2020 CPT Reimbursement Reference Guide

2020 CPT Reimbursement Reference Guide

Table of Contents

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Anesthesiology ....................................................................................................................................................................1 Ultrasound Guidance of Regional Anesthesia in the ASC....................................................................................... 2 Echocardiograph ..............................................................................................................................................................3 Emergency Medicine........................................................................................................................................................4 Endocrinology .....................................................................................................................................................................5 Musculoskeletal Applications..................................................................................................................................... 6-7 Obstetrics and Gynecology........................................................................................................................................ 8-9 Pain Management .......................................................................................................................................................... 10 Pulmonary Medicine ....................................................................................................................................................... 11 Surgery.......................................................................................................................................................................... 12-13 Vascular Access ................................................................................................................................................................14 Vascular Surgery ........................................................................................................................................................ 15-16

CPT Reimbursement Reference

Anesthesiology

CPT Code 76942

+76937

93308 +93321 +93325

CPT Code Descriptor

Ultrasonic guidance for needle placement (e.g., biopsy, aspiration injection, localization device), imaging supervision and interpretation

Ultrasonic guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent recording and reporting

Echocardiography, transthoracic, real time with image documentation (2D) includes M-mode recording; when performed, follow up or limited study

Doppler Echocardiography, pulsed wave and/or continuous wave with spectral display (List separately in addition to codes for 2D echocardiographic imaging); follow up or limited study

Doppler echocardiography color flow velocity mapping (List separately in addition to codes for echocardiography)

2020 Medicare Physician Fee Schedule -- National Average*

Global Payment

Professional Payment

Technical Payment

2020 Hospital Outpatient Prospective

Payment System (OPPS)

APC Code

APC

Payment

$58.47

$32.48

$25.98

Packaged Service

No Payment

$37.17

$14.80

$22.38

Packaged Service

No Payment

$100.69

$26.35

$74.34

5523

$233.04

$27.07

$7.58

$19.49

Packaged Service

No Payment

$25.26

$3.25

$22.01

Packaged

No

Service Payment

CPT Code 64405 64415 64417 64418 64420

64421

64425 64445 64446 64447 64448 64450

CPT Code Descriptor

Injection, anesthetic agent; occipital nerve Injection, anesthetic agent; brachial plexus, single Injection, anesthetic agent; axillary nerve Injection, anesthetic agent; suprascapular nerve Injection, anesthetic agent; intercostal nerve, single Injection, anesthetic agent; intercostal nerves, multiple, regional block Injection, anesthetic agent; ilioinguinal, iliohypogastric nerves Injection, anesthetic agent; sciatic nerve, single Nerve block injection, sciatic continuous infusion Injection, anesthetic agent; femoral nerve, single Nerve block injection, femoral continuous infusion Nerve block injection, other peripheral nerve or branch

Non-Facility Payment $74.71 $116.21 $140.39 $87.34 $102.86

$35.01

$115.13 $128.84

N/A $91.31 N/A $78.68

Facility Payment $55.94 $66.04

$63.16 $59.19 $62.07

$26.35

$57.74 $55.94 $61.71 $55.22 $63.88 $44.39

APC Code

5441 5443 5443 5442 5442

5443

5442 5442 5442 5442 5443 5442

APC Payment $261.77 $812.05 $812.05 $625.05 $625.05

$812.05

$625.05 $625.05 $625.05 $625.05 $812.05 $625.05

The information provided above is intended to assist providers in determining the correct codes for ultrasound reimbursement purposes. The charts above contain payment information that is based on the national unadjusted Medicare physician fee schedule for the medical services discussed, as obtained from the American Medical Association in September 2019. Payment will vary by region. Clarius Mobile Health disclaims any responsibility to update the information provided. It is the provider's responsibility to determine and submit appropriate codes, modifiers, and claims for the services rendered. Before filing any claims, providers should verify current requirements and policies with the applicable payer.

1

CPT Reimbursement Reference

Ultrasound Guidance of Regional Anesthesia in the ASC

2020 Medicare Physician Fee Schedule - National Average*

CPT Code 76942

CPT Code Descriptor

Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection localization device), imaging supervision and interpretation

Professional Payment $32.48

2020 Hospital Outpatient

Prospective Payment

System (0PPS)

APC Code

APC Payment

Packaged Service

No Payment

CPT Code 64415 64417 64418 64420

64421

64425

64445 64446 64447 64448 64450

2020 Medicare Physician Fee Schedule - National Average*

CPT Code Descriptor

Injection, anesthetic agent; brachial plexus, single Injection, anesthetic agent; axillary nerve Injection, anesthetic agent; suprascapular nerve Injection, anesthetic agent; intercostal nerve, single Injection, anesthetic agent; intercostal nerves, multiple, regional block Injection, anesthetic agent; ilioinguinal, iliohypogastric nerves Injection, anesthetic agent; sciatic nerve, single Nerve block injection, sciatic continuous infusion Injection, anesthetic agent; femoral nerve, single Nerve block injection, femoral continuous infusion Nerve block injection, other peripheral nerve

Physician at Facility Payment $66.04 $63.16 $59.19 $62.07

$26.35

$57.74

$55.94 $61.71 $55.22 $63.88 $44.39

2020 Hospital Outpatient Prospective Payment

System (OPPS) for ASC ASC Payment $410.32 $410.32 $43.31

$315.83

$410.32

$75.07

$89.50 $410.32 $48.36 $410.32 $48.36

The information provided above is intended to assist providers in determining the correct codes for ultrasound reimbursement purposes. The charts above contain payment information that is based on the national unadjusted Medicare physician fee schedule for the medical services discussed, as obtained from the American Medical Association in September 2019. Payment will vary by region. Clarius Mobile Health disclaims any responsibility to update the information provided. It is the provider's responsibility to determine and submit appropriate codes, modifiers, and claims for the services rendered. Beforefilingany claims,providersshouldverify current requirementsandpolicieswiththeapplicablepayer.

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CPT Reimbursement Reference

Echocardiograph

CPT Code 93306 93307 93308 93303 93304 93350

93015

+93320

+93321 +93325

2020 Medicare Physician Fee Schedule -- National Average*

CPT Code Descriptor

Echocardiography, transthoracic, real time with image documentation (2D) includes M-mode recording when performed; complete, with spectral Doppler and color flow Doppler.

Echocardiography, transthoracic, real time with image documentation (2D) includes M-mode recording when performed; complete, without spectral Doppler or color flow Doppler.

Echocardiography, transthoracic, real time with image documentation (2D) includes M-mode recording when performed; follow up or limited

Transthoracic echocardiography for congenital cardiac anomalies, complete

Transthoracic echocardiography for congenital cardiac anomalies, follow-up or limited

Echocardiography, transthoracic, real-time with image documentation (2D, with or without M-mode recording), during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report

Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with physician supervision, with interpretation and report.

Doppler Echocardiography, pulsed wave and/or continuous wave with spectral display (List separately in addition to codes for 2D echocardiographic imaging); complete.

Doppler Echocardiography, pulsed wave and/or continuous wave with spectral display (List separately in addition to codes for 2D echocardiographic imaging); follow up or limited.

Doppler echocardiography color flow velocity mapping (List separately in addition to codes for echocardiography)

Global Payment $211.49

$144.00 $100.69 $237.47 $163.12

$193.44

Non-facility Payment $72.18

$54.50

$27.07

$25.26

Professional Payment $75.07 $46.19 $26.35 $65.32 $37.53 $72.90

NA

$18.77

$7.58 $3.25

Technical Payment $136.42 $97.80

$74.34 $172.15 $125.59 $120.54

NA

$35.73

$19.49 $22.01

2020 Hospital Outpatient Prospective

Payment System (OPPS)

APC Code

APC

Payment

5524

$481.58

5523

$233.04

5523 5524 5524

$233.04 $481.58 $481.58

5524

$481.58

NA

NA

Packaged Service

No Payment

Packaged Service

No Payment

Packaged Service

No Payment

The information provided above is intended to assist providers in determining the correct codes for ultrasound reimbursement purposes. The charts above contain payment information that is based on the national unadjusted Medicare physician fee schedule for the medical services discussed, as obtained from the American Medical Association in September 2019. Payment will vary by region. Clarius Mobile Health disclaims any responsibility to update the information provided. It is the provider's responsibility to determine and submit appropriate codes, modifiers, and claims for the services rendered. Before filing any claims, providers should verify current requirements and policies with the applicable payer.

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CPT Reimbursement Reference

Emergency Medicine

CPT Code

CPT Code Descriptor

76604 76705 76775 76815 76817 76830 76857

+76937

Ultrasound, chest, (includes mediastinum) real time with image documentation.

Ultrasound, abdominal, real time with image documentation; limited (e.g., single organ, quadrant, follow-up)

Ultrasound retroperitoneal (e.g., renal, aorta, nodes), real time with image documentation; limited

Ultrasound, pregnant uterus, real time with image documentation, limited (e.g., fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume), one or more fetuses Ultrasound, pregnant uterus, real time with image documentation, transvaginal

Ultrasound, transvaginal

Ultrasound, pelvic (non-obstetric), or real time with image documentation; limited or follow-up (e.g., for follicles)

Ultrasonic guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent real time ultrasound visualization of vascular needle entry, with permanent recording and reporting

76942

Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection localization device), imaging supervision and interpretation

2020 Medicare Physician Fee Schedule

- National Average* Professional Payment

$29.59 $29.95 $29.59

$33.20 $38.25 $35.37 $25.26

$14.80

$32.48

2020 Hospital Outpatient Prospective Payment System (0PPS)

APC Code

APC Payment

5522

$112.08

5522

$112.08

5522

$112.08

5522

5522 5522 5522

$112.08

$112.08 $112.08 $112.08

Packaged Service

No Separate Payment

Packaged Service

No Separate Payment

93308

Echocardiography, transthoracic, real time with image documentation (2D)

$26.35

5523

$233.04

The information provided above is intended to assist providers in determining the correct codes for ultrasound reimbursement purposes. The charts above contain payment information that is based on the national unadjusted Medicare physician fee schedule for the medical services discussed, as obtained from the American Medical Association in September 2019. Payment will vary by region. Clarius Mobile Health disclaims any responsibility to update the information provided. It is the provider's responsibility to determine and submit appropriate codes, modifiers, and claims for the services rendered. Before filing any claims, providers should verify current requirements and policies with the applicable payer.

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CPT Reimbursement Reference

Endocrinology

CPT Code

CPT Code Descriptor

76536 76942

Ultrasound, soft tissues of head and neck (e.g. thyroid, parathyroid, parotid), real time with image documentation

Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision and interpretation

2020 Medicare Physician Fee Schedule

- National Average*

Global Professional Payment Payment

Technical Payment

2020 Hospital Outpatient Prospective

Payment System (0PPS)

APC Code APC Payment

$118.01

$28.87

$89.14

5522

$112.08

$58.47

$32.48

$25.98

Packaged Service

No Separate Payment

CPT Code

CPT Code Descriptor

10005 +10006 60100

Fine needle aspiration biopsy; including ultrasound guidance; first lesion

Fine needle aspiration biopsy, including ultrasound guidance; each additional lesion (List separately in addition to code for primary procedure, e.g. CPT code 10005)

Biopsy, thyroid, percutaneous core needle

2020 Medicare Outpatient Physician Fee Schedule

- National Average*

Non-Facility Payment

Facility Payment

2020 Hospital Prospective Payment

System (OPPS)

APC Code APC Payment

$132.45

$74.71

5071

$610.01

$61.35 $114.76

$51.25 $81.20

Packaged Service

5071

No Separate Payment

$610.01

The information provided above is intended to assist providers in determining the correct codes for ultrasound reimbursement purposes. The charts above contain payment information that is based on the national unadjusted Medicare physician fee schedule for the medical services discussed, as obtained from the American Medical Association in September 2019. Payment will vary by region. Clarius Mobile Health disclaims any responsibility to update the information provided. It is the provider's responsibility to determine and submit appropriate codes, modifiers, and claims for the services rendered. Before filing any claims, providers should verify current requirements and policies with the applicable payer.

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CPT Reimbursement Reference

Musculoskeletal Applications

Ultrasound Services

CPT Code 76881

76882

76942

CPT Code Descriptor

Ultrasound, complete joint (ie, joint space and periarticular soft tissue structure(s)) real-time with image documentation

Ultrasound, limited, joint or other nonvascular extremity structure(s) (eg, joint space, periarticular tendon(s), muscle(s), nerve(s), other soft tissue structure(s), or soft tissue mass[es]) real-time with image documentation

Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision and interpretation

2020 Medicare Physician Fee Schedule

- National Average*

Global Payment

Professional Payment

Technical Payment

$79.04

$32.12

$46.92

$58.10

$24.90

$33.20

$58.47

$32.48

$25.98

2020 Hospital

Outpatient Prospective

Payment System (0PPS)

APC Code

APC Payment

5522

$112.08

5522

$112.08

Packaged Service

No Separate Payment

Procedures that may be ultrasound guided (report CPT Code 76942 in addition)

CPT Code 20526 20527 20550

20551

20552 20553

20612

CPT Code Descriptor

Injection, therapeutic (eg local anesthetic, corticosteroid), carpal tunnel Injection, enzyme (eg collagenase) palmar fascial cord (Dupuytren's cord) post enzyme injection Injection(s) single tendon sheath, or ligament, aponeurosis (eg plantar "fascia") Injection(s) single tendon sheath, or ligament, aponeurosis (eg plantar "fascia") single tendon origin/insertion

Injection(s), single to multiple trigger point(s) one or two muscle(s)

Injection(s), single to multiple trigger point(s) three or more muscle(s)

Aspiration and/or injection of ganglion(s) cyst any location

2020 Medicare Physician Fee Schedule - National Average*

Payment

Facility Payment

$81.20

$59.55

$87.70

$68.57

$56.30

$40.78

$57.74

$41.50

$57.38

$40.06

$65.68

$45.11

$63.52

$42.95

2020 Hospital Outpatient Prospective Payment System (OPPS)

APC Code APC Payment

5441

$261.77

5441

$261.77

5441

$261.77

5441

$261.77

5441

$261.77

5441

$261.77

5441

$261.77

The information provided above is intended to assist providers in determining the correct codes for ultrasound reimbursement purposes. The charts above contain payment information that is based on the national unadjusted Medicare physician fee schedule for the medical services discussed, as obtained from the American Medical Association in March 2018. Payment will vary by region. Clarius Mobile Health disclaims any responsibility to update the information provided. It is the provider's responsibility to determine and submit appropriate codes, modifiers, and claims for the services rendered. Before filing any claims, providers should verify current requirements and policies with the applicable payer.

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