The principles of correct coding discussed in Chapter I apply to the CPT codes in the range 20000-29999. Several general guidelines are repeated in this Chapter. However, those general guidelines from Chapter I not discussed in this Chapter are nonetheless applicable.
Physicians should report the HCPCS/CPT code that describes the procedure performed to the greatest specificity possible. A HCPCS/CPT code should be reported only if all services described by the code are performed. A physician should not report multiple HCPCS/CPT codes if a single HCPCS/CPT code exists that describes the services. This type of unbundling is incorrect coding.
HCPCS/CPT codes include all services usually performed as part of the procedure as a standard of medical/surgical practice. A physician should not separately report these services simply because HCPCS/CPT codes exist for them. Specific issues unique to this section of CPT are clarified in this Chapter.
B. Evaluation and Management (E&M) Services Medicare Global Surgery Rules define the rules for reporting evaluation and management (E&M) services with procedures covered by these rules. This section summarizes some of the rules. All procedures on the Medicare Physician Fee Schedule are assigned a global period of 000, 010, 090, XXX, YYY, ZZZ, or MMM. The global concept does not apply to XXX procedures. The global period for YYY procedures is defined by the Carrier (A/B MAC processing practitioner service claims). All procedures with a global period of ZZZ are related to another procedure, and the applicable global period for the ZZZ code is determined by the related procedure. Procedures with a global period of MMM are maternity procedures.
CPT Code Reimbursement
20005 $252.00
20100 $528.00
20101 $238.00
20102 $286.00
20103 $376.00
20150 $850.85
20200 $124.00
20205 $238.00
20206 $109.00
20220 $168.00
20225 $112.94
20240 $200.00
20245 $428.00
20250 $349.47
20251 $393.07
20500 $67.00
20501 $23.44
20520 $135.00
20525 $301.00
20526 $66.00
20527 $75.10
20550 $55.36
20551 $54.25
20552 $50.96
20553 $29.00
20555 $269.83
20600 $48.20
20605 $50.31
20610 $59.00
20612 $54.93
Confidential
These rates are provided for informational purposes only and are not to be considered a guarantee of payment. Actual payment will be based on Health Options policies, procedures, and Customer Benefit Plans.
Reimbursement by Procedure Codes 20000 – 29999 Effective Jan. 1, 2015
CPT Code Reimbursement
20615 $124.00
20650 $171.00
20660 $182.49
20661 $377.00
20662 $441.73
20663 $404.00
20664 $581.00
20665 $95.00
20670 $149.78
20680 $389.00
20690 $241.26
20692 $396.90
20693 $430.00
20694 $354.00
20696 $1,001.78
20697 $1,248.21
20802 $2,362.52
20805 $3,089.63
20808 $4,002.10
20816 $2,022.11
20822 $1,849.54
20824 $2,166.45
20827 $1,844.00
20838 $2,281.94
20900 $373.00
20902 $290.70
20910 $378.00
20912 $457.99
20920 $373.77
20922 $504.00
Confidential
These rates are provided for informational purposes only and are not to be considered a guarantee of payment. Actual payment will be based on Health Options policies, procedures, and Customer Benefit Plans.
Reimbursement by Procedure Codes 20000 – 29999 Effective Jan. 1, 2015
CPT Code Reimbursement
20924 $481.17
20926 $361.00
20930 $200.00
20931 $110.44
20936 $204.00
20937 $167.17
20938 $182.41
20950 $131.00
20955 $2,425.66
20956 $2,565.01
20957 $2,307.53
20962 $2,214.80
20969 $2,688.44
20970 $2,681.13
20972 $2,240.70
20973 $2,680.73
20974 $53.00
20975 $170.86
20979 $22.00
20982 $3,772.65
21010 $675.99
21011 $304.00
21012 $329.50
21013 $474.50
21014 $509.50
21015 $403.66
21016 $1,018.03
21025 $607.00
21026 $397.00
21029 $659.00
Confidential
These rates are provided for informational purposes only and are not to be considered a guarantee of payment. Actual payment will be based on Health Options policies, procedures, and Customer Benefit Plans
Reimbursement by Procedure Codes 20000 – 29999Effective Jan. 1, 2015
CPT Code Reimbursement
21030 $394.00
21031 $295.00
21032 $293.00
21034 $1,048.00
21040 $294.00
21044 $817.33
21045 $1,132.57
21046 $937.00
21047 $1,153.00
21048 $965.00
21049 $1,097.00
21050 $800.65
21060 $745.26
21070 $601.17
21073 $305.61
21076 $900.00
21077 $2,403.71
21079 $1,632.40
21080 $1,854.59
21081 $1,684.94
21082 $1,383.00
21083 $1,358.00
21084 $1,656.94
21085 $393.00
21086 $1,795.27
21087 $1,775.09
21088 $474.74
21100 $270.00
21110 $459.00
21116 $24.83
Confidential
These rates are provided for informational purposes only and are not to be considered a guarantee of payment. Actual payment will be based on Health Options policies, procedures, and Customer Benefit Plans.
Reimbursement by Procedure Codes 20000 – 29999Effective Jan. 1, 2015
CPT Code Reimbursement
21120 $457.00
21121 $603.00
21122 $627.00
21123 $818.00
21125 $780.00
21127 $829.00
21137 $679.31
21138 $859.11
21139 $955.93
21141 $1,251.79
21142 $1,243.31
21143 $1,270.64
21145 $1,415.00
21146 $1,479.00
21147 $1,516.00
21150 $1,586.39
21151 $1,848.99
21154 $2,034.89
21155 $2,248.96
21159 $2,543.33
21160 $2,679.94
21172 $1,619.39
21175 $1,957.34
21179 $1,388.01
21180 $1,563.66
21181 $595.00
21182 $1,905.99
21183 $2,130.34
21184 $2,245.05
21188 $1,540.41
Confidential
These rates are provided for informational purposes only and are not to be considered a guarantee of payment.Actual payment will be based on Health Options policies, procedures, and Customer Benefit Plans.
Reimbursement by Procedure Codes 20000 – 29999 Effective Jan. 1, 2015
CPT Code Reimbursement
21193 $1,180.32
21194 $1,319.83
21195 $1,240.00
21196 $1,362.35
21198 $1,058.35
21199 $950.84
21206 $1,019.00
21208 $884.00
21209 $571.00
21210 $861.00
21215 $941.22
21230 $724.83
21235 $653.00
21240 $1,061.22
21242 $973.65
21243 $1,543.00
21244 $959.84
21245 $1,000.00
21246 $813.33
21247 $1,543.98
21248 $1,135.13
21249 $1,450.00
21255 $1,263.00
21256 $1,089.96
21260 $1,105.11
21261 $2,123.76
21263 $1,835.15
21267 $1,489.00
21268 $1,739.00
21270 $833.21
Confidential
These rates are provided for informational purposes only and are not to be considered a guarantee of payment. Actual payment will be based on Health Options policies, procedures, and Customer Benefit Plans.
Reimbursement by Procedure Codes 20000 – 29999 Effective Jan. 1, 2015
CPT Code Reimbursement
21275 $754.82
21280 $481.35
21282 $322.17
21295 $164.32
21296 $367.98
21310 $66.00
21315 $181.00
21320 $222.72
21325 $333.00
21330 $488.00
21335 $686.65
21336 $438.00
21337 $300.00
21338 $483.00
21339 $637.00
21340 $742.14
21343 $922.00
21344 $1,296.00
21345 $705.00
21346 $844.00
21347 $1,008.00
21348 $1,064.51
21355 $316.00
21356 $337.00
21360 $490.80
21365 $1,028.43
21366 $1,148.43
21385 $666.31
21386 $620.31
21387 $711.57
20000 series procedure codes that are “Nevers” for Assistant Surgeon
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