CPT copyright 2009 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
The 2011 CMS ASC final rule gave ASCs six new procedures they can bill Medicare for which were previously excluded from coverage, according to the ASC Association. As a result of the annual process of replacing discontinued codes with newly instituted codes, ASC have a net gain of 23 payable codes in 2011.
CMS deleted 14 codes from the ASC list for 2011.
Here are the new billable ASC CPT codes, the short description, 2011 national ASC rate and the reason for the addition and when the code becomes billable, according to the ASC Association. This list includes codes which became payable in March and July (noted under the final column). Editor's note: The six procedures previously excluded from Medicare coverage added in 2011 are CPT 37204, 37210, 37221, 37223, 50593 and 52649.
|
HCPCS Code |
Description |
2011 National ASC Rate |
Reason for the addition |
|
0226T |
Anosc high resol dx +-coll |
$26.78 |
New Code Billable July 1, 2010 |
|
0227T |
Anosc high resol dx w/bx |
$231.07 |
New Code Billable July 1, 2010 |
|
0228T |
US tfrml edrl inj crv/t 1lvl |
$288.11 |
New Code Billable July 1, 2010 |
|
0229T |
US tfrml edrl inj crv/t +lvl |
$148.93 |
New Code Billable July 1, 2010 |
|
0230T |
US tfrml edrl inj l/s 1lvl |
$288.11 |
New Code Billable July 1, 2010 |
|
0231T |
US tfrml edrl inj l/s +lvl |
$148.93 |
New Code Billable July 1, 2010 |
|
0232T |
Inj plsm img guid hrvst&prep |
$26.78 |
New Code Billable July 1, 2010 |
|
0238T |
Trluml perip athrc iliac art |
$3,592.47 |
New Code Billable January 1, 2011 |
|
0249T |
Ligation hemorrhoid w/us |
$624.25 |
New Code Billable January 1, 2011 |
|
0250T |
Insert bronchial valve |
$1,109.14 |
New Code Billable January 1, 2011 |
|
0251T |
Remov bronchial valve addl |
$406.83 |
New Code Billable January 1, 2011 |
|
0252T |
Bronchscpc rmvl bronch valve |
$406.83 |
New Code Billable January 1, 2011 |
|
0253T |
Insert aqueous drain device |
$945.91 |
New Code Billable January 1, 2011 |
|
0260T |
Hypthrm bdy neonate 28d/< |
No Separate Payment |
New Code Billable January 1, 2011 |
|
0261T |
Hypthrm head neonate 28d/< |
No Separate Payment |
New Code Billable January 1, 2011 |
|
11045 |
Deb subq tissue add-on |
$105.84 |
New Code Billable January 1, 2011 |
|
11046 |
Deb musc/fascia add-on |
$105.84 |
New Code Billable January 1, 2011 |
|
11047 |
Deb bone add-on |
$329.04 |
New Code Billable January 1, 2011 |
|
29914 |
Hip arthro w/femoroplasty |
$1,876.83 |
New Code Billable January 1, 2011 |
|
29915 |
Hip arthro acetabuloplasty |
$1,876.83 |
New Code Billable January 1, 2011 |
|
29916 |
Hip arthro w/labral repair |
$1,876.83 |
New Code Billable January 1, 2011 |
|
31295 |
Sinus endo w/balloon dil |
$1,198.96 |
New Code Billable January 1, 2011 |
|
31296 |
Sinus endo w/balloon dil |
$1,198.96 |
New Code Billable January 1, 2011 |
|
31297 |
Sinus endo w/balloon dil |
$1,198.96 |
New Code Billable January 1, 2011 |
|
31634 |
Bronch w/balloon occlusion |
$406.83 |
New Code Billable January 1, 2011 |
|
37204 |
Transcatheter occlusion |
$3,728.28 |
Previously Excluded Procedure |
|
37210 |
Embolization uterine fibroid |
$2,266.64 |
Previously Excluded Procedure |
|
37220 |
Iliac revasc |
$2,126.38 |
New Code Billable January 1, 2011 |
|
37221 |
Iliac revasc w/stent |
$2,126.38 |
Previously Excluded Procedure |
|
37222 |
Iliac revasc add-on |
$2,126.38 |
New Code Billable January 1, 2011 |
|
37223 |
Iliac revasc w/stent add-on |
$2,126.38 |
Previously Excluded Procedure |
|
38900 |
Io map of sent lymph node |
No Separate Payment |
New Code Billable January 1, 2011 |
|
43753 |
Tx gastro intub w/asp |
$26.01 |
New Code Billable January 1, 2011 |
|
43754 |
Dx gastr intub w/asp spec |
$26.01 |
New Code Billable January 1, 2011 |
|
43755 |
Dx gastr intub w/asp specs |
$37.27 |
New Code Billable January 1, 2011 |
|
43756 |
Dx duod intub w/asp spec |
$46.97 |
New Code Billable January 1, 2011 |
|
43757 |
Dx duod intub w/asp specs |
$46.97 |
New Code Billable January 1, 2011 |
|
49327 |
Lap ins device for rt |
$1,497.48 |
New Code Billable January 1, 2011 |
|
49418 |
Insert tun ip cath perc |
$1,201.08 |
New Code Billable January 1, 2011 |
|
50593 |
Perc cryo ablate renal tum |
$2,178.82 |
Previously Excluded Procedure |
|
52649 |
Prostate laser enucleation |
$1,773.68 |
Previously Excluded Procedure |
|
53860 |
Transurethral rf treatment |
$778.30 |
New Code Billable January 1, 2011 |
|
57156 |
Ins vag brachytx device |
$140.26 |
New Code Billable January 1, 2011 |
|
61781 |
Scan proc cranial intra |
No Separate Payment |
New Code Billable January 1, 2011 |
|
61782 |
Scan proc cranial extra |
No Separate Payment |
New Code Billable January 1, 2011 |
|
61783 |
Scan proc spinal |
No Separate Payment |
New Code Billable January 1, 2011 |
|
64566 |
Neuroeltrd stim post tibial |
$103.38 |
New Code Billable January 1, 2011 |
|
64568 |
Inc for vagus n elect impl |
$21,333.84 |
New Code Billable January 1, 2011 |
|
64569 |
Revise/repl vagus n eltrd |
$841.60 |
New Code Billable January 1, 2011 |
|
64570 |
Remove vagus n eltrd |
$1,444.14 |
New Code Billable January 1, 2011 |
|
64611 |
Chemodenerv saliv glands |
$41.86 |
New Code Billable January 1, 2011 |
|
65778 |
Cover eye w/membrane |
$314.70 |
New Code Billable January 1, 2011 |
|
65779 |
Cover eye w/membrane stent |
$291.90 |
New Code Billable January 1, 2011 |
|
66174 |
Translum dil eye canal |
$1,675.21 |
New Code Billable January 1, 2011 |
|
66175 |
Trnslum dil eye canal w/stnt |
$1,675.21 |
New Code Billable January 1, 2011 |
|
C9800 |
Dermal filler inj px/suppl |
$177.60 |
New Procedure Billable March 23, 2010 |
Here are the 14 deleted HCPCS codes.
|
HCPCS Code |
Description |
2010 National ASC Rate |
|
0017T |
Photocoagulat macular drusen |
$234.07 |
|
0016T |
Thermotx choroid vasc lesion |
$234.07 |
|
0193T |
Rf bladder neck microremodel |
$801.25 |
|
0177T |
Aqu canal dilat w retent |
$1,576.84 |
|
0176T |
Aqu canal dilat w/o retent |
$1,576.84 |
|
43600 |
Biopsy of stomach |
$342.03 |
|
35492 |
Atherectomy, percutaneous |
$3,734.27 |
|
35473 |
Repair arterial blockage |
$2,027.94 |
|
61795 |
Brain surgery using computer |
No Separate Payment |
|
64573 |
Implant neuroelectrodes |
$9,116.01 |
|
20000 |
Incision of abscess |
$58.25 |
|
49420 |
Insert abdom drain, temp |
$993.68 |
|
11040 |
Debride skin, partial |
$23.45 |
|
11041 |
Debride skin, full |
$25.98 |
Source: ASC Association.
The information provided should be utilized for educational purposes only. Please consult with your billing and coding expert. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.