2013 Bio-Surgery
Medicare Reimbursement Coding Guide
Effective January 1, 2013
MEDICARE NATIONAL AVERAGE RATES AND ALLOWABLES (Not Adjusted For Geography)
Physician
CPT®
HCPCS Code
Procedure Description
*MPFS
(CF=$34.023)
Fac/Non-Fac
AMBULATORY
SURGICAL
CENTER
HOSPITAL OUTPATIENT
APC
Classification
APC
Descriptor
**APC
Rate
***ASC
Cranial – Carotid Artery
+616091
Transection or ligation, carotid artery in cavernous sinus; without
repair (List separately in addition to code for primary procedure)
$624.66
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
+616101
Transection or ligation, carotid artery in cavernous sinus; with
repair by anastomosis or graft (List separately in addition to code
for primary procedure)
$1,882.83
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
+616111
Transection or ligation, carotid artery in petrous canal; without
repair (List separately in addition to code for primary procedure)
$371.87
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
+616121
Transection or ligation, carotid artery in petrous canal; with repair
by anastomosis or graft (List separately in addition to code for
primary procedure)
$1,397.66
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
Cranial – Cranioplasty
62140
Cranioplasty for skull defect; up to 5 cm diameter
$1,051.65
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
62141
Cranioplasty for skull defect; larger than 5 cm diameter
$1,159.50
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
62142
Removal of bone flap or prosthetic plate of skull
$901.27
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
62143
Replacement of bone flap or prosthetic plate of skull
$1,059.48
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
62145
Cranioplasty for skull defect with reparative brain surgery
$1,434.75
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
62146
Cranioplasty with autograft (includes obtaining bone grafts); up to
5 cm diameter
$1,263.61
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
62147
Cranioplasty with autograft (includes obtaining bone grafts); larger
than 5 cm diameter
$1,472.18
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
Physician
CPT®
HCPCS Code
Procedure Description
*MPFS
(CF=$34.023)
Fac/Non-Fac
AMBULATORY
SURGICAL
CENTER
HOSPITAL OUTPATIENT
APC
Classification
APC
Descriptor
**APC
Rate
***ASC
Cranial – Stereotactic
61760
Stereotactic implantation of depth electrodes into the cerebrum for
long-term seizure monitoring
$1,596.02
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
+617972
Stereotactic radiosurgery (particle beam, gamma ray, or linear
accelerator); each additional cranial lesion, simple (List separately
in addition to code for primary procedure)
$218.09
CPT code used by neurosurgeon to report professional services
associated with stereotactic radiosurgery procedures performed by
radiation oncologist described by another CPT code.
$1,385.76
CPT code used by neurosurgeon to report professional services
associated with stereotactic radiosurgery procedures performed by
radiation oncologist described by another CPT code.
61798
Stereotactic radiosurgery (particle beam, gamma ray, or linear
accelerator); 1 complex cranial lesion
Cranial – Aneurysm
61700
Surgery of simple intracranial aneurysm, intracranial
approach; carotid circulation
$3,440.41
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61702
Surgery of simple intracranial aneurysm, intracranial
approach; vertebrobasilar circulation
$4,051.46
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61703
Surgery of intracranial aneurysm, cervical approach by
application of occluding clamp to cervical carotid artery
(Selverstone-Crutchfield type)
$1,375.21
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61705
Surgery of aneurysm, vascular malformation or carotidcavernous fistula; by intracranial and cervical occlusion of
carotid artery
$2,622.49
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61708
Surgery of aneurysm, vascular malformation or carotidcavernous fistula; by intracranial electrothrombosis
$2,183.26
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61575
Transoral approach to skull base, brain stem or upper spinal cord
for biopsy, decompression or excision of lesion
$2,524.51
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61576
Transoral approach to skull base, brain stem or upper spinal cord
for biopsy, decompression or excision of lesion; requiring splitting
of tongue and/or mandible (including tracheostomy)
$3,473.07
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61584
Orbitocranial approach to anterior cranial fossa, extradural,
including supraorbital ridge osteotomy and elevation of frontal
and/or temporal lobe(s); without orbital exenteration
$2,901.48
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61585
Orbitocranial approach to anterior cranial fossa, extradural,
including supraorbital ridge osteotomy and elevation of frontal
and/or temporal lobe(s); with orbital exenteration
$3,290.70
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61586
Bicoronal, transzygomatic and/or LeFort I osteotomy approach to
anterior cranial fossa with or without internal fixation, without
bone graft
$2,516.00
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61590
Infratemporal pre-auricular approach to middle cranial fossa
(parapharyngeal space, infratemporal and midline skull base,
nasopharynx), with or without disarticulation of the mandible,
including parotidectomy, craniotomy, decompression and/or
mobilization of the facial nerve and/or petrous carotid artery
$3,100.86
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61591
Infratemporal post-auricular approach to middle cranial
fossa (internal auditory meatus, petrous apex, tentorium,
cavernous sinus, parasellar area, infratemporal fossa) including
mastoidectomy, resection of sigmoid sinus, with or without
decompression and/or mobilization of contents of auditory canal
or petrous carotid artery
$3,143.04
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61592
Orbitocranial zygomatic approach to middle cranial fossa
(cavernous sinus and carotid artery, clivus, basilar artery or petrous
apex) including osteotomy of zygoma, craniotomy, extra- or
intradural elevation of temporal lobe
$3,225.38
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61595
Transtemporal approach to posterior cranial fossa, jugular foramen
or midline skull base, including mastoidectomy, decompression of
sigmoid sinus and/or facial nerve, with or without mobilization
$2,410.53
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
Cranial – Approach Other
2
Physician
CPT®
HCPCS Code
Procedure Description
*MPFS
(CF=$34.023)
Fac/Non-Fac
AMBULATORY
SURGICAL
CENTER
HOSPITAL OUTPATIENT
APC
Classification
APC
Descriptor
**APC
Rate
***ASC
Cranial – Approach Other
61596
Transcochlear approach to posterior cranial fossa, jugular foramen or
midline skull base, including labyrinthectomy, decompression, with
or without mobilization of facial nerve and/or petrous carotid artery
$2,492.18
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61597
Transcondylar (far lateral) approach to posterior cranial fossa,
jugular foramen or midline skull base, including occipital
condylectomy, mastoidectomy, resection of C1-C3 vertebral
body(s), decompression of vertebral artery, with or without
mobilization
$2,931.08
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61598
Transpetrosal approach to posterior cranial fossa, clivus or foramen
magnum, including ligation of superior petrosal sinus and/or
sigmoid sinus
$2,886.85
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61680
Surgery of intracranial arteriovenous malformation; supratentorial,
simple
$2,284.30
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61682
Surgery of intracranial arteriovenous malformation; supratentorial,
complex
$4,206.94
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61684
Surgery of intracranial arteriovenous malformation; infratentorial,
simple
$2,865.42
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61686
Surgery of intracranial arteriovenous malformation; infratentorial,
complex
$4,526.08
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61690
Surgery of intracranial arteriovenous malformation; dural, simple
$2,206.39
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61692
Surgery of intracranial arteriovenous malformation; dural, complex
$3,683.33
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
Cranial Arteriovenous Malformation
Cranial Other
61154
Burr hole(s) with evacuation and/or drainage of hematoma,
extradural or subdural
$1,290.83
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61156
Burr hole(s); with aspiration of hematoma or cyst, intracerebral
$1,258.51
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61531
Subdural implantation of strip electrodes through 1 or more burr
or trephine hole(s) for long-term seizure monitoring
$1,240.14
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61548
Hypophysectomy or excision of pituitary tumor, transnasal or
transseptal approach, nonstereotactic
$1,569.82
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61566
Craniotomy with elevation of bone flap; for selective
amygdalohippocampectomy
$2,266.61
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61567
Craniotomy with elevation of bone flap; for multiple subpial
transections, with electrocorticography during surgery
$2,585.07
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61613
Obliteration of carotid aneurysm, arteriovenous malformation, or
carotid-cavernous fistula by dissection within cavernous sinus
$3,325.75
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61711
Anastomosis, arterial, extracranial-intracranial (e.g. middle
cerebral/cortical) arteries
$2,630.66
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
62000
Elevation of depressed skull fracture; simple, extradural
$1,044.85
62005
Elevation of depressed skull fracture; compound or comminuted,
extradural
$1,285.73
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
62010
Elevation of depressed skull fracture; with repair of dura and/or
debridement of brain
$1,548.39
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
62115
Reduction of craniomegalic skull (e.g. treated hydrocephalus); not
requiring bone grafts or cranioplasty
$1,263.27
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
$126.91
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
$1,535.46
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
+621483
62161
Incision and retrieval of subcutaneous cranial bone graft for
cranioplasty (List separately in addition to code for primary
procedure)
Neuroendoscopy, intracranial; with dissection of adhesions,
fenestration of septum pellucidum or intraventricular cysts (including
placement, replacement, or removal of ventricular catheter)
3
0254
Level V ENT
Procedures
$1,799.78
Not reimbursed in
ASC by Medicare
Physician
CPT®
HCPCS Code
Procedure Description
*MPFS
(CF=$34.023)
Fac/Non-Fac
AMBULATORY
SURGICAL
CENTER
HOSPITAL OUTPATIENT
APC
Classification
APC
Descriptor
**APC
Rate
***ASC
Cranial Other
62165
Neuroendoscopy, intracranial; with excision of pituitary
tumor, transnasal or trans-sphenoidal approach
$1,562.00
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
62180
Ventriculocisternostomy (Torkildsen type operation)
$1,617.45
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
62258
Removal of complete cerebrospinal fluid shunt system; with
replacement by similar or other shunt at same operation
$1,141.47
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61314
Craniectomy or craniotomy for evacuation of hematoma,
infratentorial; extradural or subdural
$1,847.79
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61322
Craniectomy or craniotomy, decompressive, with or without
duraplasty, for treatment of intracranial hypertension, without
evacuation of associated intraparenchymal hematoma; without
lobectomy
$2,398.96
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61343
Craniectomy, suboccipital with cervical laminectomy for
decompression of medulla and spinal cord, with or without dural
graft (e.g. Arnold-Chiari malformation)
$2,218.64
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61450
Craniectomy, subtemporal, for section, compression, or
decompression of sensory root of gasserian ganglion
$1,939.99
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61460
Craniectomy, suboccipital; for section of 1 or more cranial nerves
$2,123.04
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61510
Craniectomy, trephination, bone flap craniotomy; for excision of
brain tumor, supratentorial, except meningioma
$2,211.50
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61518
Craniectomy for excision of brain tumor, infratentorial or posterior
fossa; except meningioma, cerebellopontine angle tumor, or
midline tumor at base of skull
$2,788.87
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61521
Craniectomy for excision of brain tumor, infratentorial or posterior
fossa; midline tumor at base of skull
$3,205.31
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61526
Craniectomy, bone flap craniotomy, transtemporal (mastoid) for
excision of cerebellopontine angle tumor
$3,673.12
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61570
Craniectomy or craniotomy; with excision of foreign body from brain
$1,885.89
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61571
Craniectomy or craniotomy; with treatment of penetrating wound
of brain
$2,007.02
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61870
Craniectomy for implantation of neurostimulator electrodes,
cerebellar; cortical
$1,197.95
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
Craniectomy
Craniofacial Approach
61580
Craniofacial approach to anterior cranial fossa; extradural,
including lateral rhinotomy, ethmoidectomy, sphenoidectomy,
without maxillectomy or orbital exenteration
$2,523.15
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61581
Craniofacial approach to anterior cranial fossa; extradural,
including lateral rhinotomy, orbital exenteration, ethmoidectomy,
sphenoidectomy and/or maxillectomy
$2,737.49
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61582
Craniofacial approach to anterior cranial fossa; extradural,
including unilateral or bifrontal craniotomy, elevation of frontal
lobe(s), osteotomy of base of anterior cranial fossa
$3,127.73
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61583
Craniofacial approach to anterior cranial fossa; intradural,
including unilateral or bifrontal craniotomy, elevation or resection
of frontal lobe, osteotomy of base of anterior cranial fossa
$2,947.41
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
Craniotomy
61534
Craniotomy with elevation of bone flap; for excision of
epileptogenic focus without electrocorticography during surgery
$1,663.72
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61536
Craniotomy with elevation of bone flap; for excision of cerebral
epileptogenic focus, with electrocorticography during surgery
(includes removal of electrode array)
$2,598.34
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
4
Physician
CPT®
HCPCS Code
Procedure Description
*MPFS
(CF=$34.023)
Fac/Non-Fac
AMBULATORY
SURGICAL
CENTER
HOSPITAL OUTPATIENT
APC
Classification
APC
Descriptor
**APC
Rate
***ASC
Craniotomy
61544
Craniotomy with elevation of bone flap; for excision or coagulation
of choroid plexus
$1,728.03
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61545
Craniotomy with elevation of bone flap; for excision of
craniopharyngioma
$3,209.05
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
61546
Craniotomy for hypophysectomy or excision of pituitary tumor,
intracranial approach
$2,325.81
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
Spinal Arthroplasty
22861
Revision including replacement of total disc arthroplasty (artificial
disc), anterior approach, single interspace; cervical
$2,247.56
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
22862
Revision including replacement of total disc arthroplasty (artificial
disc), anterior approach, single interspace; lumbar
$1,904.27
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
22864
Removal of total disc arthroplasty (artificial disc), anterior
approach, single interspace; cervical
$2,007.36
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
22865
Removal of total disc arthroplasty (artificial disc), anterior
approach, single interspace; lumbar
$2,107.72
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
Spinal Arthroplasty
22554
Arthrodesis, anterior interbody technique, including minimal
discectomy to prepare interspace (other than for decompression);
cervical below C2
$1,286.07
22558
Arthrodesis, anterior interbody technique, including minimal
discectomy to prepare interspace (other than for decompression);
lumbar
$1,556.55
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
+225854
Arthrodesis, anterior interbody technique, including minimal
discectomy to prepare interspace (other than for decompression);
each additional interspace (List separately in addition to code for
primary procedure)
$336.15
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
0208
Laminotomies and
Laminectomies
$3,758.59
Not reimbursed in
ASC by Medicare
22590
Arthrodesis, posterior technique, craniocervical (occiput-C2)
$1,598.74
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
22600
Arthrodesis, posterior or posterolateral technique, single level;
cervical below C2 segment
$1,307.84
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
22610
Arthrodesis, posterior or posterolateral technique, single level;
thoracic (with lateral transverse technique, when performed)
$1,278.58
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
22612
Arthrodesis, posterior or posterolateral technique, single level;
lumbar (with lateral transverse technique, when performed)
$1,611.33
0208
Laminotomies and
Laminectomies
$3,758.59
Not reimbursed in
ASC by Medicare
0208
Laminotomies and
Laminectomies
$3,758.59
Not reimbursed in
ASC by Medicare
+226145
Arthrodesis, posterior or posterolateral technique, single level; each
additional vertebral segment (List separately in addition to code
for primary procedure)
$392.63
22630
Arthrodesis, posterior interbody technique, including laminectomy
and/or discectomy to prepare interspace (other than for
decompression), single interspace; lumbar
$1,562.68
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
+22632
Arthrodesis, posterior interbody technique, including laminectomy
and/or discectomy to prepare interspace (other than for
decompression), single interspace; each additional interspace (List
separately in addition to code for primary procedure)
$320.84
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
22800
Arthrodesis, posterior, for spinal deformity, with or without cast; up
to 6 vertebral segments
$1,371.47
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
22802
Arthrodesis, posterior, for spinal deformity, with or without cast; 7
to 12 vertebral segments
$2,113.51
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
22804
Arthrodesis, posterior, for spinal deformity, with or without cast; 13
or more vertebral segments
$2,430.94
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
6
5
Physician
CPT®
HCPCS Code
Procedure Description
*MPFS
(CF=$34.023)
Fac/Non-Fac
AMBULATORY
SURGICAL
CENTER
HOSPITAL OUTPATIENT
APC
Classification
APC
Descriptor
**APC
Rate
***ASC
Spinal Arthroplasty
Vertebral corpectomy (vertebral body resection), partial or
complete, anterior approach with decompression of spinal cord
and/or nerve root(s); cervical, single segment
$1,788.93
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
+63082
Vertebral corpectomy (vertebral body resection), partial or
complete, anterior approach with decompression of spinal cord
and/or nerve root(s); cervical, each additional segment (List
separately in addition to code for primary procedure)
$269.46
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
+63086
Vertebral corpectomy (vertebral body resection), partial or
complete, transthoracic approach with decompression of spinal
cord and/or nerve root(s); thoracic, each additional segment (List
separately in addition to code for primary procedure)
$190.53
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
+630889
Vertebral corpectomy (vertebral body resection), partial or
complete, combined thoracolumbar approach with decompression
of spinal cord, cauda equina or nerve root(s), lower thoracic or
lumbar; each additional segment (List separately in addition to
code for primary procedure)
$258.23
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
+6309110
Vertebral corpectomy (vertebral body resection), partial or
complete, transperitoneal or retroperitoneal approach with
decompression of spinal cord, cauda equina or nerve root(s), lower
thoracic, lumbar, or sacral; each additional segment (List separately
in addition to code for primary procedure)
$178.62
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
+6310311
Vertebral corpectomy (vertebral body resection), partial or
complete, lateral extracavitary approach with decompression of
spinal cord and/or nerve root(s) (e.g. for tumor or retropulsed
bone fragments); thoracic or lumbar, each additional segment (List
separately in addition to code for primary procedure)
$292.26
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
63081
7
8
63300
Vertebral corpectomy (vertebral body resection), partial or
complete, for excision of intraspinal lesion, single segment;
extradural, cervical
$1,853.23
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
63301
Vertebral corpectomy (vertebral body resection), partial or
complete, for excision of intraspinal lesion, single segment;
extradural, thoracic by transthoracic approach
$2,159.78
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
63302
Vertebral corpectomy (vertebral body resection), partial or
complete, for excision of intraspinal lesion, single segment;
extradural, thoracic by thoracolumbar approach
$2,198.57
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
63303
Vertebral corpectomy (vertebral body resection), partial or
complete, for excision of intraspinal lesion, single segment;
extradural, lumbar or sacral by transperitoneal or retroperitoneal
approach
$2,332.96
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
63304
Vertebral corpectomy (vertebral body resection), partial or
complete, for excision of intraspinal lesion, single segment;
intradural, cervical
$2,370.04
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
63305
Vertebral corpectomy (vertebral body resection), partial or
complete, for excision of intraspinal lesion, single segment;
intradural, thoracic by transthoracic approach
$2,303.02
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
63306
Vertebral corpectomy (vertebral body resection), partial or
complete, for excision of intraspinal lesion, single segment;
intradural, thoracic by thoracolumbar approach
$2,164.54
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
63307
Vertebral corpectomy (vertebral body resection), partial or
complete, for excision of intraspinal lesion, single segment;
intradural, lumbar or sacral by transperitoneal or retroperitoneal
approach
$2,426.52
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
6
Physician
CPT®
HCPCS Code
Procedure Description
AMBULATORY
SURGICAL
CENTER
HOSPITAL OUTPATIENT
*MPFS
(CF=$34.023)
Fac/Non-Fac
APC
Classification
APC
Descriptor
**APC
Rate
***ASC
Spinal Laminectomy
63001
Laminectomy with exploration and/or decompression of spinal
cord and/or cauda equina, without facetectomy, foraminotomy or
discectomy (e.g. spinal stenosis), 1 or 2 vertebral segments; cervical
$1,253.07
0208
Laminotomies and
Laminectomies
$3,758.59
$2,109.06
63003
Laminectomy with exploration and/or decompression of spinal
cord and/or cauda equina, without facetectomy, foraminotomy
or discectomy (e.g. spinal stenosis), 1 or 2 vertebral segments;
thoracic
$1,253.07
0208
Laminotomies and
Laminectomies
$3,758.59
$2,109.06
63005
Laminectomy with exploration and/or decompression of spinal
cord and/or cauda equina, without facetectomy, foraminotomy or
discectomy (e.g. spinal stenosis), 1 or 2 vertebral segments; lumbar,
except for spondylolisthesis
$1,195.91
0208
Laminotomies and
Laminectomies
$3,758.59
$2,109.06
63012
Laminectomy with removal of abnormal facets and/or pars interarticularis with decompression of cauda equina and nerve roots for
spondylolisthesis, lumbar (Gill type procedure)
$1,207.82
0208
Laminotomies and
Laminectomies
$3,758.59
Not reimbursed in
ASC by Medicare
63015
Laminectomy with exploration and/or decompression of spinal
cord and/or cauda equina, without facetectomy, foraminotomy or
discectomy (e.g. spinal stenosis), more than 2 vertebral segments;
cervical
$1,503.48
0208
Laminotomies and
Laminectomies
$3,758.59
Not reimbursed in
ASC by Medicare
63016
Laminectomy with exploration and/or decompression of spinal
cord and/or cauda equina, without facetectomy, foraminotomy or
discectomy (e.g. spinal stenosis), more than 2 vertebral segments;
thoracic
$1,531.72
0208
Laminotomies and
Laminectomies
$3,758.59
Not reimbursed in
ASC by Medicare
63017
Laminectomy with exploration and/or decompression of spinal
cord and/or cauda equina, without facetectomy, foraminotomy or
discectomy (e.g. spinal stenosis), more than 2 vertebral segments;
lumbar
$1,270.76
0208
Laminotomies and
Laminectomies
$3,758.59
Not reimbursed in
ASC by Medicare
63045
Laminectomy, facetectomy and foraminotomy (unilateral or
bilateral with decompression of spinal cord, cauda equina and/
or nerve root[s], [e.g. spinal or lateral recess stenosis]), single
vertebral segment; cervical
$1,290.15
0208
Laminotomies and
Laminectomies
$3,758.59
Not reimbursed in
ASC by Medicare
63046
Laminectomy, facetectomy and foraminotomy (unilateral or
bilateral with decompression of spinal cord, cauda equina and/
or nerve root[s], [e.g. spinal or lateral recess stenosis]), single
vertebral segment; thoracic
$1,226.87
0208
Laminotomies and
Laminectomies
$3,758.59
Not reimbursed in
ASC by Medicare
63047
Laminectomy, facetectomy and foraminotomy (unilateral or
bilateral with decompression of spinal cord, cauda equina and/
or nerve root[s], [e.g. spinal or lateral recess stenosis]), single
vertebral segment; lumbar
$1,119.36
0208
Laminotomies and
Laminectomies
$3,758.59
Not reimbursed in
ASC by Medicare
$213.66
0208
Laminotomies and
Laminectomies
$3,758.59
Not reimbursed in
ASC by Medicare
+6304812
Laminectomy, facetectomy and foraminotomy (unilateral or
bilateral with decompression of spinal cord, cauda equina and/
or nerve root[s], [e.g. spinal or lateral recess stenosis]), single
vertebral segment; each additional segment, cervical, thoracic, or
lumbar (List separately in addition to code for primary procedure)
63200
Laminectomy, with release of tethered spinal cord, lumbar
$1,554.17
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
63265
Laminectomy for excision or evacuation of intraspinal lesion other
than neoplasm, extradural; cervical
$1,691.62
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
63266
Laminectomy for excision or evacuation of intraspinal lesion other
than neoplasm, extradural; thoracic
$1,741.64
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
63267
Laminectomy for excision or evacuation of intraspinal lesion other
than neoplasm, extradural; lumbar
$1,396.30
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
63270
Laminectomy for excision of intraspinal lesion other than
neoplasm, intradural; cervical
$2,095.48
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
63271
Laminectomy for excision of intraspinal lesion other than
neoplasm, intradural; thoracic
$2,085.95
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
7
Physician
CPT®
HCPCS Code
Procedure Description
*MPFS
(CF=$34.023)
Fac/Non-Fac
AMBULATORY
SURGICAL
CENTER
HOSPITAL OUTPATIENT
APC
Classification
APC
Descriptor
**APC
Rate
***ASC
Spinal Laminectomy
63272
Laminectomy for excision of intraspinal lesion other than
neoplasm, intradural; lumbar
$1,929.44
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
63275
Laminectomy for biopsy/excision of intraspinal neoplasm;
extradural, cervical
$1,821.25
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
63276
Laminectomy for biopsy/excision of intraspinal neoplasm;
extradural, thoracic
$1,805.94
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
63277
Laminectomy for biopsy/excision of intraspinal neoplasm;
extradural, lumbar
$1,573.56
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
63280
Laminectomy for biopsy/excision of intraspinal neoplasm;
intradural, extramedullary, cervical
$2,139.03
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
63281
Laminectomy for biopsy/excision of intraspinal neoplasm;
intradural, extramedullary, thoracic
$2,115.89
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
63282
Laminectomy for biopsy/excision of intraspinal neoplasm;
intradural, extramedullary, lumbar
$1,994.09
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
63285
Laminectomy for biopsy/excision of intraspinal neoplasm;
intradural, intramedullary, cervical
$2,637.46
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
63286
Laminectomy for biopsy/excision of intraspinal neoplasm;
intradural, intramedullary, thoracic
$2,593.57
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
63287
Laminectomy for biopsy/excision of intraspinal neoplasm;
intradural, intramedullary, thoracolumbar
$2,766.75
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
Spinal Laminotomy
63020
Laminotomy (hemilaminectomy), with decompression of nerve
root(s), including partial facetectomy, foraminotomy and/or
excision of herniated intervertebral disc; 1 interspace, cervical
$1,186.04
0208
Laminotomies and
Laminectomies
$3,758.59
Not reimbursed in
ASC by Medicare
63030
Laminotomy (hemilaminectomy), with decompression of nerve
root(s), including partial facetectomy, foraminotomy and/or
excision of herniated intervertebral disc; 1 interspace, lumbar
$980.54
0208
Laminotomies and
Laminectomies
$3,758.59
Not reimbursed in
ASC by Medicare
Laminotomy (hemilaminectomy), with decompression of nerve
root(s), including partial facetectomy, foraminotomy and/
or excision of herniated intervertebral disc; each additional
interspace, cervical or lumbar (List separately in addition to code
for primary procedure)
$192.57
0208
Laminotomies and
Laminectomies
$3,758.59
Not reimbursed in
ASC by Medicare
63040
Laminotomy (hemilaminectomy), with decompression of nerve
root(s), including partial facetectomy, foraminotomy and/or
excision of herniated intervertebral disc, reexploration, single
interspace; cervical
$1,418.76
0208
Laminotomies and
Laminectomies
$3,758.59
Not reimbursed in
ASC by Medicare
63042
Laminotomy (hemilaminectomy), with decompression of nerve
root(s), including partial facetectomy, foraminotomy and/or
excision of herniated intervertebral disc, reexploration, single
interspace; lumbar
$1,317.03
0208
Laminotomies and
Laminectomies
$3,758.59
Not reimbursed in
ASC by Medicare
+6304314
Laminotomy (hemilaminectomy), with decompression of nerve
root(s), including partial facetectomy, foraminotomy and/or
excision of herniated intervertebral disc, reexploration, single
interspace; each additional cervical interspace (List separately in
addition to code for primary procedure)
Carrier Priced
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
+6304415
Laminotomy (hemilaminectomy), with decompression of nerve
root(s), including partial facetectomy, foraminotomy and/or
excision of herniated intervertebral disc, reexploration, single
interspace; each additional lumbar interspace (List separately in
addition to code for primary procedure)
Carrier Priced
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
+6303513
8
Physician
AMBULATORY
SURGICAL
CENTER
HOSPITAL OUTPATIENT
*MPFS
(CF=$34.023)
Fac/Non-Fac
APC
Classification
APC
Descriptor
**APC
Rate
***ASC
+22103
Partial excision of posterior vertebral component (e.g. spinous
process, lamina or facet) for intrinsic bony lesion, single vertebral
segment; each additional segment (List separately in addition to
code for primary procedure)
$141.54
0208
Laminotomies and
Laminectomies
$3,758.59
$2,109.06
+22208
Osteotomy of spine, posterior or posterolateral approach,
3 columns, 1 vertebral segment (e.g. pedicle/vertebral body
subtraction); each additional vertebral segment (List separately in
addition to code for primary procedure)
$589.62
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
+2221618
Osteotomy of spine, posterior or posterolateral approach, 1
vertebral segment; each additional vertebral segment (List
separately in addition to primary procedure)
$364.73
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
+2222619
Osteotomy of spine, including discectomy, anterior approach,
single vertebral segment; each additional vertebral segment (List
separately in addition to code for primary procedure)
$365.41
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
+22328
Open treatment and/or reduction of vertebral fracture(s) and/or
dislocation(s), posterior approach, 1 fractured vertebra or dislocated
segment; each additional fractured vertebra or dislocated segment
(List separately in addition to code for primary procedure)
$283.75
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
CPT®
HCPCS Code
Procedure Description
Spinal Other
16
17
20
22520
Percutaneous vertebroplasty (bone biopsy included when
performed), 1 vertebral body, unilateral or bilateral injection;
thoracic
$506.26/
$2,337.04
22521
Percutaneous vertebroplasty (bone biopsy included when
performed), 1 vertebral body, unilateral or bilateral injection; lumbar
$483.47/
$2,339.42
+22522
21
Percutaneous vertebroplasty (bone biopsy included when
performed), 1 vertebral body, unilateral or bilateral injection; each
additional thoracic or lumbar vertebral body (List separately in
addition to code for primary procedure)
$223.53
22523
Percutaneous vertebral augmentation, including cavity creation
(fracture reduction and bone biopsy included when performed)
using mechanical device, 1 vertebral body, unilateral or bilateral
cannulation (e.g. kyphoplasty); thoracic
$566.14/
$7,994.04
22524
Percutaneous vertebral augmentation, including cavity creation
(fracture reduction and bone biopsy included when performed)
using mechanical device, 1 vertebral body, unilateral or bilateral
cannulation (e.g. kyphoplasty); lumbar
$537.90/
$7,946.41
Percutaneous vertebral augmentation, including cavity creation
(fracture reduction and bone biopsy included when performed)
using mechanical device, 1 vertebral body, unilateral or bilateral
cannulation (e.g. kyphoplasty); each additional thoracic or lumbar
vertebral body (List separately in addition to code for primary
procedure)
$256.87/
$4,921.77
+22525
22
22830
Exploration of spinal fusion
22849
Reinsertion of spinal fixation device
22850
0050
Level II
Musculoskeletal
Procedures Except
Hand and Foot
$2,306.77
$1,294.39
0050
Level II
Musculoskeletal
Procedures Except
Hand and Foot
$2,306.77
$1,294.39
0050
Level II
Musculoskeletal
Procedures Except
Hand and Foot
$2,306.77
$1,294.39
0052
Level IV
Musculoskeletal
Procedures Except
Hand and Foot
$5,862.48
$3,289.61
0052
Level IV
Musculoskeletal
Procedures Except
Hand and Foot
$5,862.48
$3,289.61
0052
Level IV
Musculoskeletal
Procedures Except
Hand and Foot
$5,862.48
$3,289.61
$823.02
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
$1,313.63
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
Removal of posterior nonsegmental instrumentation (e.g.
Harrington rod)
$733.54
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
22852
Removal of posterior segmental instrumentation
$702.23
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
22855
Removal of anterior instrumentation
$1,133.65
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
27080
Coccygectomy, primary
$520.89
9
0050
Level II
Musculoskeletal
Procedures Except
Hand and Foot
$2,306.77
$1,294.39
Physician
AMBULATORY
SURGICAL
CENTER
HOSPITAL OUTPATIENT
*MPFS
(CF=$34.023)
Fac/Non-Fac
APC
Classification
APC
Descriptor
**APC
Rate
***ASC
+63057
Transpedicular approach with decompression of spinal cord,
equina and/or nerve root(s) (e.g. herniated intervertebral disc),
single segment; each additional segment, thoracic or lumbar (List
separately in addition to code for primary procedure)
$322.88
0208
Laminotomies and
Laminectomies
$3,758.59
Not reimbursed in
ASC by Medicare
+63066
Costovertebral approach with decompression of spinal cord or
nerve root(s) (e.g. herniated intervertebral disc), thoracic; each
additional segment (List separately in addition to code for primary
procedure)
$207.20
0208
Laminotomies and
Laminectomies
$3,758.59
Not reimbursed in
ASC by Medicare
63075
Discectomy, anterior, with decompression of spinal cord and/or nerve
root(s), including osteophytectomy; cervical, single interspace
$1,386.78
0208
Laminotomies and
Laminectomies
$3,758.59
Not reimbursed in
ASC by Medicare
+63076
Discectomy, anterior, with decompression of spinal cord and/or
nerve root(s), including osteophytectomy; cervical, each additional
interspace (List separately in addition to code for primary
procedure)
$250.75
0208
Laminotomies and
Laminectomies
$3,758.59
Not reimbursed in
ASC by Medicare
+63078
Discectomy, anterior, with decompression of spinal cord and/or
nerve root(s), including osteophytectomy; thoracic, each additional
interspace (List separately in addition to code for primary
procedure)
$193.25
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
$1,118.00
Inpatient Procedures, not reimbursed in outpatient or ASC by Medicare
CPT®
HCPCS Code
Procedure Description
Spinal Other
23
24
25
26
63710
Dural graft, spinal
References: *PFS Relative Value Files, RVU13AR (12-26-12), effective January 1, 2013; **January 2013 HOPPS Addendum B (1-1-13), effective January 1, 2013; ***January 2013 ASC Addendum AA, BB, DD1, DD2, and EE (1-3-13), effective
January 1, 2013
notes
1.
Codes 61609-61612 are reported in addition to code(s) for primary procedure(s) 61605-61608.
2.
Use 61697 in conjunction with 61797, 61798.
3.
Use 62148 in conjunction with 62140-62147.
4.
Use 22585 in conjunction with 22554, 22556, 22558.
5.
Use 22614 in conjunction with 22600, 22610, 22612, 22630 or 22633 when performed at a different level. When performing a
posterior or posteriolateral technique for fusion/arthrodesis at an additional level, use 22614.
6.
Use 22632 in conjunction with 22612, 22630 or 22633 when performed at a different level. When performing a posterior interbody
fusion arthrodesis at an additional level, use 22632.
7.
Use 63082 in conjunction with 63081.
8.
Use 63086 in conjunction with 63085.
9.
Use 63088 in conjunction with 63087.
10. Use 63091 in conjunction with 63090.
11. Use 63103 in conjunction with 63101 and 63102.
12. Use 63048 in conjunction with 63045-63047.
13. Use 63035 in conjunction with 63020-63030.
14. Use 63043 in conjunction with 63040.
15. Use 63044 in conjunction with 63042.
16. Use 22103 in conjunction with 22100, 22101 and 22102.
17. Use 22208 in conjunction with 22206, 22207.
18. Use 22216 in conjunction with 22210, 22212, 22214.
19. Use 22226 in conjunction with 22220, 22222, 22224.
20. Use 22328 in conjunction with 22325-22327.
10
21. Use 22522 in conjunction with 22520, 22521 as appropriate.
22. Use 22525 in conjunction with 22523, 22524.
23. Use 63057 in conjunction with 63055, 63056.
24. Use 63066 in conjunction with 63064.
25. Use 63076 in conjunction with 63075.
26. Use 63078 in conjunction with 63077.
Multiple Procedure Discounting – Multiple surgical procedures furnished during the same operative session are discounted.
50% is paid for any other surgical procedure(s) performed at the same time.
The above National Average APC and ASC (Freestanding) Rates represent the reimbursement amounts paid directly to the facility for
the technical portion of the procedure. The Physician (surgeon) would separately receive the professional fee (MPFS Allowable) for the
procedure performed.
ICD-9-CM Volume 3 Hospital Procedure Codes
Procedure
Code*
Description
Cranial
01.12
Open biopsy of cerebral meninges
01.14
Open biopsy of brain
01.15
Biopsy of skull
01.23
Reopening of craniotomy site
01.24
Other craniotomy
01.25
Other craniectomy
01.26
Insertion of catheter(s) into cranial cavity or tissue
01.27
Removal of catheter(s) from cranial cavity or tissue
01.28
Placement of intracerebral catheter(s) via burr hole(s)
01.31
Incision of cerebral meninges
01.32
Lobotomy and tractotomy
Spinal
03.02
Reopening of laminectomy site
03.09
Other exploration and decompression of spinal canal
80.51
Excision of intervertebral disc
81.02
Other cervical fusion of the anterior column, anterior technique
81.03
Other cervical fusion of the posterior column, posterior technique
81.04
Dorsal and dorsolumbar fusion of the anterior column, anterior technique
81.05
Dorsal and dorsolumbar fusion of the posterior column, posterior technique
81.06
Lumbar and lumbosacral fusion of the anterior column, anterior technique
81.07
Lumbar and lumbosacral fusion of the posterior column, posterior technique
81.08
Lumbar and lumbosacral fusion of the anterior column, posterior technique
81.65
Percutaneous vertebroplasty
81.66
Percutaneous vertebral augmentation
84.51
Insertion of interbody spinal fusion device
84.52
Insertion of recombinant bone morphogenetic protein
11
Procedure
Code*
Description
Spinal
84.60
Insertion of spinal disc prosthesis, not otherwise specified
84.61
Insertion of partial spinal disc prosthesis, cervical
84.62
Insertion of total spinal disc prosthesis, cervical
84.63
Insertion of spinal disc prosthesis, thoracic
84.64
Insertion of partial spinal disc prosthesis, lumbosacral
84.65
Insertion of total spinal disc prosthesis, lumbosacral
84.66
Revision or replacement of artificial spinal disc prosthesis, cervical
84.69
Revision or replacement of artificial spinal disc prosthesis, not otherwise specified
84.80
Insertion or replacement of interspinous process device(s)
References: *Hospital ICD-9-CM 2013 Volume 3, 9th Revision, Clinical Modification, Sixth Edition
notes
The ICD-9-CM Hospital Procedure Codes listed above may be used in the MS-DRG Classifications (See Inpatient DRG Payment
Rates Table).
The appropriate MS-DRG classification is also dependent on the diagnosis code, demographics, sex and possible co-conditions.
Inpatient DRG Payment Rates
MS-DRG*
Arithmetic Mean
Length of Stay (Days)
MS-DRG Title
National Average
Payment**
Cranial
023
Cranio w Major Dev Impl/Acute Complex Cns Pdx w MCC or Chemo Implant
11.1
$30,244.37
024
Cranio w Major Dev Impl/Acute Complex Cns Pdx w/o MCC
6.5
$20,370.98
025
Craniotomy and Endovascular Intracranial Procedures w MCC
10.5
$26,537.30
026
Craniotomy and Endovascular Intracranial Procedures w CC
6.8
$17,065.80
027
Craniotomy and Endovascular Intracranial Procedures w/o CC/MCC
3.6
$12,490.28
Spinal
028
Spinal Procedures w MCC
12.9
$32,351.97
029
Spinal Procedures w CC or Spinal Neurostimulators
6.4
$16,905.27
030
Spinal Procedures w/o CC/MCC
3.2
$10,309.35
453
Combined Anterior/Posterior Spinal Fusion w MCC
12.6
$61,179.33
454
Combined Anterior/Posterior Spinal Fusion w CC
6.3
$45,027.02
455
Combined Anterior/Posterior Spinal Fusion w/o CC/MCC
3.6
$33,897.73
456
Spinal Fus Exc Cerv w Spinal Curv/Malig/Infec or 9+ Fus w MCC
13.1
$54,973.17
457
Spinal Fus Exc Cerv w Spinal Curv/Malig/Infec or 9+ Fus w CC
6.5
$37,053.94
458
Spinal Fus Exc Cerv w Spinal Curv/Malig/Infec or 9+ Fus w/o CC/MCC
3.7
$28,577.34
459
Spinal Fusion Except Cervical w MCC
9.1
$37,757.82
460
Spinal Fusion Except Cervical w/o MCC
3.6
$22,394.27
471
Cervical Spinal Fusion w MCC
9.0
$27,182.28
472
Cervical Spinal Fusion w CC
3.6
$16,191.57
473
Cervical Spinal Fusion w/o CC/MCC
1.8
$12,272.59
490
Back and Neck Proc Exc Spinal Fusion w CC/MCC or Disc Device/Neurostim
4.5
$10,482.57
491
Back and Neck Proc Exc Spinal Fusion w/o CC/MCC
2.1
$5,978.66
515
Other Musculoskelet Sys and Conn Tiss O.R. Proc w MCC
9.7
$18,957.44
516
Other Musculoskelet Sys and Conn Tiss O.R. Proc w CC
5.6
$11,400.68
517
Other Musculoskelet Sys and Conn Tiss O.R. Proc w/o CC/MCC
3.5
$9,104.26
References: **Federal Register, Vol. 77, No. 170, Friday, August 31, 2012, Table 1A-1E. National Average Payment Rate is based upon National Average Operating Standardized Amount ($5,348.76) plus the Capital Standard Federal
Payment Rate ($425.49).
12
notes
*One DRG per patient is assigned to each inpatient stay.
ICD-9-CM Diagnosis Codes
Dx Code**
Description
Cranial
191.x*
Malignant neoplasm of the brain
192.0
Malignant neoplasm of cranial nerves
192.1
Malignant neoplasm of cerebral meninges
198.3
Secondary malignant neoplasm of brain and spinal cord
225.0
Benign neoplasm of brain
225.1
Benign neoplasm of cranial nerves
225.2
Benign neoplasm of cerebral meninges
237.5
Neoplasm of uncertain behavior of brain and spinal cord
237.6
Neoplasm of uncertain behavior of meninges
3313
Communicating hydrocephalus
350.x*
Trigeminal nerve disorders
432.x*
Other and unspecified intracranial hemorrhage
437.3
Cerebral aneurysm, nonruptured
437.9
Unspecified cerebrovascular disease
738.1x*
Other acquired deformity of the head
852.xx*
Subarachnoid, subdural, and extradural hemorrhage, following injury
996.2
Mechanical complication of nervous system device, implant, and graft
996.63
Infection and inflammatory reaction due to nervous system device, implant, and graft
996.75
Other complications due to nervous system device, implant, and graft
Spinal
198.5
Secondary malignant neoplasm of bone and bone marrow
225.3
Benign neoplasm of spinal cord
324.1
Intraspinal abscess
721.x*
Spondylosis and allied disorders
721.4x*
Thoracic or lumbar spondylosis with myelopathy
721.5
Kissing spine
721.6
Ankylosing vertebral hyperostosis
721.7
Traumatic spondylopathy
7218
Other allied disorders of spine
721.90
Spondylosis of unspecified site, without mention of myelopathy
721.91
Spondylosis of unspecified site, with myelopathy
722.xx*
Intervertebral disc disorders
723.x*
Other disorders of cervical region
724.xx*
Other and unspecified disorders of back
733.13
Pathologic fracture of vertebrae
737.xx*
Curvature of spine
738.4
Acquired spondylolisthesis
738.5
Other acquired deformity of back or spine
742.5x*
Other unspecified anomalies of spinal cord
13
Dx Code**
Description
Spinal
756.10
Anomaly of spine, unspecified
756.11
Spondylolysis, lumbosacral region
756.12
Spondylolisthesis
805.xx*
Fractures of vertebral column without mention of spinal cord injury
996.40
Unspecified mechanical complication of internal orthopedic device, implant, and graft
996.41
Mechanical loosening of prosthetic joint
996.49
Other mechanical complication of other internal orthopedic device, implant, and graft
996.78
Other complications due to other internal orthopedic device, implant, and graft
V43.6
Unspecified joint replacement
V43.69
Other joint replacement
References: **Hospital ICD-9-CM 2013 Volume 1 and 2, 9th Revision, Clinical Modification, Sixth Edition
notes
*Check 4th or 5th digit.
Disclaimer:
The information contained in this guide is provided to help you understand the reimbursement process. It is not intended to increase or maximize reimbursement by any
payor. We strongly recommend that providers consult their payor organization with regard to local reimbursement policies. The information contained in this guide is
provided for information purposes only and represents no statement, promise or guarantee by Covidien concerning levels of reimbursement, payment or charge.
Similarly, all CPT HCPCS and ICD-9-CM codes are supplied for information purposes only and represent no statement, promise or guarantee by Covidien that these
codes will be appropriate or that reimbursement will be made. ICD-9-CM is based on the official version of the World Health Organization’s Ninth Revision, International
Classification of Diseases. CPT codes and descriptions only are copyright 2012 American Medical Association. All rights reserved.
CPT does not include fee schedules, relative values or related listings. The source for this information is the Center for Medicare and Medicaid Services. Reimbursement
rates reflected in this guide are Medicare National Average rates as published by CMS at the time of printing, and do not reflect provider payment adjustment factors such
geographic adjustment, participation as a Disproportionate Share or Teaching Hospital, participation in the CMS Shared Service (ACO) program, or Value Base Purchasing
adjustments. The content provided by the Center for Medicare and Medicaid Services is updated frequently. It is the responsibility of the health services provider to confirm
the appropriate coding required by their local Medicare Carriers, fiscal intermediaries and commercial payors.
All Current Procedural Terminology (CPT) five-digit numeric codes, descriptions, numeric modifiers, instructions, guidelines and other material are copyright © 2012
American Medical Association. All rights reserved.
Code associations and values have been reviewed and validated by NMD Healthcare, Inc.
COVIDIEN, COVIDIEN with logo, Covidien logo and positive results for life are U.S. and internationally
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reimbursement