
68816
844.37
802.15
922.47
69603
1,311.96
1,246.36
1,433.31
68816
155.34
147.57
169.71
69604
1,147.15
1,089.79
1,253.26
68840
131.30
124.74
143.45
69610
387.71
368.32
423.57
68840
114.91
109.16
125.53
#
69610
294.66
279.93
321.92
68850
61.06
58.01
66.71
69620
738.50
701.58
806.82
68850
53.53
50.85
58.48
#
69620
499.97
474.97
546.22
69000
189.83
180.34
207.39
69631
917.33
871.46
1,002.18
69000
123.97
117.77
135.44
69632
1,115.53
1,059.75
1,218.71
69005
222.61
211.48
243.20
69633
1,082.18
1,028.07
1,182.28
69005
161.34
153.27
176.26
69635
1,297.20
1,232.34
1,417.19
69020
236.24
224.43
258.09
69636
1,439.42
1,367.45
1,572.57
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
#
#
#
0
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
63
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------69637
1,476.93
1,403.08
1,613.54
70134
58.08
55.18
63.46
69641
1,075.41
1,021.64
1,174.89
70134
TC
40.80
38.76
44.57
69642
1,381.48
1,312.41
1,509.27
70134
26
17.28
16.42
18.88
69643
1,267.82
1,204.43
1,385.09
70140
31.55
29.97
34.47
69644
1,540.15
1,463.14
1,682.61
70140
TC
21.47
20.40
23.46
69645
1,517.07
1,441.22
1,657.40
70140
26
10.08
9.58
11.02
69646
1,604.80
1,524.56
1,753.24
70150
46.11
43.80
50.37
69650
828.28
786.87
904.90
70150
TC
33.27
31.61
36.35
69660
955.21
907.45
1,043.57
70150
26
12.85
12.21
14.04
69661
1,245.59
1,183.31
1,360.81
70160
37.08
35.23
40.51
69662
1,196.44
1,136.62
1,307.11
70160
TC
28.35
26.93
30.97
69666
833.73
792.04
910.85
70160
26
8.73
8.29
9.53
69667
834.41
792.69
911.59
70170
26
14.57
13.84
15.92
69670
974.02
925.32
1,064.12
70190
37.82
35.93
41.32
69676
859.33
816.36
938.81
70190
TC
26.71
25.37
29.18
69700
691.04
656.49
754.96
70190
26
11.10
10.55
12.13
69705
2,936.43
2,789.61
3,208.05
70200
47.14
44.78
51.50
69705
179.62
170.64
196.24
70200
TC
33.27
31.61
36.35
69706
3,030.04
2,878.54
3,310.32
70200
26
13.87
13.18
15.16
69706
249.96
237.46
273.08
70210
31.51
29.93
34.42
69711
871.58
828.00
952.20
70210
TC
22.78
21.64
24.89
69714
1,088.92
1,034.47
1,189.64
70210
26
8.73
8.29
9.53
69715
1,346.46
1,279.14
1,471.01
70220
36.86
35.02
40.27
69717
1,143.89
1,086.70
1,249.71
70220
TC
26.06
24.76
28.47
69718
1,360.29
1,292.28
1,486.12
70220
26
10.80
10.26
11.80
69720
1,223.61
1,162.43
1,336.79
70240
32.53
30.90
35.54
69725
1,929.60
1,833.12
2,108.09
70240
TC
23.11
21.95
25.24
69740
1,197.53
1,137.65
1,308.30
70240
26
9.42
8.95
10.29
69745
1,276.55
1,212.72
1,394.63
70250
34.80
33.06
38.02
69801
223.67
212.49
244.36
70250
TC
25.73
24.44
28.11
69801
126.68
120.35
138.40
70250
26
9.07
8.62
9.91
69805
1,064.92
1,011.67
1,163.42
70260
43.86
41.67
47.92
69806
958.02
910.12
1,046.64
70260
TC
29.99
28.49
32.76
69905
947.23
899.87
1,034.85
70260
26
13.87
13.18
15.16
69910
1,030.05
978.55
1,125.33
70300
13.01
12.36
14.21
69915
1,559.99
1,481.99
1,704.29
70300
TC
7.71
7.32
8.42
69930
1,258.84
1,195.90
1,375.29
70300
26
5.30
5.04
5.80
69950
1,807.69
1,717.31
1,974.91
70310
37.71
35.82
41.19
69955
2,030.27
1,928.76
2,218.07
70310
TC
29.99
28.49
32.76
69960
1,953.60
1,855.92
2,134.31
70310
26
7.72
7.33
8.43
69970
2,198.39
2,088.47
2,401.74
70320
54.88
52.14
59.96
69990
238.04
226.14
260.06
70320
TC
43.42
41.25
47.44
70010
60.62
57.59
66.23
70320
26
11.45
10.88
12.51
70015
166.41
158.09
181.80
70328
33.82
32.13
36.95
70015
TC
108.30
102.89
118.32
70328
TC
24.75
23.51
27.04
70015
26
58.12
55.21
63.49
70328
26
9.07
8.62
9.91
70030
31.53
29.95
34.44
70330
51.97
49.37
56.78
70030
TC
22.45
21.33
24.53
70330
TC
40.15
38.14
43.86
70030
26
9.07
8.62
9.91
70330
26
11.82
11.23
12.91
70100
37.43
35.56
40.89
70332
84.58
80.35
92.40
70100
TC
28.35
26.93
30.97
70332
TC
57.18
54.32
62.47
70100
26
9.07
8.62
9.91
70332
26
27.40
26.03
29.93
70110
42.49
40.37
46.43
C
70336
288.60
274.17
315.30
70110
TC
30.32
28.80
33.12
C
70336
TC
216.59
205.76
236.62
70110
26
12.17
11.56
13.29
70336
26
72.01
68.41
78.67
70120
37.10
35.25
40.54
70350
16.43
15.61
17.95
70120
TC
28.02
26.62
30.61
70350
TC
7.71
7.32
8.42
70120
26
9.07
8.62
9.91
70350
26
8.73
8.29
9.53
70130
61.03
57.98
66.68
70355
18.46
17.54
20.17
70130
TC
44.41
42.19
48.52
70355
TC
8.04
7.64
8.79
70130
26
16.62
15.79
18.16
70355
26
10.43
9.91
11.40
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
C - THE PAYMENT FOR THE TECHNICAL COMPONENT IS CAPPED AT THE OPPS AMOUNT.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
C
C
C
C
C
C
C
C
0
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
64
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------70360
30.87
29.33
33.73
70542
TC
215.61
204.83
235.55
70360
TC
21.80
20.71
23.82
70542
26
80.36
76.34
87.79
70360
26
9.07
8.62
9.91
70543
371.98
353.38
406.39
70370
91.30
86.74
99.75
70543
TC
266.72
253.38
291.39
70370
TC
76.19
72.38
83.24
70543
26
105.26
100.00
115.00
70370
26
15.12
14.36
16.51
70544
232.46
220.84
253.97
70371
108.00
102.60
117.99
70544
TC
174.00
165.30
190.10
70371
TC
66.03
62.73
72.14
70544
26
58.46
55.54
63.87
70371
26
41.97
39.87
45.85
70545
244.59
232.36
267.21
70380
36.75
34.91
40.15
70545
TC
186.12
176.81
203.33
70380
TC
28.35
26.93
30.97
70545
26
58.46
55.54
63.87
70380
26
8.40
7.98
9.18
70546
354.48
336.76
387.27
70390
116.33
110.51
127.09
70546
TC
282.47
268.35
308.60
70390
TC
97.48
92.61
106.50
70546
26
72.01
68.41
78.67
70390
26
18.85
17.91
20.60
70547
233.45
221.78
255.05
70450
111.78
106.19
122.12
70547
TC
174.65
165.92
190.81
70450
TC
69.96
66.46
76.43
70547
26
58.79
55.85
64.23
70450
26
41.82
39.73
45.69
70548
263.42
250.25
287.79
70460
156.78
148.94
171.28
70548
TC
190.38
180.86
207.99
70460
TC
101.42
96.35
110.80
70548
26
73.04
69.39
79.80
70460
26
55.37
52.60
60.49
70549
373.04
354.39
407.55
70470
183.95
174.75
200.96
70549
TC
284.43
270.21
310.74
70470
TC
122.06
115.96
133.35
70549
26
88.61
84.18
96.81
70470
26
61.89
58.80
67.62
70551
211.61
201.03
231.18
70480
164.64
156.41
179.87
70551
TC
139.60
132.62
152.51
70480
TC
102.40
97.28
111.87
70551
26
72.01
68.41
78.67
70480
26
62.24
59.13
68.00
70552
294.02
279.32
321.22
70481
191.84
182.25
209.59
70552
TC
206.44
196.12
225.54
70481
TC
136.47
129.65
149.10
70552
26
87.59
83.21
95.69
70481
26
55.37
52.60
60.49
70553
347.55
330.17
379.70
70482
225.40
214.13
246.25
70553
TC
234.94
223.19
256.67
70482
TC
163.84
155.65
179.00
70553
26
112.61
106.98
123.03
70482
26
61.56
58.48
67.25
70554
413.04
392.39
451.25
70486
134.72
127.98
147.18
70554
TC
308.68
293.25
337.24
70486
TC
92.90
88.26
101.50
70554
26
104.36
99.14
114.01
70486
26
41.82
39.73
45.69
70555
26
123.30
117.14
134.71
70487
161.04
152.99
175.94
70557
26
171.55
162.97
187.42
70487
TC
106.00
100.70
115.81
70558
26
171.92
163.32
187.82
70487
26
55.04
52.29
60.13
70559
26
164.65
156.42
179.88
70488
196.73
186.89
214.92
71045
25.30
24.04
27.65
70488
TC
134.84
128.10
147.32
71045
TC
16.23
15.42
17.73
70488
26
61.89
58.80
67.62
71045
26
9.07
8.62
9.91
70490
158.41
150.49
173.06
71046
32.92
31.27
35.96
70490
TC
96.17
91.36
105.06
71046
TC
22.13
21.02
24.17
70490
26
62.24
59.13
68.00
71046
26
10.80
10.26
11.80
70491
195.65
185.87
213.75
71047
41.55
39.47
45.39
70491
TC
128.61
122.18
140.51
71047
TC
28.02
26.62
30.61
70491
26
67.04
63.69
73.24
71047
26
13.53
12.85
14.78
70492
237.48
225.61
259.45
71048
44.58
42.35
48.70
70492
TC
157.44
149.57
172.01
71048
TC
29.01
27.56
31.69
70492
26
80.04
76.04
87.45
71048
26
15.58
14.80
17.02
70496
253.98
241.28
277.47
71100
35.87
34.08
39.19
70496
TC
168.10
159.70
183.66
71100
TC
24.75
23.51
27.04
70496
26
85.88
81.59
93.83
71100
26
11.13
10.57
12.16
70498
253.98
241.28
277.47
71101
41.22
39.16
45.03
70498
TC
168.10
159.70
183.66
71101
TC
28.02
26.62
30.61
70498
26
85.88
81.59
93.83
71101
26
13.20
12.54
14.42
70540
247.85
235.46
270.78
71110
42.90
40.76
46.87
70540
TC
182.52
173.39
199.40
71110
TC
28.68
27.25
31.34
70540
26
65.34
62.07
71.38
71110
26
14.22
13.51
15.54
70542
295.97
281.17
323.35
71111
51.16
48.60
55.89
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
C - THE PAYMENT FOR THE TECHNICAL COMPONENT IS CAPPED AT THE OPPS AMOUNT.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
C
C
C
C
C
C
0
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
65
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------71111
TC
35.56
33.78
38.85
72081
26
12.85
12.21
14.04
71111
26
15.60
14.82
17.04
72082
67.85
64.46
74.13
71120
32.88
31.24
35.93
72082
TC
52.60
49.97
57.47
71120
TC
23.11
21.95
25.24
72082
26
15.25
14.49
16.66
71120
26
9.77
9.28
10.67
72083
76.78
72.94
83.88
71130
40.46
38.44
44.21
72083
TC
59.15
56.19
64.62
71130
TC
29.66
28.18
32.41
72083
26
17.63
16.75
19.26
71130
26
10.80
10.26
11.80
72084
94.77
90.03
103.53
71250
140.29
133.28
153.27
72084
TC
74.22
70.51
81.09
71250
TC
87.33
82.96
95.40
72084
26
20.55
19.52
22.45
71250
26
52.97
50.32
57.87
72100
38.82
36.88
42.41
71260
176.83
167.99
193.19
72100
TC
27.70
26.32
30.27
71260
TC
119.76
113.77
130.84
72100
26
11.13
10.57
12.16
71260
26
57.07
54.22
62.35
72110
49.39
46.92
53.96
71270
209.13
198.67
228.47
72110
TC
36.54
34.71
39.92
71270
TC
148.27
140.86
161.99
72110
26
12.85
12.21
14.04
71270
26
60.86
57.82
66.49
72114
60.29
57.28
65.87
71271
144.88
137.64
158.29
72114
TC
45.39
43.12
49.59
71271
TC
91.91
87.31
100.41
72114
26
14.90
14.16
16.28
71271
26
52.97
50.32
57.87
72120
39.80
37.81
43.48
71275
257.41
244.54
281.22
72120
TC
28.68
27.25
31.34
71275
TC
168.10
159.70
183.66
72120
26
11.13
10.57
12.16
71275
26
89.31
84.84
97.57
72125
137.50
130.63
150.22
71550
287.41
273.04
314.00
72125
TC
88.31
83.89
96.47
71550
TC
216.09
205.29
236.08
72125
26
49.19
46.73
53.74
71550
26
71.31
67.74
77.90
72126
178.60
169.67
195.12
71551
415.49
394.72
453.93
72126
TC
119.11
113.15
130.12
71551
TC
330.30
313.79
360.86
72126
26
59.49
56.52
65.00
71551
26
85.19
80.93
93.07
72127
209.18
198.72
228.53
71552
456.59
433.76
498.82
72127
TC
147.61
140.23
161.26
71552
TC
346.19
328.88
378.21
72127
26
61.56
58.48
67.25
71552
26
110.40
104.88
120.61
72128
137.17
130.31
149.86
71555
366.84
348.50
400.78
72128
TC
87.98
83.58
96.12
71555
TC
278.54
264.61
304.30
72128
26
49.19
46.73
53.74
71555
26
88.30
83.89
96.47
72129
179.58
170.60
196.19
72020
24.28
23.07
26.53
72129
TC
120.09
114.09
131.20
72020
TC
16.23
15.42
17.73
72129
26
59.49
56.52
65.00
72020
26
8.05
7.65
8.80
72130
210.16
199.65
229.60
72040
38.49
36.57
42.06
72130
TC
148.60
141.17
162.35
72040
TC
27.37
26.00
29.90
72130
26
61.56
58.48
67.25
72040
26
11.13
10.57
12.16
72131
136.85
130.01
149.51
72050
51.38
48.81
56.13
72131
TC
87.65
83.27
95.76
72050
TC
37.85
35.96
41.35
72131
26
49.19
46.73
53.74
72050
26
13.53
12.85
14.78
72132
178.60
169.67
195.12
72052
60.29
57.28
65.87
72132
TC
119.11
113.15
130.12
72052
TC
45.72
43.43
49.94
72132
26
59.49
56.52
65.00
72052
26
14.57
13.84
15.92
72133
209.18
198.72
228.53
72070
31.90
30.31
34.86
72133
TC
147.61
140.23
161.26
72070
TC
21.80
20.71
23.82
72133
26
61.56
58.48
67.25
72070
26
10.10
9.60
11.04
72141
206.85
196.51
225.99
72072
38.19
36.28
41.72
72141
TC
134.51
127.78
146.95
72072
TC
27.04
25.69
29.54
72141
26
72.34
68.72
79.03
72072
26
11.15
10.59
12.18
72142
300.90
285.86
328.74
72074
43.47
41.30
47.50
72142
TC
212.99
202.34
232.69
72074
TC
31.30
29.74
34.20
72142
26
87.91
83.51
96.04
72074
26
12.17
11.56
13.29
72146
206.85
196.51
225.99
72080
33.89
32.20
37.03
72146
TC
134.51
127.78
146.95
72080
TC
23.44
22.27
25.61
72146
26
72.34
68.72
79.03
72080
26
10.45
9.93
11.42
72147
298.94
283.99
326.59
72081
41.20
39.14
45.01
72147
TC
211.02
200.47
230.54
72081
TC
28.35
26.93
30.97
72147
26
87.91
83.51
96.04
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
C - THE PAYMENT FOR THE TECHNICAL COMPONENT IS CAPPED AT THE OPPS AMOUNT.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
C
C
C
C
C
C
0
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
66
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------72148
207.17
196.81
226.33
72255
TC
68.32
64.90
74.64
72148
TC
134.84
128.10
147.32
72255
26
48.56
46.13
53.05
72148
26
72.34
68.72
79.03
72265
106.50
101.18
116.36
72149
296.31
281.49
323.71
72265
TC
66.03
62.73
72.14
72149
TC
208.40
197.98
227.68
72265
26
40.47
38.45
44.22
72149
26
87.91
83.51
96.04
72270
146.24
138.93
159.77
72156
350.82
333.28
383.27
72270
TC
79.79
75.80
87.17
72156
TC
238.22
226.31
260.26
72270
26
66.45
63.13
72.60
72156
26
112.61
106.98
123.03
72275
136.82
129.98
149.48
72157
351.48
333.91
384.00
72275
TC
98.14
93.23
107.21
72157
TC
238.87
226.93
260.97
72275
26
38.68
36.75
42.26
72157
26
112.61
106.98
123.03
72285
124.08
117.88
135.56
72158
350.17
332.66
382.56
72285
TC
66.36
63.04
72.50
72158
TC
237.56
225.68
259.53
72285
26
57.72
54.83
63.05
72158
26
112.61
106.98
123.03
72295
110.60
105.07
120.83
72159
378.61
359.68
413.63
72295
TC
68.65
65.22
75.00
72159
TC
290.00
275.50
316.83
72295
26
41.95
39.85
45.83
72159
26
88.61
84.18
96.81
73000
31.49
29.92
34.41
72170
27.25
25.89
29.77
73000
TC
23.11
21.95
25.24
72170
TC
18.52
17.59
20.23
73000
26
8.38
7.96
9.15
72170
26
8.73
8.29
9.53
73010
23.32
22.15
25.47
72190
40.85
38.81
44.63
73010
TC
14.26
13.55
15.58
72190
TC
28.35
26.93
30.97
73010
26
9.05
8.60
9.89
72190
26
12.50
11.88
13.66
73020
21.31
20.24
23.28
72191
255.90
243.11
279.58
73020
TC
13.61
12.93
14.87
72191
TC
167.60
159.22
183.10
73020
26
7.70
7.32
8.42
72191
26
88.30
83.89
96.47
73030
33.49
31.82
36.59
72192
140.64
133.61
153.65
73030
TC
24.09
22.89
26.32
72192
TC
87.33
82.96
95.40
73030
26
9.40
8.93
10.27
72192
26
53.32
50.65
58.25
73040
127.83
121.44
139.66
72193
224.67
213.44
245.46
73040
TC
99.78
94.79
109.01
72193
TC
167.93
159.53
183.46
73040
26
28.05
26.65
30.65
72193
26
56.74
53.90
61.99
73050
27.92
26.52
30.50
72194
227.59
216.21
248.64
73050
TC
18.52
17.59
20.23
72194
TC
168.10
159.70
183.66
73050
26
9.40
8.93
10.27
72194
26
59.49
56.52
65.00
73060
31.49
29.92
34.41
72195
252.19
239.58
275.52
73060
TC
23.11
21.95
25.24
72195
TC
180.88
171.84
197.62
73060
26
8.38
7.96
9.15
72195
26
71.31
67.74
77.90
73070
28.54
27.11
31.18
72196
296.54
281.71
323.97
73070
TC
20.16
19.15
22.02
72196
TC
211.02
200.47
230.54
73070
26
8.38
7.96
9.15
72196
26
85.51
81.23
93.41
73080
31.51
29.93
34.42
72197
372.09
353.49
406.51
73080
TC
22.78
21.64
24.89
72197
TC
264.43
251.21
288.89
73080
26
8.73
8.29
9.53
72197
26
107.66
102.28
117.62
73085
114.73
108.99
125.34
72198
368.79
350.35
402.90
73085
TC
86.02
81.72
93.98
72198
TC
281.16
267.10
307.17
73085
26
28.71
27.27
31.36
72198
26
87.63
83.25
95.74
73090
28.54
27.11
31.18
72200
32.16
30.55
35.13
73090
TC
20.49
19.47
22.39
72200
TC
23.76
22.57
25.96
73090
26
8.05
7.65
8.80
72200
26
8.40
7.98
9.18
73092
30.83
29.29
33.68
72202
38.19
36.28
41.72
73092
TC
22.78
21.64
24.89
72202
TC
27.04
25.69
29.54
73092
26
8.05
7.65
8.80
72202
26
11.15
10.59
12.18
73100
33.12
31.46
36.18
72220
31.51
29.93
34.42
73100
TC
24.75
23.51
27.04
72220
TC
22.78
21.64
24.89
73100
26
8.38
7.96
9.15
72220
26
8.73
8.29
9.53
73110
39.37
37.40
43.01
72240
114.38
108.66
124.96
73110
TC
30.64
29.11
33.48
72240
TC
68.98
65.53
75.36
73110
26
8.73
8.29
9.53
72240
26
45.40
43.13
49.60
73115
133.40
126.73
145.74
72255
116.88
111.04
127.70
73115
TC
105.02
99.77
114.74
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
C - THE PAYMENT FOR THE TECHNICAL COMPONENT IS CAPPED AT THE OPPS AMOUNT.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
C
C
C
C
C
C
C
C
C
C
0
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
67
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------73115
26
28.38
26.96
31.00
73525
131.28
124.72
143.43
73120
30.50
28.98
33.33
73525
TC
101.74
96.65
111.15
73120
TC
22.13
21.02
24.17
73525
26
29.54
28.06
32.27
73120
26
8.38
7.96
9.15
73551
28.86
27.42
31.53
73130
35.44
33.67
38.72
73551
TC
20.49
19.47
22.39
73130
TC
26.71
25.37
29.18
73551
26
8.38
7.96
9.15
73130
26
8.73
8.29
9.53
73552
34.48
32.76
37.67
73140
36.34
34.52
39.70
73552
TC
25.40
24.13
27.75
73140
TC
29.33
27.86
32.04
73552
26
9.07
8.62
9.91
73140
26
7.00
6.65
7.65
73560
33.45
31.78
36.55
73200
151.59
144.01
165.61
73560
TC
25.07
23.82
27.39
73200
TC
102.40
97.28
111.87
73560
26
8.38
7.96
9.15
73200
26
49.19
46.73
53.74
73562
39.39
37.42
43.03
73201
215.49
204.72
235.43
73562
TC
29.99
28.49
32.76
73201
TC
158.75
150.81
173.43
73562
26
9.40
8.93
10.27
73201
26
56.74
53.90
61.99
73564
44.72
42.48
48.85
73202
227.59
216.21
248.64
73564
TC
33.59
31.91
36.70
73202
TC
168.10
159.70
183.66
73564
26
11.13
10.57
12.16
73202
26
59.49
56.52
65.00
73565
39.68
37.70
43.36
73206
256.25
243.44
279.96
73565
TC
30.97
29.42
33.83
73206
TC
168.27
159.86
183.84
73565
26
8.70
8.27
9.51
73206
26
87.98
83.58
96.12
73580
142.42
135.30
155.60
73218
282.58
268.45
308.72
73580
TC
113.54
107.86
124.04
73218
TC
216.59
205.76
236.62
73580
26
28.88
27.44
31.56
73218
26
65.99
62.69
72.09
73590
30.83
29.29
33.68
73219
368.38
349.96
402.45
73590
TC
22.78
21.64
24.89
73219
TC
288.02
273.62
314.66
73590
26
8.05
7.65
8.80
73219
26
80.36
76.34
87.79
73592
30.83
29.29
33.68
73220
451.94
429.34
493.74
73592
TC
22.78
21.64
24.89
73220
TC
346.36
329.04
378.40
73592
26
8.05
7.65
8.80
73220
26
105.58
100.30
115.35
73600
31.81
30.22
34.75
73221
219.19
208.23
239.46
73600
TC
23.44
22.27
25.61
73221
TC
152.37
144.75
166.46
73600
26
8.38
7.96
9.15
73221
26
66.82
63.48
73.00
73610
35.77
33.98
39.08
73222
349.05
331.60
381.34
73610
TC
27.04
25.69
29.54
73222
TC
268.36
254.94
293.18
73610
26
8.73
8.29
9.53
73222
26
80.69
76.66
88.16
73615
133.90
127.21
146.29
73223
430.63
409.10
470.47
73615
TC
104.69
99.46
114.38
73223
TC
324.72
308.48
354.75
73615
26
29.21
27.75
31.91
73223
26
105.91
100.61
115.70
73620
27.88
26.49
30.46
73225
375.52
356.74
410.25
73620
TC
20.16
19.15
22.02
73225
TC
290.00
275.50
316.83
73620
26
7.72
7.33
8.43
73225
26
85.51
81.23
93.41
73630
33.47
31.80
36.57
73501
31.53
29.95
34.44
73630
TC
25.07
23.82
27.39
73501
TC
22.13
21.02
24.17
73630
26
8.40
7.98
9.18
73501
26
9.40
8.93
10.27
73650
28.21
26.80
30.82
73502
45.37
43.10
49.57
73650
TC
20.16
19.15
22.02
73502
TC
34.25
32.54
37.42
73650
26
8.05
7.65
8.80
73502
26
11.13
10.57
12.16
73660
28.47
27.05
31.11
73503
56.95
54.10
62.22
73660
TC
21.80
20.71
23.82
73503
TC
43.42
41.25
47.44
73660
26
6.68
6.35
7.30
73503
26
13.53
12.85
14.78
73700
136.85
130.01
149.51
73521
40.13
38.12
43.84
73700
TC
87.65
83.27
95.76
73521
TC
29.01
27.56
31.69
73700
26
49.19
46.73
53.74
73521
26
11.13
10.57
12.16
73701
176.50
167.68
192.83
73522
52.08
49.48
56.90
73701
TC
119.76
113.77
130.84
73522
TC
37.52
35.64
40.99
73701
26
56.74
53.90
61.99
73522
26
14.55
13.82
15.89
73702
205.47
195.20
224.48
73523
59.65
56.67
65.17
73702
TC
146.30
138.99
159.84
73523
TC
44.41
42.19
48.52
73702
26
59.16
56.20
64.63
73523
26
15.25
14.49
16.66
C
73706
260.37
247.35
284.45
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
C - THE PAYMENT FOR THE TECHNICAL COMPONENT IS CAPPED AT THE OPPS AMOUNT.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
---C
C
C
C
C
C
C
0
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
68
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------73706
TC
168.27
159.86
183.84
74181
26
70.99
67.44
77.56
73706
26
92.10
87.50
100.63
74182
334.22
317.51
365.14
73718
244.90
232.66
267.56
74182
TC
249.03
236.58
272.07
73718
TC
179.24
170.28
195.82
74182
26
85.19
80.93
93.07
73718
26
65.66
62.38
71.74
74183
372.74
354.10
407.22
73719
289.42
274.95
316.19
74183
TC
265.08
251.83
289.60
73719
TC
209.06
198.61
228.40
74183
26
107.66
102.28
117.62
73719
26
80.36
76.34
87.79
74185
369.44
350.97
403.62
73720
371.98
353.38
406.39
74185
TC
281.49
267.42
307.53
73720
TC
266.39
253.07
291.03
74185
26
87.96
83.56
96.09
73720
26
105.58
100.30
115.35
74190
26
23.34
22.17
25.50
73721
218.54
207.61
238.75
74210
97.47
92.60
106.49
73721
TC
152.05
144.45
166.12
74210
TC
68.00
64.60
74.29
73721
26
66.49
63.17
72.65
74210
26
29.47
28.00
32.20
73722
349.71
332.22
382.05
74220
99.13
94.17
108.30
73722
TC
269.02
255.57
293.91
74220
TC
68.98
65.53
75.36
73722
26
80.69
76.66
88.16
74220
26
30.15
28.64
32.94
73723
429.32
407.85
469.03
74221
111.13
105.57
121.41
73723
TC
323.73
307.54
353.67
74221
TC
76.51
72.68
83.58
73723
26
105.58
100.30
115.35
74221
26
34.62
32.89
37.82
73725
367.85
349.46
401.88
74230
130.10
123.60
142.14
73725
TC
279.52
265.54
305.37
74230
TC
103.38
98.21
112.94
73725
26
88.33
83.91
96.50
74230
26
26.72
25.38
29.19
74018
29.23
27.77
31.94
74235
26
58.12
55.21
63.49
74018
TC
20.16
19.15
22.02
74240
122.81
116.67
134.17
74018
26
9.07
8.62
9.91
74240
TC
83.40
79.23
91.11
74019
36.22
34.41
39.57
74240
26
39.42
37.45
43.07
74019
TC
24.75
23.51
27.04
74246
140.72
133.68
153.73
74019
26
11.47
10.90
12.54
74246
TC
96.83
91.99
105.79
74021
41.88
39.79
45.76
74246
26
43.89
41.70
47.96
74021
TC
28.68
27.25
31.34
74248
83.77
79.58
91.52
74021
26
13.20
12.54
14.42
74248
TC
49.15
46.69
53.69
74022
48.54
46.11
53.03
74248
26
34.62
32.89
37.82
74022
TC
32.94
31.29
35.98
74250
123.16
117.00
134.55
74022
26
15.60
14.82
17.04
74250
TC
83.40
79.23
91.11
74150
144.46
137.24
157.83
74250
26
39.77
37.78
43.45
74150
TC
86.34
82.02
94.32
C
74251
225.02
213.77
245.84
74150
26
58.12
55.21
63.49
C
74251
TC
167.93
159.53
183.46
74160
229.82
218.33
251.08
74251
26
57.09
54.24
62.38
74160
TC
167.93
159.53
183.46
C
74261
220.48
209.46
240.88
74160
26
61.89
58.80
67.62
C
74261
TC
102.73
97.59
112.23
74170
236.34
224.52
258.20
74261
26
117.76
111.87
128.65
74170
TC
168.10
159.70
183.66
C
74262
290.16
275.65
317.00
74170
26
68.24
64.83
74.55
C
74262
TC
167.93
159.53
183.46
74174
400.13
380.12
437.14
74262
26
122.23
116.12
133.54
74174
TC
292.95
278.30
320.05
74270
155.94
148.14
170.36
74174
26
107.17
101.81
117.08
74270
TC
105.02
99.77
114.74
74175
256.58
243.75
280.31
74270
26
50.92
48.37
55.63
74175
TC
167.60
159.22
183.10
74280
224.23
213.02
244.97
74175
26
88.98
84.53
97.21
74280
TC
163.01
154.86
178.09
74176
193.83
184.14
211.76
74280
26
61.21
58.15
66.87
74176
TC
107.97
102.57
117.96
74283
259.30
246.34
283.29
74176
26
85.86
81.57
93.81
74283
TC
156.79
148.95
171.29
74177
324.25
308.04
354.25
74283
26
102.51
97.38
111.99
74177
TC
234.61
222.88
256.31
74290
85.23
80.97
93.12
74177
26
89.64
85.16
97.93
74290
TC
69.63
66.15
76.07
74178
363.32
345.15
396.92
74290
26
15.60
14.82
17.04
74178
TC
265.08
251.83
289.60
74300
26
14.35
13.63
15.67
74178
26
98.23
93.32
107.32
74301
26
10.45
9.93
11.42
74181
213.68
203.00
233.45
74328
26
28.21
26.80
30.82
74181
TC
142.70
135.57
155.91
74329
26
28.21
26.80
30.82
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
C - THE PAYMENT FOR THE TECHNICAL COMPONENT IS CAPPED AT THE OPPS AMOUNT.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
C
C
0
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
69
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------74330
26
35.94
34.14
39.26
75565
50.84
48.30
55.55
74340
26
27.07
25.72
29.58
75565
TC
38.66
36.73
42.24
74355
26
37.70
35.82
41.19
75565
26
12.17
11.56
13.29
74360
26
27.73
26.34
30.29
75571
103.34
98.17
112.90
74363
26
42.87
40.73
46.84
75571
TC
74.22
70.51
81.09
74400
131.97
125.37
144.18
75571
26
29.12
27.66
31.81
74400
TC
108.30
102.89
118.32
C
75572
252.48
239.86
275.84
74400
26
23.67
22.49
25.86
C
75572
TC
168.10
159.70
183.66
74410
136.22
129.41
148.82
75572
26
84.38
80.16
92.18
74410
TC
112.56
106.93
122.97
C
75573
292.58
277.95
319.64
74410
26
23.67
22.49
25.86
C
75573
TC
168.27
159.86
183.84
74415
154.57
146.84
168.87
75573
26
124.30
118.09
135.80
74415
TC
130.90
124.36
143.01
C
75574
284.37
270.15
310.67
74415
26
23.67
22.49
25.86
C
75574
TC
167.77
159.38
183.29
74420
75.02
71.27
81.96
75574
26
116.60
110.77
127.39
74420
TC
49.98
47.48
54.60
75600
195.89
186.10
214.02
74420
26
25.04
23.79
27.36
75600
TC
171.20
162.64
187.04
74425
134.96
128.21
147.44
75600
26
24.69
23.46
26.98
74425
TC
110.26
104.75
120.46
75605
125.56
119.28
137.17
74425
26
24.69
23.46
26.98
75605
TC
69.96
66.46
76.43
74430
40.02
38.02
43.72
75605
26
55.60
52.82
60.74
74430
TC
24.75
23.51
27.04
75625
135.29
128.53
147.81
74430
26
15.27
14.51
16.69
75625
TC
63.74
60.55
69.63
74440
95.84
91.05
104.71
75625
26
71.55
67.97
78.17
74440
TC
77.83
73.94
85.03
75630
166.65
158.32
182.07
74440
26
18.02
17.12
19.69
75630
TC
67.67
64.29
73.93
74445
26
54.56
51.83
59.60
75630
26
98.98
94.03
108.13
74450
26
15.95
15.15
17.42
C
75635
285.22
270.96
311.60
74455
102.29
97.18
111.76
C
75635
TC
168.10
159.70
183.66
74455
TC
86.67
82.34
94.69
75635
26
117.12
111.26
127.95
74455
26
15.62
14.84
17.07
75705
250.57
238.04
273.75
74470
26
26.42
25.10
28.87
75705
TC
129.44
122.97
141.42
74485
116.63
110.80
127.42
75705
26
121.13
115.07
132.33
74485
TC
77.50
73.63
84.67
75710
159.73
151.74
174.50
74485
26
39.14
37.18
42.76
75710
TC
72.26
68.65
78.95
74710
39.58
37.60
43.24
75710
26
87.48
83.11
95.58
74710
TC
22.78
21.64
24.89
75716
171.67
163.09
187.55
74710
26
16.80
15.96
18.35
75716
TC
74.39
70.67
81.27
74712
364.17
345.96
397.85
75716
26
97.27
92.41
106.27
74712
TC
216.77
205.93
236.82
75726
177.34
168.47
193.74
74712
26
147.40
140.03
161.03
75726
TC
80.29
76.28
87.72
74713
218.97
208.02
239.22
75726
26
97.04
92.19
106.02
74713
TC
127.96
121.56
139.79
75731
154.36
146.64
168.64
74713
26
91.01
86.46
99.43
75731
TC
98.64
93.71
107.77
74740
95.03
90.28
103.82
75731
26
55.72
52.93
60.87
74740
TC
76.19
72.38
83.24
75733
169.96
161.46
185.68
74740
26
18.85
17.91
20.60
75733
TC
107.50
102.13
117.45
74742
26
30.50
28.98
33.33
75733
26
62.46
59.34
68.24
74775
26
31.17
29.61
34.05
75736
144.24
137.03
157.58
75557
307.51
292.13
335.95
75736
TC
89.79
85.30
98.10
75557
TC
193.81
184.12
211.74
75736
26
54.44
51.72
59.48
75557
26
113.70
108.02
124.22
75741
136.23
129.42
148.83
75559
425.12
403.86
464.44
75741
TC
73.57
69.89
80.37
75559
TC
286.38
272.06
312.87
75741
26
62.67
59.54
68.47
75559
26
138.74
131.80
151.57
75743
154.03
146.33
168.28
75561
404.89
384.65
442.35
75743
TC
74.55
70.82
81.44
75561
TC
278.52
264.59
304.28
75743
26
79.49
75.52
86.85
75561
26
126.37
120.05
138.06
75746
137.49
130.62
150.21
75563
476.19
452.38
520.24
75746
TC
83.24
79.08
90.94
75563
TC
331.60
315.02
362.27
75746
26
54.25
51.54
59.27
75563
26
144.59
137.36
157.96
75756
159.33
151.36
174.06
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
C - THE PAYMENT FOR THE TECHNICAL COMPONENT IS CAPPED AT THE OPPS AMOUNT.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
0
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
70
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------75756
TC
102.90
97.76
112.42
75893
108.17
102.76
118.17
75756
26
56.43
53.61
61.65
75893
TC
81.76
77.67
89.32
75774
103.48
98.31
113.06
75893
26
26.42
25.10
28.87
75774
TC
54.89
52.15
59.97
75894
26
73.76
70.07
80.58
75774
26
48.59
46.16
53.08
75898
26
92.89
88.25
101.49
75801
26
45.91
43.61
50.15
75901
230.45
218.93
251.77
75803
26
57.09
54.24
62.38
75901
TC
206.44
196.12
225.54
75805
26
39.77
37.78
43.45
75901
26
24.02
22.82
26.24
75807
26
54.31
51.59
59.33
75902
90.16
85.65
98.50
75809
87.38
83.01
95.46
75902
TC
70.62
67.09
77.15
75809
TC
63.08
59.93
68.92
75902
26
19.54
18.56
21.34
75809
26
24.30
23.09
26.55
75956
26
357.30
339.44
390.36
75810
26
48.68
46.25
53.19
75957
26
306.70
291.37
335.08
75820
117.00
111.15
127.82
75958
26
202.97
192.82
221.74
75820
TC
64.72
61.48
70.70
75959
26
178.09
169.19
194.57
75820
26
52.28
49.67
57.12
75970
26
39.00
37.05
42.61
75822
140.89
133.85
153.93
75984
102.56
97.43
112.04
75822
TC
68.65
65.22
75.00
75984
TC
63.74
60.55
69.63
75822
26
72.24
68.63
78.92
75984
26
38.83
36.89
42.42
75825
121.34
115.27
132.56
75989
117.77
111.88
128.66
75825
TC
64.72
61.48
70.70
75989
TC
60.79
57.75
66.41
75825
26
56.62
53.79
61.86
75989
26
56.98
54.13
62.25
75827
126.58
120.25
138.29
76000
42.46
40.34
46.39
75827
TC
69.63
66.15
76.07
76000
TC
26.38
25.06
28.82
75827
26
56.95
54.10
62.22
76000
26
16.07
15.27
17.56
75831
124.40
118.18
135.91
76010
29.23
27.77
31.94
75831
TC
70.62
67.09
77.15
76010
TC
20.16
19.15
22.02
75831
26
53.79
51.10
58.77
76010
26
9.07
8.62
9.91
75833
151.93
144.33
165.98
76080
60.01
57.01
65.56
75833
TC
78.98
75.03
86.28
76080
TC
33.92
32.22
37.05
75833
26
72.95
69.30
79.70
76080
26
26.09
24.79
28.51
75840
133.21
126.55
145.53
76098
41.48
39.41
45.32
75840
TC
77.50
73.63
84.67
76098
TC
25.73
24.44
28.11
75840
26
55.72
52.93
60.87
76098
26
15.75
14.96
17.20
75842
162.15
154.04
177.15
76100
92.20
87.59
100.73
75842
TC
89.47
85.00
97.75
76100
TC
62.43
59.31
68.21
75842
26
72.69
69.06
79.42
76100
26
29.78
28.29
32.53
75860
132.27
125.66
144.51
76101
103.11
97.95
112.64
75860
TC
76.19
72.38
83.24
76101
TC
73.41
69.74
80.20
75860
26
56.08
53.28
61.27
76101
26
29.70
28.22
32.45
75870
171.85
163.26
187.75
C
76102
133.18
126.52
145.50
75870
TC
107.64
102.26
117.60
C
76102
TC
102.74
97.60
112.24
75870
26
64.21
61.00
70.15
76102
26
30.43
28.91
33.25
75872
133.21
126.55
145.53
76120
112.75
107.11
123.18
75872
TC
77.50
73.63
84.67
76120
TC
92.57
87.94
101.13
75872
26
55.72
52.93
60.87
76120
26
20.18
19.17
22.05
75880
111.79
106.20
122.13
76125
26
13.20
12.54
14.42
75880
TC
77.17
73.31
84.31
76145
805.85
765.56
880.39
75880
26
34.62
32.89
37.82
76376
22.40
21.28
24.47
75885
141.75
134.66
154.86
76376
TC
12.62
11.99
13.79
75885
TC
74.55
70.82
81.44
76376
26
9.77
9.28
10.67
75885
26
67.20
63.84
73.42
76377
70.70
67.17
77.25
75887
143.06
135.91
156.30
76377
TC
31.63
30.05
34.56
75887
TC
75.20
71.44
82.16
76377
26
39.07
37.12
42.69
75887
26
67.86
64.47
74.14
C
76380
123.37
117.20
134.78
75889
127.32
120.95
139.09
C
76380
TC
76.19
72.38
83.24
75889
TC
74.88
71.14
81.81
76380
26
47.18
44.82
51.54
75889
26
52.44
49.82
57.29
76391
223.08
211.93
243.72
75891
128.63
122.20
140.53
76391
TC
169.08
160.63
184.72
75891
TC
75.53
71.75
82.51
76391
26
53.99
51.29
58.98
75891
26
53.09
50.44
58.01
76506
115.09
109.34
125.74
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
C - THE PAYMENT FOR THE TECHNICAL COMPONENT IS CAPPED AT THE OPPS AMOUNT.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
71
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------76506
TC
83.07
78.92
90.76
76801
26
48.67
46.24
53.18
76506
26
32.02
30.42
34.98
76802
62.42
59.30
68.20
76510
71.62
68.04
78.25
76802
TC
21.30
20.24
23.28
76510
TC
32.61
30.98
35.63
76802
26
41.12
39.06
44.92
76510
26
39.01
37.06
42.62
76805
137.31
130.44
150.01
76511
56.75
53.91
62.00
76805
TC
88.64
84.21
96.84
76511
TC
21.47
20.40
23.46
76805
26
48.67
46.24
53.18
76511
26
35.28
33.52
38.55
76810
90.43
85.91
98.80
76512
48.39
45.97
52.87
76810
TC
42.11
40.00
46.00
76512
TC
17.87
16.98
19.53
76810
26
48.32
45.90
52.79
76512
26
30.53
29.00
33.35
76811
173.99
165.29
190.08
76513
76.65
72.82
83.74
76811
TC
81.27
77.21
88.79
76513
TC
44.73
42.49
48.86
76811
26
92.72
88.08
101.29
76513
26
31.92
30.32
34.87
76812
195.69
185.91
213.80
76514
11.78
11.19
12.87
76812
TC
108.80
103.36
118.86
76514
TC
3.78
3.59
4.13
76812
26
86.89
82.55
94.93
76514
26
8.01
7.61
8.75
76813
120.35
114.33
131.48
76516
45.76
43.47
49.99
76813
TC
62.43
59.31
68.21
76516
TC
23.44
22.27
25.61
76813
26
57.92
55.02
63.27
76516
26
22.32
21.20
24.38
76814
78.00
74.10
85.22
76519
65.71
62.42
71.78
76814
TC
29.01
27.56
31.69
76519
TC
35.56
33.78
38.85
76814
26
49.00
46.55
53.53
76519
26
30.16
28.65
32.95
76815
83.18
79.02
90.87
76529
84.78
80.54
92.62
76815
TC
50.63
48.10
55.32
76529
TC
52.92
50.27
57.81
76815
26
32.55
30.92
35.56
76529
26
31.86
30.27
34.81
76816
111.78
106.19
122.12
76536
114.11
108.40
124.66
76816
TC
69.63
66.15
76.07
76536
TC
85.69
81.41
93.62
76816
26
42.15
40.04
46.05
76536
26
28.42
27.00
31.05
76817
94.86
90.12
103.64
76604
66.34
63.02
72.47
76817
TC
57.51
54.63
62.82
76604
TC
37.52
35.64
40.99
76817
26
37.35
35.48
40.80
76604
26
28.82
27.38
31.49
76818
115.33
109.56
125.99
76641
104.64
99.41
114.32
76818
TC
63.58
60.40
69.46
76641
TC
68.65
65.22
75.00
76818
26
51.75
49.16
56.53
76641
26
35.99
34.19
39.32
76819
85.40
81.13
93.30
76642
86.52
82.19
94.52
76819
TC
47.03
44.68
51.38
76642
TC
52.60
49.97
57.47
76819
26
38.37
36.45
41.92
76642
26
33.92
32.22
37.05
76820
46.14
43.83
50.40
76700
119.56
113.58
130.62
76820
TC
21.47
20.40
23.46
76700
TC
79.79
75.80
87.17
76820
26
24.67
23.44
26.96
76700
26
39.77
37.78
43.45
76821
89.82
85.33
98.13
76705
89.60
85.12
97.89
76821
TC
55.55
52.77
60.69
76705
TC
60.13
57.12
65.69
76821
26
34.27
32.56
37.44
76705
26
29.47
28.00
32.20
76825
269.52
256.04
294.45
76706
107.54
102.16
117.48
76825
TC
188.43
179.01
205.86
76706
TC
79.79
75.80
87.17
76825
26
81.09
77.04
88.60
76706
26
27.75
26.36
30.31
76826
161.39
153.32
176.32
76770
110.56
105.03
120.78
76826
TC
120.59
114.56
131.74
76770
TC
74.22
70.51
81.09
76826
26
40.79
38.75
44.56
76770
26
36.34
34.52
39.70
76827
72.20
68.59
78.88
76775
58.46
55.54
63.87
76827
TC
44.08
41.88
48.16
76775
TC
29.33
27.86
32.04
76827
26
28.12
26.71
30.72
76775
26
29.12
27.66
31.81
76828
51.19
48.63
55.92
76776
152.06
144.46
166.13
76828
TC
23.76
22.57
25.96
76776
TC
114.69
108.96
125.30
76828
26
27.42
26.05
29.96
76776
26
37.37
35.50
40.83
76830
121.60
115.52
132.85
76800
142.96
135.81
156.18
76830
TC
87.33
82.96
95.40
76800
TC
82.41
78.29
90.03
76830
26
34.27
32.56
37.44
76800
26
60.55
57.52
66.15
76831
118.71
112.77
129.69
76801
119.61
113.63
130.67
76831
TC
82.74
78.60
90.39
76801
TC
70.94
67.39
77.50
76831
26
35.97
34.17
39.30
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
C
C
C
C
0
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
72
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------76856
107.84
102.45
117.82
76981
26
29.47
28.00
32.20
76856
TC
73.57
69.89
80.37
76982
97.79
92.90
106.84
76856
26
34.27
32.56
37.44
76982
TC
68.00
64.60
74.29
76857
47.45
45.08
51.84
76982
26
29.80
28.31
32.56
76857
TC
23.44
22.27
25.61
76983
61.37
58.30
67.05
76857
26
24.02
22.82
26.24
76983
TC
36.37
34.55
39.73
76870
103.14
97.98
112.68
76983
26
25.00
23.75
27.31
76870
TC
71.27
67.71
77.87
76998
26
65.49
62.22
71.55
76870
26
31.87
30.28
34.82
77001
100.30
95.29
109.58
76872
135.67
128.89
148.22
77001
TC
81.10
77.05
88.61
76872
TC
102.73
97.59
112.23
77001
26
19.19
18.23
20.96
76872
26
32.94
31.29
35.98
77002
113.74
108.05
124.26
76873
174.06
165.36
190.16
77002
TC
85.69
81.41
93.62
76873
TC
97.16
92.30
106.15
77002
26
28.05
26.65
30.65
76873
26
76.90
73.06
84.02
77003
102.73
97.59
112.23
76881
65.42
62.15
71.47
77003
TC
72.91
69.26
79.65
76881
TC
34.58
32.85
37.78
77003
26
29.82
28.33
32.58
76881
26
30.85
29.31
33.71
77011
230.38
218.86
251.69
76882
55.62
52.84
60.77
77011
TC
166.94
158.59
182.38
76882
TC
31.95
30.35
34.90
77011
26
63.44
60.27
69.31
76882
26
23.67
22.49
25.86
77012
146.79
139.45
160.37
76885
112.86
107.22
123.30
77012
TC
73.89
70.20
80.73
76885
TC
76.19
72.38
83.24
77012
26
72.90
69.26
79.65
76885
26
36.67
34.84
40.07
77013
26
188.07
178.67
205.47
76886
103.10
97.95
112.64
77014
121.28
115.22
132.50
76886
TC
71.93
68.33
78.58
77014
TC
76.19
72.38
83.24
76886
26
31.17
29.61
34.05
77014
26
45.10
42.85
49.28
76932
26
35.06
33.31
38.31
77021
447.05
424.70
488.41
76936
268.06
254.66
292.86
77021
TC
375.83
357.04
410.60
76936
TC
169.43
160.96
185.10
77021
26
71.23
67.67
77.82
76936
26
98.63
93.70
107.76
77022
26
211.04
200.49
230.56
76937
37.68
35.80
41.17
77046
232.84
221.20
254.38
76937
TC
23.59
22.41
25.77
77046
TC
162.20
154.09
177.20
76937
26
14.09
13.39
15.40
77046
26
70.64
67.11
77.18
76940
26
104.91
99.66
114.61
77047
239.38
227.41
261.52
76941
26
65.47
62.20
71.53
77047
TC
161.55
153.47
176.49
76942
57.66
54.78
63.00
77047
26
77.84
73.95
85.04
76942
TC
26.06
24.76
28.47
77048
370.23
351.72
404.48
76942
26
31.61
30.03
34.53
77048
TC
267.05
253.70
291.76
76945
26
32.90
31.26
35.95
77048
26
103.18
98.02
112.72
76946
32.28
30.67
35.27
77049
378.70
359.77
413.74
76946
TC
13.61
12.93
14.87
77049
TC
265.74
252.45
290.32
76946
26
18.67
17.74
20.40
77049
26
112.96
107.31
123.41
76948
78.94
74.99
86.24
77053
54.36
51.64
59.39
76948
TC
46.04
43.74
50.30
77053
TC
36.54
34.71
39.92
76948
26
32.90
31.26
35.95
77053
26
17.82
16.93
19.47
76965
92.18
87.57
100.71
77054
70.28
66.77
76.79
76965
TC
25.07
23.82
27.39
77054
TC
48.34
45.92
52.81
76965
26
67.11
63.75
73.31
77054
26
21.95
20.85
23.98
76975
26
41.06
39.01
44.86
77063
54.07
51.37
59.08
76977
7.33
6.96
8.00
77063
TC
23.92
22.72
26.13
76977
TC
4.43
4.21
4.84
77063
26
30.15
28.64
32.94
76977
26
2.90
2.76
3.17
77065
125.78
119.49
137.41
76978
309.23
293.77
337.84
77065
TC
86.02
81.72
93.98
76978
TC
229.20
217.74
250.40
77065
26
39.77
37.78
43.45
76978
26
80.04
76.04
87.45
77066
159.13
151.17
173.85
76979
210.07
199.57
229.51
77066
TC
109.93
104.43
120.09
76979
TC
168.26
159.85
183.83
77066
26
49.19
46.73
53.74
76979
26
41.82
39.73
45.69
77067
128.63
122.20
140.53
76981
105.00
99.75
114.71
77067
TC
90.93
86.38
99.34
76981
TC
75.53
71.75
82.51
77067
26
37.70
35.82
41.19
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
C - THE PAYMENT FOR THE TECHNICAL COMPONENT IS CAPPED AT THE OPPS AMOUNT.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
C
C
C
C
0
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
73
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------77071
54.33
51.61
59.35
77306
145.41
138.14
158.86
77072
25.65
24.37
28.03
77306
TC
72.10
68.50
78.78
77072
TC
16.23
15.42
17.73
77306
26
73.31
69.64
80.09
77072
26
9.42
8.95
10.29
77307
283.34
269.17
309.55
77073
44.32
42.10
48.42
77307
TC
130.77
124.23
142.86
77073
TC
30.64
29.11
33.48
77307
26
152.57
144.94
166.68
77073
26
13.68
13.00
14.95
77316
226.68
215.35
247.65
77074
63.71
60.52
69.60
77316
TC
153.38
145.71
167.57
77074
TC
42.11
40.00
46.00
77316
26
73.31
69.64
80.09
77074
26
21.60
20.52
23.60
77317
297.40
282.53
324.91
77075
96.73
91.89
105.67
77317
TC
201.71
191.62
220.36
77075
TC
68.98
65.53
75.36
77317
26
95.69
90.91
104.55
77075
26
27.75
26.36
30.31
77318
424.57
403.34
463.84
77076
104.25
99.04
113.90
77318
TC
272.33
258.71
297.52
77076
TC
69.63
66.15
76.07
77318
26
152.24
144.63
166.32
77076
26
34.62
32.89
37.82
77321
92.99
88.34
101.59
77077
46.11
43.80
50.37
77321
TC
42.77
40.63
46.72
77077
TC
29.01
27.56
31.69
77321
26
50.22
47.71
54.87
77077
26
17.10
16.25
18.69
77331
64.64
61.41
70.62
77078
88.36
83.94
96.53
77331
TC
18.52
17.59
20.23
77078
TC
76.19
72.38
83.24
77331
26
46.12
43.81
50.38
77078
26
12.17
11.56
13.29
77332
41.45
39.38
45.29
77080
37.14
35.28
40.57
77332
TC
17.54
16.66
19.16
77080
TC
27.37
26.00
29.90
77332
26
23.91
22.71
26.12
77080
26
9.77
9.28
10.67
77333
129.92
123.42
141.93
77081
30.92
29.37
33.78
77333
TC
89.95
85.45
98.27
77081
TC
20.81
19.77
22.74
77333
26
39.97
37.97
43.67
77081
26
10.10
9.60
11.04
77334
123.56
117.38
134.99
77084
294.43
279.71
321.67
77334
TC
63.41
60.24
69.28
77084
TC
216.59
205.76
236.62
77334
26
60.15
57.14
65.71
77084
26
77.84
73.95
85.04
77336
78.69
74.76
85.97
77085
51.11
48.55
55.83
77338
463.93
440.73
506.84
77085
TC
36.21
34.40
39.56
77338
TC
239.56
227.58
261.72
77085
26
14.90
14.16
16.28
77338
26
224.37
213.15
245.12
77086
32.82
31.18
35.86
77370
125.12
118.86
136.69
77086
TC
24.42
23.20
26.68
77372
1,010.76
960.22
1,104.25
77086
26
8.40
7.98
9.18
77373
1,104.20
1,048.99
1,206.34
77261
71.82
68.23
78.46
77401
41.46
39.39
45.30
77262
109.23
103.77
119.34
77417
11.31
10.74
12.35
77263
170.05
161.55
185.78
77427
191.71
182.12
209.44
77280
274.30
260.59
299.68
77431
107.52
102.14
117.46
77280
TC
236.08
224.28
257.92
77432
429.57
408.09
469.30
77280
26
38.22
36.31
41.76
77435
647.61
615.23
707.51
77285
453.79
431.10
495.77
77469
321.12
305.06
350.82
77285
TC
396.80
376.96
433.50
77470
132.52
125.89
144.77
77285
26
56.99
54.14
62.26
77470
TC
25.07
23.82
27.39
77290
475.36
451.59
519.33
77470
26
107.45
102.08
117.39
77290
TC
393.85
374.16
430.28
77600
474.04
450.34
517.89
77290
26
81.51
77.43
89.04
77600
TC
403.87
383.68
441.23
77293
433.76
412.07
473.88
77600
26
70.17
66.66
76.66
77293
TC
328.01
311.61
358.35
77605
988.34
938.92
1,079.76
77293
26
105.75
100.46
115.53
77605
TC
881.91
837.81
963.48
77295
473.59
449.91
517.40
77605
26
106.44
101.12
116.29
77295
TC
249.22
236.76
272.27
77610
686.68
652.35
750.20
77295
26
224.37
213.15
245.12
77610
TC
617.82
586.93
674.97
77300
65.07
61.82
71.09
77610
26
68.86
65.42
75.23
77300
TC
32.61
30.98
35.63
77615
1,071.40
1,017.83
1,170.50
77300
26
32.46
30.84
35.47
77615
TC
975.03
926.28
1,065.22
77301
1,843.82
1,751.63
2,014.37
77615
26
96.37
91.55
105.28
77301
TC
1,425.52
1,354.24
1,557.38
77620
636.36
604.54
695.22
77301
26
418.30
397.39
457.00
77620
TC
546.40
519.08
596.94
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
C - THE PAYMENT FOR THE TECHNICAL COMPONENT IS CAPPED AT THE OPPS AMOUNT.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
74
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------77620
26
89.96
85.46
98.28
78071
26
57.48
54.61
62.80
77750
383.40
364.23
418.86
78072
432.39
410.77
472.39
77750
TC
121.44
115.37
132.68
78072
TC
357.67
339.79
390.76
77750
26
261.96
248.86
286.19
78072
26
74.71
70.97
81.62
77761
402.54
382.41
439.77
78075
434.64
412.91
474.85
77761
TC
200.07
190.07
218.58
78075
TC
397.97
378.07
434.78
77761
26
202.46
192.34
221.19
78075
26
36.67
34.84
40.07
77762
532.18
505.57
581.41
78102
168.00
159.60
183.54
77762
TC
229.93
218.43
251.19
78102
TC
142.24
135.13
155.40
77762
26
302.26
287.15
330.22
78102
26
25.76
24.47
28.14
77763
749.32
711.85
818.63
78103
209.71
199.22
229.10
77763
TC
294.49
279.77
321.74
78103
TC
175.66
166.88
191.91
77763
26
454.83
432.09
496.90
78103
26
34.05
32.35
37.20
77767
240.18
228.17
262.40
78104
242.92
230.77
265.39
77767
TC
184.83
175.59
201.93
78104
TC
204.49
194.27
223.41
77767
26
55.35
52.58
60.47
78104
26
38.44
36.52
42.00
77768
354.31
336.59
387.08
78110
68.76
65.32
75.12
77768
TC
280.68
266.65
306.65
78110
TC
60.65
57.62
66.26
77768
26
73.63
69.95
80.44
78110
26
8.11
7.70
8.86
77770
337.96
321.06
369.22
78111
73.09
69.44
79.86
77770
TC
236.12
224.31
257.96
78111
TC
63.60
60.42
69.48
77770
26
101.84
96.75
111.26
78111
26
9.49
9.02
10.37
77771
590.69
561.16
645.33
78120
70.49
66.97
77.02
77771
TC
391.46
371.89
427.67
78120
TC
60.65
57.62
66.26
77771
26
199.24
189.28
217.67
78120
26
9.84
9.35
10.75
77772
882.86
838.72
964.53
78121
77.23
73.37
84.38
77772
TC
601.86
571.77
657.54
78121
TC
63.60
60.42
69.48
77772
26
281.00
266.95
306.99
78121
26
13.63
12.95
14.89
77778
871.98
828.38
952.64
78122
95.53
90.75
104.36
77778
TC
412.64
392.01
450.81
78122
TC
75.07
71.32
82.02
77778
26
459.34
436.37
501.83
78122
26
20.46
19.44
22.36
77789
128.63
122.20
140.53
78130
123.57
117.39
135.00
77789
TC
68.50
65.08
74.84
78130
TC
98.18
93.27
107.26
77789
26
60.13
57.12
65.69
78130
26
25.39
24.12
27.74
77790
14.92
14.17
16.30
78140
109.96
104.46
120.13
78012
79.90
75.91
87.30
78140
TC
84.57
80.34
92.39
78012
TC
70.81
67.27
77.36
78140
26
25.39
24.12
27.74
78012
26
9.10
8.65
9.95
78185
167.18
158.82
182.64
78013
190.05
180.55
207.63
78185
TC
150.43
142.91
164.35
78013
TC
172.38
163.76
188.32
78185
26
16.75
15.91
18.30
78013
26
17.67
16.79
19.31
78191
123.57
117.39
135.00
78014
232.44
220.82
253.94
78191
TC
98.18
93.27
107.26
78014
TC
208.42
198.00
227.70
78191
26
25.39
24.12
27.74
78014
26
24.02
22.82
26.24
78195
345.69
328.41
377.67
78015
221.35
210.28
241.82
78195
TC
288.54
274.11
315.23
78015
TC
188.43
179.01
205.86
78195
26
57.15
54.29
62.43
78015
26
32.92
31.27
35.96
78201
185.78
176.49
202.96
78016
275.71
261.92
301.21
78201
TC
164.84
156.60
180.09
78016
TC
242.01
229.91
264.40
78201
26
20.94
19.89
22.87
78016
26
33.70
32.02
36.82
78202
203.95
193.75
222.81
78018
305.81
290.52
334.10
78202
TC
179.91
170.91
196.55
78018
TC
264.95
251.70
289.46
78202
26
24.04
22.84
26.27
78018
26
40.86
38.82
44.64
78215
190.81
181.27
208.46
78020
80.93
76.88
88.41
78215
TC
167.14
158.78
182.60
78020
TC
53.42
50.75
58.36
78215
26
23.67
22.49
25.86
78020
26
27.51
26.13
30.05
78216
126.76
120.42
138.48
78070
287.48
273.11
314.08
78216
TC
99.97
94.97
109.22
78070
TC
248.72
236.28
271.72
78216
26
26.79
25.45
29.27
78070
26
38.76
36.82
42.34
78226
318.66
302.73
348.14
78071
343.73
326.54
375.52
78226
TC
282.64
268.51
308.79
78071
TC
286.25
271.94
312.73
78226
26
36.01
34.21
39.34
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
75
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------78227
428.10
406.70
467.71
78434
26
30.19
28.68
32.98
78227
TC
384.54
365.31
420.11
78445
200.00
190.00
218.50
78227
26
43.56
41.38
47.59
78445
TC
174.67
165.94
190.83
78230
170.73
162.19
186.52
78445
26
25.33
24.06
27.67
78230
TC
148.79
141.35
162.55
78451
332.64
316.01
363.41
78230
26
21.95
20.85
23.98
78451
TC
266.59
253.26
291.25
78231
104.20
98.99
113.84
78451
26
66.06
62.76
72.17
78231
TC
82.60
78.47
90.24
78452
462.09
438.99
504.84
78231
26
21.59
20.51
23.59
78452
TC
384.71
365.47
420.29
78232
102.13
97.02
111.57
78452
26
77.38
73.51
84.54
78232
TC
82.60
78.47
90.24
78453
291.84
277.25
318.84
78232
26
19.52
18.54
21.32
78453
TC
243.48
231.31
266.01
78258
208.38
197.96
227.65
78453
26
48.36
45.94
52.83
78258
TC
174.34
165.62
190.46
78454
421.68
400.60
460.69
78258
26
34.03
32.33
37.18
78454
TC
357.02
339.17
390.05
78261
199.90
189.91
218.40
78454
26
64.66
61.43
70.64
78261
TC
171.40
162.83
187.25
78456
305.78
290.49
334.06
78261
26
28.51
27.08
31.14
78456
TC
257.41
244.54
281.22
78262
236.44
224.62
258.31
78456
26
48.36
45.94
52.83
78262
TC
202.85
192.71
221.62
78457
175.69
166.91
191.95
78262
26
33.59
31.91
36.70
78457
TC
137.98
131.08
150.74
78264
323.35
307.18
353.26
78457
26
37.72
35.83
41.20
78264
TC
284.93
270.68
311.28
78458
201.20
191.14
219.81
78264
26
38.41
36.49
41.96
78458
TC
156.98
149.13
171.50
78265
381.42
362.35
416.70
78458
26
44.22
42.01
48.31
78265
TC
334.41
317.69
365.34
78459
26
74.41
70.69
81.29
78265
26
47.01
44.66
51.36
78466
193.54
183.86
211.44
78266
423.42
402.25
462.59
78466
TC
158.62
150.69
173.29
78266
TC
374.23
355.52
408.85
78466
26
34.93
33.18
38.16
78266
26
49.19
46.73
53.74
78468
193.45
183.78
211.35
78278
339.17
322.21
370.54
78468
TC
154.69
146.96
169.00
78278
TC
291.49
276.92
318.46
78468
26
38.76
36.82
42.34
78278
26
47.69
45.31
52.11
78469
215.66
204.88
235.61
78282
26
16.05
15.25
17.54
78469
TC
171.07
162.52
186.90
78290
321.48
305.41
351.22
78469
26
44.59
42.36
48.71
78290
TC
288.21
273.80
314.87
78472
222.99
211.84
243.62
78290
26
33.27
31.61
36.35
78472
TC
175.98
167.18
192.26
78291
244.73
232.49
267.36
78472
26
47.01
44.66
51.36
78291
TC
203.18
193.02
221.97
78473
282.86
268.72
309.03
78291
26
41.56
39.48
45.40
78473
TC
213.01
202.36
232.71
78300
224.19
212.98
244.93
78473
26
69.85
66.36
76.31
78300
TC
193.35
183.68
211.23
78481
174.17
165.46
190.28
78300
26
30.84
29.30
33.70
78481
TC
126.84
120.50
138.58
78305
271.17
257.61
296.25
78481
26
47.34
44.97
51.72
78305
TC
231.03
219.48
252.40
78483
237.97
226.07
259.98
78305
26
40.14
38.13
43.85
78483
TC
167.14
158.78
182.60
78306
291.54
276.96
318.50
78483
26
70.83
67.29
77.38
78306
TC
250.03
237.53
273.16
78491
26
72.01
68.41
78.67
78306
26
41.51
39.43
45.34
78492
26
84.97
80.72
92.83
78315
337.27
320.41
368.47
78494
223.77
212.58
244.47
78315
TC
288.21
273.80
314.87
78494
TC
166.48
158.16
181.88
78315
26
49.06
46.61
53.60
78494
26
57.29
54.43
62.59
78414
26
21.77
20.68
23.78
78496
42.54
40.41
46.47
78428
182.59
173.46
199.48
78496
TC
18.52
17.59
20.23
78428
TC
144.86
137.62
158.26
78496
26
24.02
22.82
26.24
78428
26
37.74
35.85
41.23
78579
182.29
173.18
199.16
78429
26
81.61
77.53
89.16
78579
TC
158.95
151.00
173.65
78430
26
77.49
73.62
84.66
78579
26
23.34
22.17
25.50
78431
26
89.77
85.28
98.07
78580
231.00
219.45
252.37
78432
26
95.87
91.08
104.74
78580
TC
194.99
185.24
213.03
78433
26
104.14
98.93
113.77
78580
26
36.01
34.21
39.34
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
76
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------78582
324.60
308.37
354.63
78740
214.89
204.15
234.77
78582
TC
273.47
259.80
298.77
78740
TC
187.78
178.39
205.15
78582
26
51.13
48.57
55.86
78740
26
27.12
25.76
29.62
78597
197.93
188.03
216.23
78761
207.02
196.67
226.17
78597
TC
162.55
154.42
177.58
78761
TC
171.72
163.13
187.60
78597
26
35.38
33.61
38.65
78761
26
35.30
33.54
38.57
78598
296.11
281.30
323.50
78800
249.64
237.16
272.73
78598
TC
255.60
242.82
279.24
78800
TC
217.59
206.71
237.72
78598
26
40.51
38.48
44.25
78800
26
32.04
30.44
35.01
78600
178.90
169.96
195.45
78801
275.39
261.62
300.86
78600
TC
157.31
149.44
171.86
78801
TC
239.55
227.57
261.71
78600
26
21.60
20.52
23.60
78801
26
35.84
34.05
39.16
78601
210.18
199.67
229.62
78802
304.85
289.61
333.05
78601
TC
185.81
176.52
203.00
78802
TC
266.41
253.09
291.05
78601
26
24.37
23.15
26.62
78802
26
38.44
36.52
42.00
78605
194.49
184.77
212.49
78803
376.74
357.90
411.59
78605
TC
168.77
160.33
184.38
78803
TC
325.56
309.28
355.67
78605
26
25.72
24.43
28.09
78803
26
51.18
48.62
55.91
78606
322.70
306.57
352.56
78804
640.69
608.66
699.96
78606
TC
291.16
276.60
318.09
78804
TC
592.63
563.00
647.45
78606
26
31.54
29.96
34.45
78804
26
48.06
45.66
52.51
78608
26
70.24
66.73
76.74
78808
39.72
37.73
43.39
78610
169.59
161.11
185.28
78811
26
72.29
68.68
78.98
78610
TC
155.34
147.57
169.71
78812
26
90.66
86.13
99.05
78610
26
14.25
13.54
15.57
78813
26
90.97
86.42
99.38
78630
328.36
311.94
358.73
78814
26
104.21
99.00
113.85
78630
TC
295.09
280.34
322.39
78815
26
116.69
110.86
127.49
78630
26
33.27
31.61
36.35
78816
26
117.30
111.44
128.16
78635
328.54
312.11
358.93
78830
478.68
454.75
522.96
78635
TC
298.04
283.14
325.61
78830
TC
408.78
388.34
446.59
78635
26
30.50
28.98
33.33
78830
26
69.89
66.40
76.36
78645
314.34
298.62
343.41
78831
690.27
655.76
754.12
78645
TC
287.56
273.18
314.16
78831
TC
605.08
574.83
661.05
78645
26
26.79
25.45
29.27
78831
26
85.19
80.93
93.07
78650
270.02
256.52
295.00
78832
898.67
853.74
981.80
78650
TC
244.63
232.40
267.26
78832
TC
798.24
758.33
872.08
78650
26
25.39
24.12
27.74
78832
26
100.43
95.41
109.72
78660
185.32
176.05
202.46
78835
99.81
94.82
109.04
78660
TC
158.95
151.00
173.65
78835
TC
77.83
73.94
85.03
78660
26
26.38
25.06
28.82
78835
26
21.99
20.89
24.02
78700
167.46
159.09
182.95
79005
135.62
128.84
148.17
78700
TC
145.84
138.55
159.33
79005
TC
49.82
47.33
54.43
78700
26
21.62
20.54
23.62
79005
26
85.80
81.51
93.74
78701
214.40
203.68
234.23
79101
147.10
139.75
160.71
78701
TC
190.73
181.19
208.37
79101
TC
51.46
48.89
56.22
78701
26
23.67
22.49
25.86
79101
26
95.64
90.86
104.49
78707
226.23
214.92
247.16
79200
134.35
127.63
146.77
78707
TC
180.57
171.54
197.27
79200
TC
52.77
50.13
57.65
78707
26
45.66
43.38
49.89
79200
26
81.58
77.50
89.13
78708
174.35
165.63
190.47
79300
26
65.50
62.23
71.56
78708
TC
116.52
110.69
127.29
79403
184.43
175.21
201.49
78708
26
57.83
54.94
63.18
79403
TC
79.33
75.36
86.66
78709
358.92
340.97
392.12
79403
26
105.10
99.85
114.83
78709
TC
292.14
277.53
319.16
79440
121.24
115.18
132.46
78709
26
66.77
63.43
72.94
79440
TC
39.66
37.68
43.33
78725
110.13
104.62
120.31
79440
26
81.58
77.50
89.13
78725
TC
92.11
87.50
100.63
79445
26
112.86
107.22
123.30
78725
26
18.02
17.12
19.69
80500
22.10
21.00
24.15
78730
74.54
70.81
81.43
#
80500
19.15
18.19
20.92
78730
TC
67.01
63.66
73.21
80502
72.02
68.42
78.68
78730
26
7.53
7.15
8.22
#
80502
69.07
65.62
75.46
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
77
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------83020
26
18.50
17.58
20.22
88162
26
38.49
36.57
42.06
84165
26
18.50
17.58
20.22
88172
54.24
51.53
59.26
84166
26
18.50
17.58
20.22
88172
TC
18.85
17.91
20.60
84181
26
18.50
17.58
20.22
88172
26
35.39
33.62
38.66
84182
26
18.50
17.58
20.22
88173
151.11
143.55
165.08
85060
24.91
23.66
27.21
88173
TC
80.62
76.59
88.08
85097
68.40
64.98
74.73
88173
26
70.49
66.97
77.02
85097
49.06
46.61
53.60
88177
28.59
27.16
31.23
85390
26
37.67
35.79
41.16
88177
TC
6.88
6.54
7.52
85396
19.81
18.82
21.64
88177
26
21.71
20.62
23.71
85576
26
18.50
17.58
20.22
88182
134.55
127.82
146.99
86077
53.98
51.28
58.97
88182
TC
96.36
91.54
105.27
86077
50.37
47.85
55.03
88182
26
38.18
36.27
41.71
86078
53.98
51.28
58.97
88184
65.88
62.59
71.98
86078
50.37
47.85
55.03
88185
21.62
20.54
23.62
86079
53.65
50.97
58.62
88187
36.67
34.84
40.07
86079
50.05
47.55
54.68
88188
62.40
59.28
68.17
86153
26
34.93
33.18
38.16
88189
85.12
80.86
92.99
86255
26
18.50
17.58
20.22
88291
33.58
31.90
36.69
86256
26
18.50
17.58
20.22
88300
15.26
14.50
16.68
86320
26
18.50
17.58
20.22
88300
TC
10.66
10.13
11.65
86325
26
18.50
17.58
20.22
88300
26
4.60
4.37
5.03
86327
26
22.04
20.94
24.08
88302
30.77
29.23
33.61
86334
26
18.50
17.58
20.22
88302
TC
23.76
22.57
25.96
86335
26
18.50
17.58
20.22
88302
26
7.00
6.65
7.65
86486
5.74
5.45
6.27
88304
40.46
38.44
44.21
86490
86.67
82.34
94.69
88304
TC
29.01
27.56
31.69
86510
7.05
6.70
7.71
88304
26
11.45
10.88
12.51
86580
9.67
9.19
10.57
88305
69.11
65.65
75.50
87164
26
19.31
18.34
21.09
88305
TC
31.95
30.35
34.90
87207
26
18.50
17.58
20.22
88305
26
37.16
35.30
40.60
88104
64.77
61.53
70.76
88307
277.37
263.50
303.03
88104
TC
37.52
35.64
40.99
88307
TC
194.99
185.24
213.03
88104
26
27.25
25.89
29.77
88307
26
82.38
78.26
90.00
88106
64.04
60.84
69.97
88309
422.32
401.20
461.38
88106
TC
44.73
42.49
48.86
88309
TC
277.55
263.67
303.22
88106
26
19.31
18.34
21.09
88309
26
144.76
137.52
158.15
88108
61.24
58.18
66.91
88311
20.84
19.80
22.77
88108
TC
38.84
36.90
42.44
88311
TC
8.36
7.94
9.13
88108
26
22.41
21.29
24.48
88311
26
12.48
11.86
13.64
88112
65.10
61.85
71.13
88312
107.65
102.27
117.61
88112
TC
37.52
35.64
40.99
88312
TC
81.10
77.05
88.61
88112
26
27.58
26.20
30.13
88312
26
26.55
25.22
29.00
88120
597.60
567.72
652.88
88313
77.53
73.65
84.70
88120
TC
539.98
512.98
589.93
88313
TC
65.37
62.10
71.42
88120
26
57.62
54.74
62.95
88313
26
12.15
11.54
13.27
88121
431.54
409.96
471.45
88314
96.65
91.82
105.59
88121
TC
383.52
364.34
418.99
88314
TC
75.20
71.44
82.16
88121
26
48.02
45.62
52.46
88314
26
21.44
20.37
23.43
88125
26.13
24.82
28.54
88319
123.86
117.67
135.32
88125
TC
12.30
11.69
13.44
88319
TC
97.00
92.15
105.97
88125
26
13.83
13.14
15.11
88319
26
26.86
25.52
29.35
88141
21.37
20.30
23.35
88321
98.08
93.18
107.16
88160
68.91
65.46
75.28
#
88321
84.65
80.42
92.48
88160
TC
43.42
41.25
47.44
88323
112.21
106.60
122.59
88160
26
25.48
24.21
27.84
88323
TC
25.73
24.44
28.11
88161
68.91
65.46
75.28
88323
26
86.48
82.16
94.48
88161
TC
43.75
41.56
47.79
88325
165.10
156.85
180.38
88161
26
25.16
23.90
27.49
#
88325
141.19
134.13
154.25
88162
100.10
95.10
109.37
88329
57.82
54.93
63.17
88162
TC
61.62
58.54
67.32
#
88329
35.87
34.08
39.19
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
78
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------88331
101.35
96.28
110.72
88367
26
33.51
31.83
36.60
88331
TC
39.82
37.83
43.50
88368
131.16
124.60
143.29
88331
26
61.53
58.45
67.22
88368
TC
90.12
85.61
98.45
88332
53.37
50.70
58.31
88368
26
41.04
38.99
44.84
88332
TC
22.78
21.64
24.89
88369
112.91
107.26
123.35
88332
26
30.59
29.06
33.42
88369
TC
80.77
76.73
88.24
88333
93.50
88.83
102.15
88369
26
32.13
30.52
35.10
88333
TC
31.95
30.35
34.90
88371
26
19.31
18.34
21.09
88333
26
61.55
58.47
67.24
88372
26
18.50
17.58
20.22
88334
55.46
52.69
60.59
88373
70.21
66.70
76.71
88334
TC
18.02
17.12
19.69
88373
TC
44.23
42.02
48.32
88334
26
37.44
35.57
40.91
88373
26
25.98
24.68
28.38
88341
89.50
85.03
97.78
88374
333.25
316.59
364.08
88341
TC
61.27
58.21
66.94
88374
TC
289.81
275.32
316.62
88341
26
28.23
26.82
30.84
88374
26
43.44
41.27
47.46
88342
101.44
96.37
110.83
88375
49.00
46.55
53.53
88342
TC
66.69
63.36
72.86
88377
402.42
382.30
439.65
88342
26
34.76
33.02
37.97
88377
TC
338.48
321.56
369.79
88344
169.41
160.94
185.08
88377
26
63.94
60.74
69.85
88344
TC
131.56
124.98
143.73
88380
129.26
122.80
141.22
88344
26
37.85
35.96
41.35
88380
TC
74.39
70.67
81.27
88346
138.88
131.94
151.73
88380
26
54.87
52.13
59.95
88346
TC
103.05
97.90
112.59
88381
194.32
184.60
212.29
88346
26
35.82
34.03
39.13
88381
TC
169.76
161.27
185.46
88348
411.05
390.50
449.08
88381
26
24.56
23.33
26.83
88348
TC
333.75
317.06
364.62
88387
35.09
33.34
38.34
88348
26
77.30
73.44
84.46
88387
TC
7.71
7.32
8.42
88350
105.47
100.20
115.23
88387
26
27.38
26.01
29.91
88350
TC
76.51
72.68
83.58
88388
36.69
34.86
40.09
88350
26
28.95
27.50
31.63
88388
TC
13.28
12.62
14.51
88355
140.91
133.86
153.94
88388
26
23.41
22.24
25.58
88355
TC
57.84
54.95
63.19
89049
257.85
244.96
281.70
88355
26
83.07
78.92
90.76
#
89049
63.55
60.37
69.43
88356
236.37
224.55
258.23
89060
26
18.50
17.58
20.22
88356
TC
107.50
102.13
117.45
89220
17.87
16.98
19.53
88356
26
128.86
122.42
140.78
89230
2.47
2.35
2.70
88358
134.91
128.16
147.38
90460
16.59
15.76
18.12
88358
TC
85.36
81.09
93.25
90461
12.62
11.99
13.79
88358
26
49.55
47.07
54.13
90471
16.59
15.76
18.12
88360
119.45
113.48
130.50
90472
12.62
11.99
13.79
88360
TC
77.83
73.94
85.03
90473
16.59
15.76
18.12
88360
26
41.63
39.55
45.48
90474
12.62
11.99
13.79
88361
119.01
113.06
130.02
90785
14.96
14.21
16.34
88361
TC
75.53
71.75
82.51
#
90785
13.33
12.66
14.56
88361
26
43.48
41.31
47.51
90791
180.32
171.30
197.00
88362
216.51
205.68
236.53
#
90791
157.38
149.51
171.94
88362
TC
104.87
99.63
114.57
90792
200.83
190.79
219.41
88362
26
111.64
106.06
121.97
#
90792
177.24
168.38
193.64
88363
23.09
21.94
25.23
90832
77.55
73.67
84.72
88363
19.81
18.82
21.64
#
90832
69.03
65.58
75.42
88364
137.48
130.61
150.20
90833
70.90
67.36
77.46
88364
TC
103.05
97.90
112.59
#
90833
63.69
60.51
69.59
88364
26
34.43
32.71
37.62
90834
103.31
98.14
112.86
88365
177.20
168.34
193.59
#
90834
91.84
87.25
100.34
88365
TC
133.70
127.02
146.07
90836
89.62
85.14
97.91
88365
26
43.50
41.33
47.53
#
90836
80.44
76.42
87.88
88366
278.88
264.94
304.68
90837
152.48
144.86
166.59
88366
TC
217.25
206.39
237.35
#
90837
135.77
128.98
148.33
88366
26
61.63
58.55
67.33
90838
119.11
113.15
130.12
88367
110.68
105.15
120.92
#
90838
107.31
101.94
117.23
88367
TC
77.17
73.31
84.31
90839
145.21
137.95
158.64
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
---#
#
#
#
#
#
#
#
#
#
#
#
#
0
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
79
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------90839
129.16
122.70
141.11
91030
TC
98.31
93.39
107.40
90840
68.60
65.17
74.95
91030
26
46.86
44.52
51.20
90840
61.07
58.02
66.72
91034
194.78
185.04
212.80
90845
98.10
93.20
107.18
91034
TC
144.67
137.44
158.06
90845
87.94
83.54
96.07
91034
26
50.11
47.60
54.74
90846
99.72
94.73
108.94
91035
490.71
466.17
536.10
90846
99.06
94.11
108.23
91035
TC
407.44
387.07
445.13
90847
103.21
98.05
112.76
91035
26
83.27
79.11
90.98
90847
102.55
97.42
112.03
91037
170.68
162.15
186.47
90849
34.69
32.96
37.90
91037
TC
121.07
115.02
132.27
90849
28.14
26.73
30.74
91037
26
49.61
47.13
54.20
90853
27.49
26.12
30.04
91038
436.68
414.85
477.08
90853
24.21
23.00
26.45
91038
TC
380.57
361.54
415.77
90865
167.18
158.82
182.64
91038
26
56.11
53.30
61.30
90865
125.90
119.61
137.55
91040
530.94
504.39
580.05
90870
173.32
164.65
189.35
91040
TC
481.16
457.10
525.67
90870
108.45
103.03
118.48
91040
26
49.78
47.29
54.38
90880
107.46
102.09
117.40
91065
89.24
84.78
97.50
90880
90.75
86.21
99.14
91065
TC
78.81
74.87
86.10
90901
40.54
38.51
44.29
91065
26
10.43
9.91
11.40
90901
19.89
18.90
21.74
91110
838.60
796.67
916.17
90912
80.76
76.72
88.23
91110
TC
711.17
675.61
776.95
90912
44.06
41.86
48.14
91110
26
127.43
121.06
139.22
90913
32.56
30.93
35.57
C
91111
811.62
771.04
886.70
90913
25.02
23.77
27.34
C
91111
TC
760.31
722.29
830.63
90935
73.51
69.83
80.30
91111
26
51.31
48.74
56.05
90937
105.69
100.41
115.47
91112
1,618.03
1,537.13
1,767.70
90945
86.64
82.31
94.66
91112
TC
1,511.28
1,435.72
1,651.08
90947
125.26
119.00
136.85
91112
26
106.75
101.41
116.62
90951
1,203.20
1,143.04
1,314.50
91117
137.56
130.68
150.28
90954
793.11
753.45
866.47
91120
517.84
491.95
565.74
90955
534.32
507.60
583.74
91120
TC
468.38
444.96
511.70
90956
354.79
337.05
387.61
91120
26
49.46
46.99
54.04
90957
790.33
750.81
863.43
91122
267.46
254.09
292.20
90958
514.03
488.33
561.58
91122
TC
178.26
169.35
194.75
90959
331.02
314.47
361.64
91122
26
89.20
84.74
97.45
90960
362.10
344.00
395.60
91132
403.65
383.47
440.99
90961
299.24
284.28
326.92
91132
TC
376.97
358.12
411.84
90962
204.22
194.01
223.11
91132
26
26.68
25.35
29.15
90963
620.44
589.42
677.83
91133
425.90
404.61
465.30
90964
532.88
506.24
582.18
91133
TC
392.37
372.75
428.66
90965
512.57
486.94
559.98
91133
26
33.53
31.85
36.63
90966
298.91
283.96
326.55
91200
31.59
30.01
34.51
90967
18.13
17.22
19.80
91200
TC
20.49
19.47
22.39
90968
17.78
16.89
19.42
91200
26
11.10
10.55
12.13
90969
17.10
16.25
18.69
92002
84.80
80.56
92.64
90970
9.73
9.24
10.63
#
92002
47.13
44.77
51.49
90997
90.68
86.15
99.07
92004
147.92
140.52
161.60
91010
217.56
206.68
237.68
#
92004
95.50
90.73
104.34
91010
TC
152.05
144.45
166.12
92012
88.17
83.76
96.32
91010
26
65.51
62.23
71.56
#
92012
51.14
48.58
55.87
91013
26.11
24.80
28.52
92014
124.46
118.24
135.98
91013
TC
16.71
15.87
18.25
#
92014
76.95
73.10
84.07
91013
26
9.40
8.93
10.27
92018
140.08
133.08
153.04
91020
275.24
261.48
300.70
92019
71.80
68.21
78.44
91020
TC
201.52
191.44
220.16
92020
27.50
26.13
30.05
91020
26
73.72
70.03
80.53
#
92020
20.29
19.28
22.17
91022
172.51
163.88
188.46
92025
36.15
34.34
39.49
91022
TC
99.30
94.34
108.49
92025
TC
16.88
16.04
18.45
91022
26
73.22
69.56
79.99
92025
26
19.27
18.31
21.06
91030
145.17
137.91
158.60
92060
62.10
59.00
67.85
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
C - THE PAYMENT FOR THE TECHNICAL COMPONENT IS CAPPED AT THE OPPS AMOUNT.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
#
#
#
#
#
#
#
0
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
80
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------92060
TC
25.40
24.13
27.75
92265
26
45.15
42.89
49.32
92060
26
36.70
34.87
40.10
92270
100.36
95.34
109.64
92065
52.25
49.64
57.09
92270
TC
58.82
55.88
64.26
92065
TC
34.58
32.85
37.78
92270
26
41.54
39.46
45.38
92065
26
17.67
16.79
19.31
92273
127.48
121.11
139.28
92071
36.70
34.87
40.10
92273
TC
91.10
86.55
99.53
92071
32.44
30.82
35.44
92273
26
36.37
34.55
39.73
92072
127.10
120.75
138.86
92274
86.83
82.49
94.86
92072
96.30
91.49
105.21
92274
TC
54.56
51.83
59.60
92081
33.09
31.44
36.16
92274
26
32.27
30.66
35.26
92081
TC
17.21
16.35
18.80
92283
52.80
50.16
57.68
92081
26
15.88
15.09
17.35
92283
TC
43.75
41.56
47.79
92082
46.41
44.09
50.70
92283
26
9.05
8.60
9.89
92082
TC
25.40
24.13
27.75
92284
57.39
54.52
62.70
92082
26
21.01
19.96
22.95
92284
TC
45.23
42.97
49.42
92083
61.70
58.62
67.41
92284
26
12.15
11.54
13.27
92083
TC
34.90
33.16
38.13
92285
22.40
21.28
24.47
92083
26
26.79
25.45
29.27
92285
TC
19.18
18.22
20.95
92100
82.90
78.76
90.57
92285
26
3.23
3.07
3.53
92100
32.77
31.13
35.80
92286
38.55
36.62
42.11
92132
31.13
29.57
34.01
92286
TC
16.88
16.04
18.45
92132
TC
14.92
14.17
16.30
92286
26
21.67
20.59
23.68
92132
26
16.21
15.40
17.71
C
92287
150.67
143.14
164.61
92133
36.58
34.75
39.96
C
92287
TC
105.52
100.24
115.28
92133
TC
14.92
14.17
16.30
92287
26
45.15
42.89
49.32
92133
26
21.67
20.59
23.68
92311
105.20
99.94
114.93
92134
40.29
38.28
44.02
#
92311
53.43
50.76
58.37
92134
TC
15.24
14.48
16.65
92312
120.98
114.93
132.17
92134
26
25.05
23.80
27.37
#
92312
61.35
58.28
67.02
92136
53.59
50.91
58.55
92313
98.79
93.85
107.93
92136
TC
23.44
22.27
25.61
#
92313
43.74
41.55
47.78
92136
26
30.16
28.65
32.95
92315
80.09
76.09
87.50
92145
13.34
12.67
14.57
#
92315
21.12
20.06
23.07
92145
TC
7.05
6.70
7.71
92316
99.26
94.30
108.45
92145
26
6.28
5.97
6.87
#
92316
31.76
30.17
34.70
92201
24.79
23.55
27.08
92317
84.03
79.83
91.80
92201
22.82
21.68
24.93
#
92317
21.12
20.06
23.07
92202
15.80
15.01
17.26
92325
45.39
43.12
49.59
92202
14.49
13.77
15.84
92326
37.85
35.96
41.35
92227
15.24
14.48
16.65
92502
94.39
89.67
103.12
92228
30.19
28.68
32.98
92504
28.73
27.29
31.38
92228
TC
12.30
11.69
13.44
#
92504
9.40
8.93
10.27
92228
26
17.89
17.00
19.55
92507
77.03
73.18
84.16
92230
88.80
84.36
97.01
92508
23.48
22.31
25.66
92230
33.75
32.06
36.87
92511
115.03
109.28
125.67
92235
114.00
108.30
124.55
#
92511
37.38
35.51
40.84
92235
TC
72.26
68.65
78.95
92512
59.53
56.55
65.03
92235
26
41.74
39.65
45.60
#
92512
28.07
26.67
30.67
92240
197.04
187.19
215.27
92516
68.12
64.71
74.42
92240
TC
150.56
143.03
164.48
#
92516
23.56
22.38
25.74
92240
26
46.47
44.15
50.77
92517
84.31
80.09
92.10
92242
243.36
231.19
265.87
#
92517
43.68
41.50
47.73
92242
TC
189.88
180.39
207.45
92518
78.74
74.80
86.02
92242
26
53.48
50.81
58.43
#
92518
43.68
41.50
47.73
92250
38.55
36.62
42.11
92519
130.55
124.02
142.62
92250
TC
17.54
16.66
19.16
#
92519
65.34
62.07
71.38
92250
26
21.01
19.96
22.95
92520
79.61
75.63
86.97
92260
19.60
18.62
21.41
#
92520
39.97
37.97
43.67
92260
10.76
10.22
11.75
92521
134.76
128.02
147.22
92265
85.29
81.03
93.18
92522
113.29
107.63
123.77
92265
TC
40.15
38.14
43.86
92523
231.60
220.02
253.02
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
C - THE PAYMENT FOR THE TECHNICAL COMPONENT IS CAPPED AT THE OPPS AMOUNT.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
81
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------92524
110.82
105.28
121.07
92587
22.39
21.27
24.46
92526
84.97
80.72
92.83
92587
TC
4.10
3.90
4.49
92537
41.60
39.52
45.45
92587
26
18.28
17.37
19.98
92537
TC
10.33
9.81
11.28
92588
33.95
32.25
37.09
92537
26
31.27
29.71
34.17
92588
TC
5.42
5.15
5.92
92538
22.61
21.48
24.70
92588
26
28.54
27.11
31.18
92538
TC
6.73
6.39
7.35
92596
64.39
61.17
70.35
92538
26
15.88
15.09
17.35
92597
71.70
68.12
78.34
92540
109.23
103.77
119.34
92601
166.34
158.02
181.72
92540
TC
30.97
29.42
33.83
#
92601
125.39
119.12
136.99
92540
26
78.26
74.35
85.50
92602
105.20
99.94
114.93
92541
25.44
24.17
27.80
#
92602
70.80
67.26
77.35
92541
TC
4.43
4.21
4.84
92603
155.10
147.35
169.45
92541
26
21.01
19.96
22.95
#
92603
122.01
115.91
133.30
92542
29.55
28.07
32.28
92604
93.63
88.95
102.29
92542
TC
4.43
4.21
4.84
#
92604
67.74
64.35
74.00
92542
26
25.11
23.85
27.43
92607
124.89
118.65
136.45
92544
18.29
17.38
19.99
92608
50.35
47.83
55.00
92544
TC
3.78
3.59
4.13
92609
104.32
99.10
113.97
92544
26
14.51
13.78
15.85
92610
84.89
80.65
92.75
92545
16.93
16.08
18.49
#
92610
70.14
66.63
76.62
92545
TC
3.45
3.28
3.77
92611
92.55
87.92
101.11
92545
26
13.48
12.81
14.73
92612
192.79
183.15
210.62
92546
115.16
109.40
125.81
#
92612
66.65
63.32
72.82
92546
TC
100.28
95.27
109.56
92613
37.26
35.40
40.71
92546
26
14.88
14.14
16.26
92614
144.63
137.40
158.01
92547
9.50
9.03
10.38
#
92614
65.99
62.69
72.09
92548
49.45
46.98
54.03
92615
33.16
31.50
36.23
92548
TC
14.92
14.17
16.30
92616
213.31
202.64
233.04
92548
26
34.54
32.81
37.73
#
92616
99.61
94.63
108.82
92549
63.66
60.48
69.55
92617
41.54
39.46
45.38
92549
TC
18.19
17.28
19.87
92620
92.52
87.89
101.07
92549
26
45.47
43.20
49.68
#
92620
80.73
76.69
88.19
92550
22.39
21.27
24.46
92621
22.54
21.41
24.62
92552
30.97
29.42
33.83
#
92621
18.94
17.99
20.69
92553
37.85
35.96
41.35
92625
69.83
66.34
76.29
92555
23.76
22.57
25.96
#
92625
62.29
59.18
68.06
92556
37.52
35.64
40.99
92626
89.69
85.21
97.99
92557
38.67
36.74
42.25
#
92626
75.60
71.82
82.59
92557
33.10
31.45
36.17
92627
21.19
20.13
23.15
92561
38.03
36.13
41.55
#
92627
17.91
17.01
19.56
92562
44.41
42.19
48.52
92640
113.06
107.41
123.52
92563
29.99
28.49
32.76
#
92640
95.04
90.29
103.83
92564
22.78
21.64
24.89
92651
88.84
84.40
97.06
92565
16.88
16.04
18.45
92652
117.13
111.27
127.96
92567
16.33
15.51
17.84
92653
85.34
81.07
93.23
92567
10.76
10.22
11.75
92920
564.74
536.50
616.98
92568
15.71
14.92
17.16
92924
673.34
639.67
735.62
92568
15.38
14.61
16.80
92928
628.43
597.01
686.56
92570
33.64
31.96
36.75
92933
705.94
670.64
771.24
92570
30.37
28.85
33.18
92937
627.76
596.37
685.83
92571
26.71
25.37
29.18
92941
705.96
670.66
771.26
92572
34.25
32.54
37.42
92943
706.96
671.61
772.35
92575
65.55
62.27
71.61
92950
333.74
317.05
364.61
92576
36.21
34.40
39.56
#
92950
191.21
181.65
208.90
92577
14.59
13.86
15.94
92953
1.18
1.12
1.29
92579
47.07
44.72
51.43
92960
158.88
150.94
173.58
92579
38.55
36.62
42.11
#
92960
110.39
104.87
120.60
92582
72.10
68.50
78.78
92961
261.58
248.50
285.78
92583
48.34
45.92
52.81
92970
201.18
191.12
219.79
92584
117.01
111.16
127.83
92971
106.86
101.52
116.75
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
82
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------92973
188.85
179.41
206.32
93281
82.62
78.49
90.26
92974
172.13
163.52
188.05
93281
TC
39.49
37.52
43.15
92975
401.48
381.41
438.62
93281
26
43.13
40.97
47.12
92977
54.02
51.32
59.02
93282
78.69
74.76
85.97
92978
26
100.47
95.45
109.77
93282
TC
35.89
34.10
39.22
92979
26
79.65
75.67
87.02
93282
26
42.80
40.66
46.76
92986
1,394.57
1,324.84
1,523.57
93283
96.36
91.54
105.27
92987
1,442.48
1,370.36
1,575.91
93283
TC
39.16
37.20
42.78
92990
1,150.16
1,092.65
1,256.55
93283
26
57.20
54.34
62.49
92997
670.76
637.22
732.80
93284
104.11
98.90
113.74
92998
334.78
318.04
365.75
93284
TC
41.78
39.69
45.64
93000
14.80
14.06
16.17
93284
26
62.33
59.21
68.09
93005
6.40
6.08
6.99
93285
58.31
55.39
63.70
93010
8.40
7.98
9.18
93285
TC
32.28
30.67
35.27
93015
69.96
66.46
76.43
93285
26
26.03
24.73
28.44
93016
21.95
20.85
23.98
93286
44.23
42.02
48.32
93017
33.44
31.77
36.54
93286
TC
29.01
27.56
31.69
93018
14.57
13.84
15.92
93286
26
15.23
14.47
16.64
93024
107.06
101.71
116.97
93287
51.93
49.33
56.73
93024
TC
50.80
48.26
55.50
93287
TC
29.01
27.56
31.69
93024
26
56.26
53.45
61.47
93287
26
22.93
21.78
25.05
93025
131.38
124.81
143.53
93288
53.68
51.00
58.65
93025
TC
94.05
89.35
102.75
93288
TC
32.94
31.29
35.98
93025
26
37.33
35.46
40.78
93288
26
20.75
19.71
22.67
93040
12.79
12.15
13.97
93289
70.94
67.39
77.50
93041
5.74
5.45
6.27
93289
TC
33.27
31.61
36.35
93042
7.05
6.70
7.71
93289
26
37.67
35.79
41.16
93050
16.11
15.30
17.60
93290
51.56
48.98
56.33
93050
TC
7.71
7.32
8.42
93290
TC
29.99
28.49
32.76
93050
26
8.40
7.98
9.18
93290
26
21.58
20.50
23.58
93224
77.04
73.19
84.17
93291
47.33
44.96
51.70
93225
19.18
18.22
20.95
93291
TC
29.01
27.56
31.69
93226
39.16
37.20
42.78
93291
26
18.33
17.41
20.02
93227
18.70
17.77
20.44
93292
48.62
46.19
53.12
93228
26.37
25.05
28.81
93292
TC
27.37
26.00
29.90
93229
674.87
641.13
737.30
93292
26
21.25
20.19
23.22
93242
14.59
13.86
15.94
93293
49.50
47.03
54.08
93244
24.67
23.44
26.96
93293
TC
34.58
32.85
37.78
93246
14.59
13.86
15.94
93293
26
14.92
14.17
16.30
93248
27.07
25.72
29.58
93294
30.80
29.26
33.65
93260
75.08
71.33
82.03
93295
38.15
36.24
41.68
93260
TC
31.95
30.35
34.90
93296
24.42
23.20
26.68
93260
26
43.13
40.97
47.12
93297
27.03
25.68
29.53
93261
68.28
64.87
74.60
93298
27.03
25.68
29.53
93261
TC
31.63
30.05
34.56
93303
227.26
215.90
248.29
93261
26
36.65
34.82
40.04
93303
TC
164.82
156.58
180.07
93264
49.86
47.37
54.48
93303
26
62.44
59.32
68.22
93264
36.10
34.30
39.45
93304
159.25
151.29
173.98
93268
191.18
181.62
208.86
93304
TC
122.23
116.12
133.54
93270
8.69
8.26
9.50
93304
26
37.02
35.17
40.45
93271
157.44
149.57
172.01
93306
199.60
189.62
218.06
93272
25.04
23.79
27.36
93306
TC
129.11
122.65
141.05
93278
29.38
27.91
32.10
93306
26
70.49
66.97
77.02
93278
TC
16.88
16.04
18.45
93307
140.94
133.89
153.97
93278
26
12.50
11.88
13.66
93307
TC
95.69
90.91
104.55
93279
65.14
61.88
71.16
93307
26
45.24
42.98
49.43
93279
TC
33.27
31.61
36.35
93308
98.30
93.39
107.40
93279
26
31.87
30.28
34.82
93308
TC
72.91
69.26
79.65
93280
77.54
73.66
84.71
93308
26
25.39
24.12
27.74
93280
TC
38.84
36.90
42.44
93312
243.69
231.51
266.24
93280
26
38.70
36.77
42.29
93312
TC
134.68
127.95
147.14
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
83
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------93312
26
109.01
103.56
119.09
93462
223.63
212.45
244.32
93313
11.71
11.12
12.79
93463
100.23
95.22
109.50
93314
235.75
223.96
257.55
93464
234.26
222.55
255.93
93314
TC
143.20
136.04
156.45
93464
TC
145.32
138.05
158.76
93314
26
92.55
87.92
101.11
93464
26
88.94
84.49
97.16
93315
26
128.18
121.77
140.04
93503
90.75
86.21
99.14
93316
28.03
26.63
30.62
93505
700.15
665.14
764.91
93317
26
91.49
86.92
99.96
93505
TC
464.95
441.70
507.96
93318
26
104.79
99.55
114.48
93505
26
235.20
223.44
256.96
93320
52.27
49.66
57.11
93530
26
208.43
198.01
227.71
93320
TC
34.25
32.54
37.42
93531
26
435.25
413.49
475.51
93320
26
18.02
17.12
19.69
93532
26
557.26
529.40
608.81
93321
26.05
24.75
28.46
93533
26
372.89
354.25
407.39
93321
TC
18.68
17.75
20.41
93561
26
45.96
43.66
50.21
93321
26
7.37
7.00
8.05
93562
26
37.72
35.83
41.20
93325
24.07
22.87
26.30
93563
60.02
57.02
65.57
93325
TC
20.97
19.92
22.91
93564
64.73
61.49
70.71
93325
26
3.10
2.95
3.39
93565
46.85
44.51
51.19
93350
189.11
179.65
206.60
93566
140.90
133.86
153.94
93350
TC
118.63
112.70
129.61
#
93566
47.85
45.46
52.28
93350
26
70.49
66.97
77.02
93567
120.70
114.67
131.87
93351
233.65
221.97
255.27
#
93567
55.50
52.73
60.64
93351
TC
149.77
142.28
163.62
93568
132.29
125.68
144.53
93351
26
83.88
79.69
91.64
#
93568
50.70
48.17
55.40
93352
32.86
31.22
35.90
93571
26
76.90
73.06
84.02
93355
232.03
220.43
253.49
93572
26
55.87
53.08
61.04
93356
39.52
37.54
43.17
93580
1,033.89
982.20
1,129.53
93356
12.32
11.70
13.46
93581
1,414.13
1,343.42
1,544.93
93451
890.67
846.14
973.06
93582
707.98
672.58
773.47
93451
TC
752.97
715.32
822.62
93583
791.25
751.69
864.44
93451
26
137.71
130.82
150.44
93590
1,101.30
1,046.24
1,203.18
93452
946.11
898.80
1,033.62
93591
908.75
863.31
992.81
93452
TC
697.27
662.41
761.77
93592
400.77
380.73
437.84
93452
26
248.84
236.40
271.86
93600
26
125.80
119.51
137.44
93453
1,209.40
1,148.93
1,321.27
93602
26
123.66
117.48
135.10
93453
TC
875.18
831.42
956.13
93603
26
123.66
117.48
135.10
93453
26
334.22
317.51
365.14
93609
26
292.28
277.67
319.32
93454
948.53
901.10
1,036.27
93610
26
173.39
164.72
189.43
93454
TC
695.96
661.16
760.33
93612
26
171.73
163.14
187.61
93454
26
252.57
239.94
275.93
93613
315.45
299.68
344.63
93455
1,066.41
1,013.09
1,165.05
93615
26
37.63
35.75
41.11
93455
TC
771.97
733.37
843.38
93616
26
59.36
56.39
64.85
93455
26
294.44
279.72
321.68
93618
26
231.34
219.77
252.74
93456
1,189.86
1,130.37
1,299.93
93619
26
412.72
392.08
450.89
93456
TC
861.09
818.04
940.75
93620
26
660.71
627.67
721.82
93456
26
328.77
312.33
359.18
93621
26
123.62
117.44
135.06
93457
1,306.59
1,241.26
1,427.45
93622
26
181.29
172.23
198.06
93457
TC
936.30
889.49
1,022.91
93623
26
127.26
120.90
139.04
93457
26
370.29
351.78
404.55
93624
26
253.27
240.61
276.70
93458
1,097.58
1,042.70
1,199.11
93631
26
418.53
397.60
457.24
93458
TC
786.72
747.38
859.49
93640
26
189.03
179.58
206.52
93458
26
310.87
295.33
339.63
93641
26
328.74
312.30
359.15
93459
1,188.95
1,129.50
1,298.93
93642
348.14
330.73
380.34
93459
TC
835.71
793.92
913.01
93642
TC
80.29
76.28
87.72
93459
26
353.24
335.58
385.92
93642
26
267.85
254.46
292.63
93460
1,319.61
1,253.63
1,441.67
93644
196.77
186.93
214.97
93460
TC
923.84
877.65
1,009.30
93644
TC
51.29
48.73
56.04
93460
26
395.77
375.98
432.38
93644
26
145.49
138.22
158.95
93461
1,462.53
1,389.40
1,597.81
93650
627.43
596.06
685.47
93461
TC
1,026.07
974.77
1,120.99
93653
889.10
844.65
971.35
93461
26
436.46
414.64
476.84
93654
1,190.09
1,130.59
1,300.18
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
#
#
#
C
C
C
C
C
C
C
C
C
C
C
C
0
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
84
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------93655
452.46
429.84
494.32
93930
202.18
192.07
220.88
93656
1,193.91
1,134.21
1,304.34
93930
TC
161.57
153.49
176.51
93657
452.13
429.52
493.95
93930
26
40.61
38.58
44.37
93660
155.97
148.17
170.40
93931
126.13
119.82
137.79
93660
TC
63.93
60.73
69.84
93931
TC
101.26
96.20
110.63
93660
26
92.04
87.44
100.56
93931
26
24.86
23.62
27.16
93662
26
112.05
106.45
122.42
93970
190.77
181.23
208.41
93668
13.61
12.93
14.87
93970
TC
156.63
148.80
171.12
93701
26.71
25.37
29.18
93970
26
34.14
32.43
37.29
93702
141.23
134.17
154.30
93971
120.10
114.10
131.22
93724
283.96
269.76
310.22
93971
TC
97.81
92.92
106.86
93724
TC
41.78
39.69
45.64
93971
26
22.29
21.18
24.36
93724
26
242.18
230.07
264.58
93975
271.42
257.85
296.53
93750
50.51
47.98
55.18
93975
TC
213.99
203.29
233.78
93750
40.68
38.65
44.45
93975
26
57.43
54.56
62.74
93784
45.56
43.28
49.77
C
93976
141.99
134.89
155.12
93786
22.13
21.02
24.17
C
93976
TC
102.90
97.76
112.42
93788
5.09
4.84
5.57
93976
26
39.09
37.14
42.71
93790
18.35
17.43
20.04
93978
184.97
175.72
202.08
93792
64.26
61.05
70.21
93978
TC
144.51
137.28
157.87
93793
11.37
10.80
12.42
93978
26
40.46
38.44
44.21
93797
16.78
15.94
18.33
93979
119.25
113.29
130.28
93797
9.58
9.10
10.47
93979
TC
94.71
89.97
103.47
93798
25.52
24.24
27.88
93979
26
24.54
23.31
26.81
93798
14.05
13.35
15.35
93980
119.03
113.08
130.04
93880
194.76
185.02
212.77
93980
TC
58.17
55.26
63.55
93880
TC
155.32
147.55
169.68
93980
26
60.86
57.82
66.49
93880
26
39.44
37.47
43.09
93981
71.57
67.99
78.19
93882
127.28
120.92
139.06
93981
TC
50.30
47.79
54.96
93882
TC
101.92
96.82
111.34
93981
26
21.27
20.21
23.24
93882
26
25.37
24.10
27.72
C
93985
257.24
244.38
281.04
93886
263.63
250.45
288.02
C
93985
TC
216.94
206.09
237.00
93886
TC
216.59
205.76
236.62
93985
26
40.30
38.29
44.03
93886
26
47.03
44.68
51.38
C
93986
127.61
121.23
139.41
93888
128.40
121.98
140.28
C
93986
TC
102.90
97.76
112.42
93888
TC
102.40
97.28
111.87
93986
26
24.71
23.47
26.99
93888
26
26.00
24.70
28.41
C
93990
128.46
122.04
140.35
93890
267.92
254.52
292.70
C
93990
TC
102.90
97.76
112.42
93890
TC
216.94
206.09
237.00
93990
26
25.56
24.28
27.92
93890
26
50.98
48.43
55.69
94002
93.99
89.29
102.68
93892
161.91
153.81
176.88
94003
67.07
63.72
73.28
93892
TC
102.90
97.76
112.42
94004
49.04
46.59
53.58
93892
26
59.01
56.06
64.47
94010
28.89
27.45
31.57
93893
162.57
154.44
177.61
94010
TC
20.49
19.47
22.39
93893
TC
102.40
97.28
111.87
94010
26
8.40
7.98
9.18
93893
26
60.17
57.16
65.73
94011
87.89
83.50
96.03
93922
83.31
79.14
91.01
94012
142.38
135.26
155.55
93922
TC
69.96
66.46
76.43
94013
20.24
19.23
22.11
93922
26
13.35
12.68
14.58
94014
54.70
51.97
59.77
93923
128.97
122.52
140.90
94015
29.66
28.18
32.41
93923
TC
106.50
101.18
116.36
94016
25.04
23.79
27.36
93923
26
22.46
21.34
24.54
94060
45.05
42.80
49.22
93924
159.55
151.57
174.31
94060
TC
34.58
32.85
37.78
93924
TC
134.68
127.95
147.14
94060
26
10.47
9.95
11.44
93924
26
24.86
23.62
27.16
94070
61.10
58.05
66.76
93925
247.36
234.99
270.24
94070
TC
32.61
30.98
35.63
93925
TC
208.75
198.31
228.06
94070
26
28.49
27.07
31.13
93925
26
38.61
36.68
42.18
94200
17.49
16.62
19.11
93926
127.11
120.75
138.86
94200
TC
13.61
12.93
14.87
93926
TC
102.90
97.76
112.42
94200
26
3.88
3.69
4.24
93926
26
24.21
23.00
26.45
94375
38.03
36.13
41.55
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
C - THE PAYMENT FOR THE TECHNICAL COMPONENT IS CAPPED AT THE OPPS AMOUNT.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
85
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------94375
TC
23.44
22.27
25.61
#
94781
8.40
7.98
9.18
94375
26
14.59
13.86
15.94
95004
4.13
3.92
4.51
94450
60.19
57.18
65.76
95012
19.18
18.22
20.95
94450
TC
41.63
39.55
45.48
95017
8.51
8.08
9.29
94450
26
18.56
17.63
20.27
#
95017
3.93
3.73
4.29
94452
49.83
47.34
54.44
95018
20.79
19.75
22.71
94452
TC
35.56
33.78
38.85
#
95018
7.35
6.98
8.03
94452
26
14.27
13.56
15.59
95024
8.39
7.97
9.17
94453
68.54
65.11
74.88
#
95024
1.18
1.12
1.29
94453
TC
49.65
47.17
54.25
95027
4.78
4.54
5.22
94453
26
18.89
17.95
20.64
95028
12.62
11.99
13.79
94610
56.45
53.63
61.67
95044
5.42
5.15
5.92
94617
92.30
87.69
100.84
95052
6.73
6.39
7.35
94617
TC
58.34
55.42
63.73
95056
46.37
44.05
50.66
94617
26
33.96
32.26
37.10
95060
34.90
33.16
38.13
94618
33.32
31.65
36.40
95065
25.73
24.44
28.11
94618
TC
10.66
10.13
11.65
95070
33.77
32.08
36.89
94618
26
22.66
21.53
24.76
95076
116.77
110.93
127.57
94619
71.52
67.94
78.13
#
95076
74.17
70.46
81.03
94619
TC
47.85
45.46
52.28
95079
83.75
79.56
91.49
94619
26
23.67
22.49
25.86
#
95079
68.35
64.93
74.67
94621
155.14
147.38
169.49
95115
9.02
8.57
9.86
94621
TC
86.21
81.90
94.19
95117
10.99
10.44
12.01
94621
26
68.93
65.48
75.30
95144
16.03
15.23
17.51
94640
13.61
12.93
14.87
#
95144
3.25
3.09
3.55
94644
57.84
54.95
63.19
95145
33.07
31.42
36.13
94645
15.90
15.11
17.38
#
95145
3.25
3.09
3.55
94660
62.44
59.32
68.22
95146
60.59
57.56
66.19
94660
38.20
36.29
41.73
#
95146
3.25
3.09
3.55
94662
36.23
34.42
39.58
95147
59.93
56.93
65.47
94664
16.23
15.42
17.73
#
95147
3.25
3.09
3.55
94667
20.49
19.47
22.39
95148
87.45
83.08
95.54
94668
31.80
30.21
34.74
#
95148
3.25
3.09
3.55
94669
22.30
21.19
24.37
95149
116.29
110.48
127.05
94680
51.68
49.10
56.47
#
95149
3.25
3.09
3.55
94680
TC
39.16
37.20
42.78
95165
15.37
14.60
16.79
94680
26
12.52
11.89
13.67
#
95165
3.25
3.09
3.55
94681
49.59
47.11
54.18
95170
11.44
10.87
12.50
94681
TC
39.49
37.52
43.15
#
95170
3.25
3.09
3.55
94681
26
10.10
9.60
11.04
95180
135.26
128.50
147.78
94690
42.43
40.31
46.36
#
95180
103.15
97.99
112.69
94690
TC
38.51
36.58
42.07
95249
55.74
52.95
60.89
94690
26
3.93
3.73
4.29
95250
148.46
141.04
162.20
94726
53.17
50.51
58.09
95251
35.60
33.82
38.89
94726
TC
40.97
38.92
44.76
95717
103.66
98.48
113.25
94726
26
12.19
11.58
13.32
#
95717
102.68
97.55
112.18
94727
42.84
40.70
46.81
95718
138.20
131.29
150.98
94727
TC
30.64
29.11
33.48
#
95718
135.91
129.11
148.48
94727
26
12.19
11.58
13.32
95719
160.08
152.08
174.89
94728
39.89
37.90
43.59
#
95719
158.44
150.52
173.10
94728
TC
27.37
26.00
29.90
95720
211.29
200.73
230.84
94728
26
12.52
11.89
13.67
#
95720
208.34
197.92
227.61
94729
57.43
54.56
62.74
95721
212.60
201.97
232.27
94729
TC
48.34
45.92
52.81
#
95721
208.67
198.24
227.98
94729
26
9.10
8.65
9.95
95722
259.35
246.38
283.34
94760
2.47
2.35
2.70
#
95722
254.76
242.02
278.32
94761
3.78
3.59
4.13
95723
264.54
251.31
289.01
94762
26.06
24.76
28.47
#
95723
258.97
246.02
282.92
94780
50.21
47.70
54.86
95724
330.84
314.30
361.45
94780
24.32
23.10
26.57
#
95724
324.94
308.69
354.99
94781
19.54
18.56
21.34
95725
302.35
287.23
330.31
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
---#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
86
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------95725
295.47
280.70
322.81
#
95852
5.65
5.37
6.18
95726
419.52
398.54
458.32
95857
55.23
52.47
60.34
95726
411.66
391.08
449.74
#
95857
30.00
28.50
32.78
95782
899.96
854.96
983.20
95860
117.26
111.40
128.11
95782
TC
774.26
735.55
845.88
95860
TC
65.70
62.42
71.78
95782
26
125.70
119.42
137.33
95860
26
51.55
48.97
56.32
95783
953.85
906.16
1,042.08
95861
169.62
161.14
185.31
95783
TC
817.51
776.63
893.12
95861
TC
87.65
83.27
95.76
95783
26
136.35
129.53
148.96
95861
26
81.97
77.87
89.55
95800
162.57
154.44
177.61
95863
220.46
209.44
240.86
95800
TC
120.75
114.71
131.92
95863
TC
121.07
115.02
132.27
95800
26
41.82
39.73
45.69
95863
26
99.38
94.41
108.57
95801
88.52
84.09
96.70
95864
246.96
234.61
269.80
95801
TC
46.70
44.37
51.03
95864
TC
139.75
132.76
152.67
95801
26
41.82
39.73
45.69
95864
26
107.21
101.85
117.13
95803
150.22
142.71
164.12
95865
154.44
146.72
168.73
95803
TC
105.35
100.08
115.09
95865
TC
71.60
68.02
78.22
95803
26
44.87
42.63
49.02
95865
26
82.84
78.70
90.51
95805
407.81
387.42
445.53
95866
134.26
127.55
146.68
95805
TC
349.52
332.04
381.85
95866
TC
68.65
65.22
75.00
95805
26
58.29
55.38
63.69
95866
26
65.61
62.33
71.68
95806
99.35
94.38
108.54
95867
110.34
104.82
120.54
95806
TC
54.08
51.38
59.09
95867
TC
68.00
64.60
74.29
95806
26
45.27
43.01
49.46
95867
26
42.35
40.23
46.26
95807
387.18
367.82
422.99
95868
144.11
136.90
157.44
95807
TC
325.93
309.63
356.07
95868
TC
81.10
77.05
88.61
95807
26
61.26
58.20
66.93
95868
26
63.01
59.86
68.84
95808
639.97
607.97
699.17
95869
99.60
94.62
108.81
95808
TC
553.16
525.50
604.33
95869
TC
79.46
75.49
86.81
95808
26
86.81
82.47
94.84
95869
26
20.14
19.13
22.00
95810
599.55
569.57
655.01
95870
89.12
84.66
97.36
95810
TC
478.65
454.72
522.93
95870
TC
69.31
65.84
75.72
95810
26
120.90
114.86
132.09
95870
26
19.81
18.82
21.64
95811
625.64
594.36
683.51
95872
205.81
195.52
224.85
95811
TC
500.27
475.26
546.55
95872
TC
51.61
49.03
56.38
95811
26
125.37
119.10
136.97
95872
26
154.20
146.49
168.46
95812
335.76
318.97
366.82
95873
77.30
73.44
84.46
95812
TC
278.21
264.30
303.95
95873
TC
57.34
54.47
62.64
95812
26
57.55
54.67
62.87
95873
26
19.96
18.96
21.80
95813
413.97
393.27
452.26
95874
80.58
76.55
88.03
95813
TC
326.04
309.74
356.20
95874
TC
60.94
57.89
66.57
95813
26
87.92
83.52
96.05
95874
26
19.64
18.66
21.46
95816
366.89
348.55
400.83
95875
135.42
128.65
147.95
95816
TC
309.34
293.87
337.95
95875
TC
76.51
72.68
83.58
95816
26
57.55
54.67
62.87
95875
26
58.91
55.96
64.35
95819
439.30
417.34
479.94
95885
64.81
61.57
70.81
95819
TC
381.42
362.35
416.70
95885
TC
46.20
43.89
50.47
95819
26
57.88
54.99
63.24
95885
26
18.61
17.68
20.33
95822
400.96
380.91
438.05
95886
100.49
95.47
109.79
95822
TC
343.08
325.93
374.82
95886
TC
54.39
51.67
59.42
95822
26
57.88
54.99
63.24
95886
26
46.10
43.80
50.37
95824
26
39.62
37.64
43.29
95887
87.06
82.71
95.12
95829
1,868.46
1,775.04
2,041.30
95887
TC
49.15
46.69
53.69
95829
TC
1,530.16
1,453.65
1,671.70
95887
26
37.92
36.02
41.42
95829
26
338.30
321.39
369.60
95905
46.00
43.70
50.26
95830
627.91
596.51
685.99
95905
TC
43.09
40.94
47.08
95830
94.18
89.47
102.89
95905
26
2.90
2.76
3.17
95836
107.74
102.35
117.70
95907
94.08
89.38
102.79
95851
22.14
21.03
24.18
95907
TC
40.47
38.45
44.22
95851
7.72
7.33
8.43
95907
26
53.61
50.93
58.57
95852
17.77
16.88
19.41
95908
118.70
112.77
129.69
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
87
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------95908
TC
51.61
49.03
56.38
95954
TC
274.45
260.73
299.84
95908
26
67.09
63.74
73.30
95954
26
112.29
106.68
122.68
95909
141.51
134.43
154.59
95955
211.57
200.99
231.14
95909
TC
61.77
58.68
67.48
95955
TC
157.44
149.57
172.01
95909
26
79.74
75.75
87.11
95955
26
54.13
51.42
59.13
95910
186.52
177.19
203.77
95957
248.92
236.47
271.94
95910
TC
78.81
74.87
86.10
95957
TC
146.17
138.86
159.69
95910
26
107.71
102.32
117.67
95957
26
102.76
97.62
112.26
95911
223.80
212.61
244.50
95958
590.64
561.11
645.28
95911
TC
90.28
85.77
98.64
95958
TC
362.10
344.00
395.60
95911
26
133.52
126.84
145.87
95958
26
228.53
217.10
249.67
95912
259.63
246.65
283.65
95961
314.24
298.53
343.31
95912
TC
99.62
94.64
108.84
95961
TC
149.75
142.26
163.60
95912
26
160.01
152.01
174.81
95961
26
164.49
156.27
179.71
95913
301.47
286.40
329.36
95962
263.76
250.57
288.16
95913
TC
112.07
106.47
122.44
95962
TC
88.81
84.37
97.03
95913
26
189.40
179.93
206.92
95962
26
174.95
166.20
191.13
95921
88.30
83.89
96.47
95965
26
417.05
396.20
455.63
95921
TC
42.77
40.63
46.72
95966
26
213.26
202.60
232.99
95921
26
45.53
43.25
49.74
95967
26
186.63
177.30
203.90
95922
104.65
99.42
114.33
95970
19.79
18.80
21.62
95922
TC
56.70
53.87
61.95
#
95970
19.46
18.49
21.26
95922
26
47.95
45.55
52.38
95971
49.55
47.07
54.13
95923
128.27
121.86
140.14
#
95971
40.71
38.67
44.47
95923
TC
82.74
78.60
90.39
95972
57.32
54.45
62.62
95923
26
45.53
43.25
49.74
#
95972
42.58
40.45
46.52
95924
150.41
142.89
164.32
95976
40.93
38.88
44.71
95924
TC
62.60
59.47
68.39
#
95976
40.27
38.26
44.00
95924
26
87.81
83.42
95.93
95977
55.24
52.48
60.35
95925
153.56
145.88
167.76
#
95977
54.25
51.54
59.27
95925
TC
124.52
118.29
136.03
95980
47.89
45.50
52.33
95925
26
29.04
27.59
31.73
95981
36.89
35.05
40.31
95926
141.42
134.35
154.50
#
95981
18.54
17.61
20.25
95926
TC
113.71
108.02
124.22
95982
59.66
56.68
65.18
95926
26
27.71
26.32
30.27
#
95982
39.35
37.38
42.99
95927
139.14
132.18
152.01
95983
52.49
49.87
57.35
95927
TC
112.09
106.49
122.46
#
95983
51.50
48.93
56.27
95927
26
27.05
25.70
29.56
95984
45.85
43.56
50.09
95928
232.45
220.83
253.95
#
95984
45.53
43.25
49.74
95928
TC
152.53
144.90
166.64
95990
89.81
85.32
98.12
95928
26
79.92
75.92
87.31
95991
113.29
107.63
123.77
95929
238.83
226.89
260.92
#
95991
41.86
39.77
45.74
95929
TC
159.74
151.75
174.51
95992
44.23
42.02
48.32
95929
26
79.09
75.14
86.41
#
95992
37.35
35.48
40.80
95930
65.64
62.36
71.71
96000
90.09
85.59
98.43
95930
TC
47.03
44.68
51.38
96001
113.33
107.66
123.81
95930
26
18.61
17.68
20.33
96002
22.86
21.72
24.98
95933
85.02
80.77
92.89
96003
17.02
16.17
18.60
95933
TC
52.92
50.27
57.81
96004
112.83
107.19
123.27
95933
26
32.09
30.49
35.06
96020
26
162.23
154.12
177.24
95937
102.84
97.70
112.36
96105
100.80
95.76
110.12
95937
TC
67.67
64.29
73.93
96112
131.39
124.82
143.54
95937
26
35.17
33.41
38.42
#
96112
129.43
122.96
141.40
95938
349.86
332.37
382.23
96113
58.38
55.46
63.78
95938
TC
303.77
288.58
331.87
#
96113
54.45
51.73
59.49
95938
26
46.10
43.80
50.37
96116
96.60
91.77
105.54
95939
532.27
505.66
581.51
#
96116
84.15
79.94
91.93
95939
TC
412.39
391.77
450.54
96121
82.52
78.39
90.15
95939
26
119.89
113.90
130.99
#
96121
74.99
71.24
81.93
95940
33.10
31.45
36.17
96125
105.76
100.47
115.54
95954
386.74
367.40
422.51
96127
4.76
4.52
5.20
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
---#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
88
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------96130
120.72
114.68
131.88
96440
947.92
900.52
1,035.60
96130
109.25
103.79
119.36
#
96440
130.77
124.23
142.86
96131
91.57
86.99
100.04
96446
206.04
195.74
225.10
96131
82.40
78.28
90.02
#
96446
27.80
26.41
30.37
96132
132.34
125.72
144.58
96450
176.87
168.03
193.23
96132
106.78
101.44
116.66
#
96450
79.55
75.57
86.91
96133
102.85
97.71
112.37
96521
145.51
138.23
158.96
96133
80.24
76.23
87.66
96522
124.87
118.63
136.42
96136
45.77
43.48
50.00
96523
27.63
26.25
30.19
96136
24.80
23.56
27.09
96542
134.35
127.63
146.77
96137
40.64
38.61
44.40
#
96542
42.28
40.17
46.20
96137
19.02
18.07
20.78
96567
139.42
132.45
152.32
96138
35.23
33.47
38.49
96570
57.86
54.97
63.22
96139
35.23
33.47
38.49
96571
26.44
25.12
28.89
96146
2.14
2.03
2.33
96573
227.44
216.07
248.48
96156
97.44
92.57
106.46
96574
281.01
266.96
307.00
96156
86.96
82.61
95.00
96900
22.45
21.33
24.53
96158
66.53
63.20
72.68
96904
70.13
66.62
76.61
96158
59.32
56.35
64.80
96910
115.02
109.27
125.66
96159
23.04
21.89
25.17
96912
98.79
93.85
107.93
96159
20.74
19.70
22.66
96913
145.82
138.53
159.31
96160
2.62
2.49
2.86
96920
159.27
151.31
174.01
96161
2.62
2.49
2.86
#
96920
64.26
61.05
70.21
96164
9.79
9.30
10.70
96921
174.01
165.31
190.11
96164
8.81
8.37
9.63
#
96921
72.11
68.50
78.78
96165
4.47
4.25
4.89
96922
237.02
225.17
258.95
96165
3.82
3.63
4.17
#
96922
116.77
110.93
127.57
96167
71.00
67.45
77.57
96931
170.98
162.43
186.79
96167
63.14
59.98
68.98
96932
125.99
119.69
137.64
96168
25.43
24.16
27.78
96933
44.99
42.74
49.15
96168
22.49
21.37
24.58
96934
111.74
106.15
122.07
96360
34.78
33.04
38.00
96935
68.81
65.37
75.18
96361
13.47
12.80
14.72
96936
42.94
40.79
46.91
96365
70.27
66.76
76.77
97012
14.79
14.05
16.16
96366
21.53
20.45
23.52
97016
12.02
11.42
13.13
96367
30.89
29.35
33.75
97018
5.87
5.58
6.42
96368
20.52
19.49
22.41
97022
17.57
16.69
19.19
96369
149.87
142.38
163.74
97024
7.18
6.82
7.84
96370
14.97
14.22
16.35
97026
6.53
6.20
7.13
96371
61.93
58.83
67.65
97028
8.21
7.80
8.97
96372
13.97
13.27
15.26
97032
14.79
14.05
16.16
96373
17.90
17.01
19.56
97033
20.06
19.06
21.92
96374
40.05
38.05
43.76
97034
14.71
13.97
16.07
96375
16.44
15.62
17.96
97035
14.38
13.66
15.71
96377
19.54
18.56
21.34
97036
33.86
32.17
37.00
96401
78.64
74.71
85.92
97110
29.81
28.32
32.57
96402
31.88
30.29
34.83
97112
34.50
32.78
37.70
96405
84.04
79.84
91.82
97113
37.41
35.54
40.87
96405
29.32
27.85
32.03
97116
29.81
28.32
32.57
96406
130.35
123.83
142.40
97124
28.77
27.33
31.43
96406
45.16
42.90
49.34
97129
23.36
22.19
25.52
96409
108.03
102.63
118.02
97130
22.66
21.53
24.76
96411
59.44
56.47
64.94
#
97130
22.34
21.22
24.40
96413
141.40
134.33
154.48
97140
27.47
26.10
30.02
96415
30.24
28.73
33.04
97150
17.83
16.94
19.48
96416
140.27
133.26
153.25
97161
99.82
94.83
109.05
96417
68.63
65.20
74.98
97162
99.82
94.83
109.05
96420
109.85
104.36
120.01
97163
99.82
94.83
109.05
96422
171.33
162.76
187.17
97164
68.26
64.85
74.58
96423
78.88
74.94
86.18
97165
96.87
92.03
105.83
96425
183.80
174.61
200.80
97166
96.87
92.03
105.83
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
1HNPRDS21
0
NOTE
----
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
#
0
0
0
FLORIDA
- MEDICARE CARRIER 09102
PAGE
89
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------97167
96.87
92.03
105.83
#
98968
38.18
36.27
41.71
97168
65.32
62.05
71.36
98970
11.85
11.26
12.95
97530
38.31
36.39
41.85
#
98970
11.52
10.94
12.58
97533
58.38
55.46
63.78
98971
20.94
19.89
22.87
97535
33.09
31.44
36.16
#
98971
20.61
19.58
22.52
97537
31.84
30.25
34.79
98972
32.96
31.31
36.01
97542
32.17
30.56
35.14
99091
56.79
53.95
62.04
97597
98.83
93.89
107.97
99151
85.15
80.89
93.02
97597
36.58
34.75
39.96
#
99151
25.85
24.56
28.24
97598
45.83
43.54
50.07
99152
50.35
47.83
55.00
97598
25.85
24.56
28.24
#
99152
12.67
12.04
13.85
97605
42.14
40.03
46.03
99153
10.33
9.81
11.28
97605
25.43
24.16
27.78
99155
87.30
82.94
95.38
97606
49.79
47.30
54.40
99156
79.02
75.07
86.33
97606
27.83
26.44
30.41
99157
64.52
61.29
70.48
97607
332.70
316.07
363.48
99170
159.64
151.66
174.41
97607
24.38
23.16
26.63
#
99170
87.89
83.50
96.03
97608
323.96
307.76
353.92
99175
28.35
26.93
30.97
97608
26.78
25.44
29.26
99183
112.20
106.59
122.58
97610
391.91
372.31
428.16
99184
223.15
211.99
243.79
97610
18.39
17.47
20.09
99195
102.94
97.79
112.46
97750
33.74
32.05
36.86
99202
73.00
69.35
79.75
97755
38.03
36.13
41.55
#
99202
50.39
47.87
55.05
97760
48.59
46.16
53.08
99203
112.81
107.17
123.25
97761
41.38
39.31
45.21
#
99203
85.29
81.03
93.18
97763
53.14
50.48
58.05
99204
169.08
160.63
184.72
97802
36.86
35.02
40.27
#
99204
138.61
131.68
151.43
97802
32.60
30.97
35.62
99205
223.49
212.32
244.17
97803
31.78
30.19
34.72
#
99205
188.11
178.70
205.51
97803
27.84
26.45
30.42
99211
22.18
21.07
24.23
97804
16.76
15.92
18.31
#
99211
9.07
8.62
9.91
97804
15.45
14.68
16.88
99212
55.76
52.97
60.92
97810
36.87
35.03
40.28
#
99212
36.43
34.61
39.80
97810
30.98
29.43
33.84
99213
91.32
86.75
99.76
97811
27.97
26.57
30.56
#
99213
68.39
64.97
74.72
97811
25.67
24.39
28.05
99214
129.70
123.22
141.70
97813
41.89
39.80
45.77
#
99214
100.87
95.83
110.20
97813
33.38
31.71
36.47
99215
181.61
172.53
198.41
97814
34.80
33.06
38.02
#
99215
148.52
141.09
162.25
97814
28.58
27.15
31.22
99217
72.10
68.50
78.78
98925
31.81
30.22
34.75
99218
99.25
94.29
108.43
98925
24.61
23.38
26.89
99219
135.14
128.38
147.64
98926
44.80
42.56
48.94
99220
182.61
173.48
199.50
98926
35.95
34.15
39.27
99221
102.57
97.44
112.06
98927
58.61
55.68
64.03
99222
136.97
130.12
149.64
98927
47.47
45.10
51.87
99223
201.13
191.07
219.73
98928
71.26
67.70
77.86
99224
38.85
36.91
42.45
98928
59.14
56.18
64.61
99225
72.18
68.57
78.86
98929
86.25
81.94
94.23
99226
103.66
98.48
113.25
98929
72.82
69.18
79.56
99231
38.52
36.59
42.08
98940
27.69
26.31
30.26
99232
72.18
68.57
78.86
98940
22.12
21.01
24.16
99233
103.66
98.48
113.25
98941
39.69
37.71
43.37
99234
132.61
125.98
144.88
98941
33.79
32.10
36.92
99235
167.82
159.43
183.34
98942
52.19
49.58
57.02
99236
215.63
204.85
235.58
98942
46.29
43.98
50.58
99238
72.10
68.50
78.78
98966
13.98
13.28
15.27
99239
106.23
100.92
116.06
98966
13.00
12.35
14.20
99281
22.86
21.72
24.98
98967
26.99
25.64
29.49
99282
44.34
42.12
48.44
98967
25.67
24.39
28.05
99283
74.65
70.92
81.56
98968
39.49
37.52
43.15
99284
126.82
120.48
138.55
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.
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FLORIDA
- MEDICARE CARRIER 09102
PAGE
90
FSY21 LOCALITY FEE SCHEDULE FOR AREA 99
DATE 12/31/20
PAR
NON-PAR
LIMITING
PAR
NON-PAR
LIMITING
PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
NOTE PROCEDURE MOD
AMOUNT
AMOUNT
CHARGE
--------- --- ------------ ------------ --------------- --------- --- ------------ ------------ -----------99285
185.68
176.40
202.86
99446
19.13
18.17
20.90
99291
282.40
268.28
308.52
99447
34.31
32.59
37.48
99291
224.07
212.87
244.80
99448
54.25
51.54
59.27
99292
124.74
118.50
136.28
99449
73.69
70.01
80.51
99292
112.62
106.99
123.04
99451
36.43
34.61
39.80
99304
89.60
85.12
97.89
99452
36.76
34.92
40.16
99305
129.15
122.69
141.09
99453
18.19
17.28
19.87
99306
166.26
157.95
181.64
99454
59.48
56.51
64.99
99307
43.77
41.58
47.82
99457
49.83
47.34
54.44
99308
68.90
65.46
75.28
#
99457
31.81
30.22
34.75
99309
90.55
86.02
98.92
99458
40.65
38.62
44.41
99310
134.40
127.68
146.83
#
99458
31.81
30.22
34.75
99315
72.76
69.12
79.49
99460
96.11
91.30
105.00
99316
104.92
99.67
114.62
99461
91.07
86.52
99.50
99318
95.32
90.55
104.13
#
99461
63.22
60.06
69.07
99324
53.80
51.11
58.78
99462
41.64
39.56
45.49
99325
79.17
75.21
86.49
99463
110.49
104.97
120.72
99326
138.10
131.20
150.88
99464
75.04
71.29
81.98
99327
185.13
175.87
202.25
99465
146.65
139.32
160.22
99328
218.14
207.23
238.31
99466
238.69
226.76
260.77
99334
59.50
56.53
65.01
99467
119.43
113.46
130.48
99335
95.17
90.41
103.97
99468
918.98
873.03
1,003.98
99336
134.96
128.21
147.44
99469
397.38
377.51
434.14
99337
193.10
183.45
210.97
99471
795.60
755.82
869.19
99341
54.13
51.42
59.13
99472
404.94
384.69
442.39
99342
76.36
72.54
83.42
99473
10.99
10.44
12.01
99343
126.90
120.56
138.64
99474
14.64
13.91
16.00
99344
180.88
171.84
197.62
#
99474
8.75
8.31
9.56
99345
221.14
210.08
241.59
99475
575.80
547.01
629.06
99347
54.43
51.71
59.47
99476
345.41
328.14
377.36
99348
83.51
79.33
91.23
99477
348.37
330.95
380.59
99349
128.78
122.34
140.69
99478
136.58
129.75
149.21
99350
178.54
169.61
195.05
99479
124.40
118.18
135.91
99354
128.78
122.34
140.69
99480
119.43
113.46
130.48
99354
120.92
114.87
132.10
99483
277.81
263.92
303.51
99355
96.10
91.30
105.00
#
99483
199.17
189.21
217.59
99355
89.22
84.76
97.47
99484
45.90
43.61
50.15
99356
91.39
86.82
99.84
#
99484
30.82
29.28
33.67
99357
91.71
87.12
100.19
99487
89.16
84.70
97.41
99358
111.91
106.31
122.26
#
99487
51.16
48.60
55.89
99359
53.30
50.64
58.24
99489
43.04
40.89
47.02
99406
15.60
14.82
17.04
#
99489
26.00
24.70
28.41
99406
12.65
12.02
13.82
99490
40.65
38.62
44.41
99407
28.95
27.50
31.63
#
99490
31.81
30.22
34.75
99407
26.00
24.70
28.41
99491
81.97
77.87
89.55
99415
9.67
9.19
10.57
99492
151.07
143.52
165.05
99416
4.91
4.66
5.36
#
99492
94.39
89.67
103.12
99421
14.97
14.22
16.35
99493
151.43
143.86
165.44
99421
13.00
12.35
14.20
#
99493
102.94
97.79
112.46
99422
29.93
28.43
32.69
99494
57.98
55.08
63.34
99422
26.33
25.01
28.76
#
99494
40.95
38.90
44.74
99423
47.13
44.77
51.49
99495
204.14
193.93
223.02
99423
41.23
39.17
45.05
#
99495
145.16
137.90
158.59
99439
37.23
35.37
40.68
99496
276.46
262.64
302.04
99439
28.38
26.96
31.00
#
99496
197.50
187.63
215.77
99441
55.76
52.97
60.92
99497
85.52
81.24
93.43
99441
36.43
34.61
39.80
#
99497
78.64
74.71
85.92
99442
91.82
87.23
100.31
99498
74.33
70.61
81.20
99442
68.89
65.45
75.27
#
99498
74.00
70.30
80.85
99443
130.21
123.70
142.26
99443
101.37
96.30
110.75
** END OF REPORT **
# - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING.
LIMITING CHARGE APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS.
ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2020 BY THE AMERICAN MEDICAL ASSOCIATION.