| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
30,652 |
27,670 |
$17.05M |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
36,646 |
34,061 |
$7.04M |
| G0463 |
Hospital outpatient clinic visit for assessment and management of a patient |
90,100 |
79,059 |
$4.84M |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
33,571 |
31,567 |
$4.26M |
| G0378 |
Hospital observation service, per hour |
23,680 |
18,862 |
$4.09M |
| 96374 |
Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance |
21,947 |
19,895 |
$1.15M |
| 99282 |
Emergency department visit for the evaluation and management, low to moderate severity |
9,590 |
9,239 |
$826K |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
8,602 |
8,332 |
$772K |
| 43239 |
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple |
1,902 |
1,837 |
$660K |
| 96361 |
Intravenous infusion, hydration; each additional hour |
17,288 |
13,683 |
$488K |
| 70450 |
Computed tomography, head or brain; without contrast material |
9,202 |
8,785 |
$484K |
| 71046 |
Radiologic examination, chest; 2 views |
16,706 |
15,949 |
$480K |
| 82947 |
|
17,288 |
10,874 |
$476K |
| 45385 |
Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) |
840 |
822 |
$453K |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
21,824 |
5,506 |
$449K |
| 93306 |
Echocardiography, transthoracic, real-time with image documentation, with and without Doppler, complete |
2,594 |
2,553 |
$379K |
| 59025 |
Fetal non-stress test |
4,109 |
2,772 |
$365K |
| 64483 |
|
644 |
619 |
$360K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
5,843 |
5,821 |
$358K |
| 96365 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour |
6,419 |
5,899 |
$351K |
| 45380 |
Colonoscopy, flexible; with biopsy, single or multiple |
700 |
667 |
$336K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
5,443 |
5,391 |
$334K |
| 78452 |
Myocardial perfusion imaging, tomographic (SPECT); multiple studies at rest and/or stress |
1,118 |
1,088 |
$321K |
| 70553 |
Magnetic resonance imaging, brain; without contrast material, followed by contrast material and further sequences |
1,562 |
1,541 |
$286K |
| 80061 |
Lipid panel |
22,652 |
22,345 |
$276K |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
4,216 |
4,181 |
$268K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
4,060 |
4,056 |
$257K |
| 96375 |
Therapeutic injection; each additional sequential IV push |
17,462 |
13,963 |
$245K |
| 76856 |
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete |
5,296 |
5,186 |
$237K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
4,844 |
4,831 |
$236K |
| 87637 |
Infectious agent detection by nucleic acid; SARS-CoV-2, influenza, and RSV |
4,761 |
4,671 |
$223K |
| 71045 |
Radiologic examination, chest; single view |
9,625 |
9,165 |
$221K |
| 74176 |
Computed tomography, abdomen and pelvis; without contrast material |
3,020 |
2,922 |
$209K |
| 96360 |
Intravenous infusion, hydration; initial, 31 minutes to 1 hour |
3,672 |
3,536 |
$209K |
| 99396 |
Periodic comprehensive preventive medicine reevaluation, established patient, 40-64 years |
3,284 |
3,257 |
$201K |
| 84443 |
Thyroid stimulating hormone (TSH) |
32,793 |
31,925 |
$178K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
2,781 |
2,775 |
$178K |
| 20610 |
|
1,132 |
1,020 |
$177K |
| 97140 |
Manual therapy techniques, each 15 minutes (e.g., mobilization/manipulation, manual lymphatic drainage) |
13,325 |
3,679 |
$170K |
| 82306 |
Vitamin D; 25 hydroxy, includes fraction(s), if performed |
16,423 |
16,233 |
$166K |
| 87491 |
Infectious agent detection by nucleic acid; Chlamydia trachomatis, amplified probe |
12,987 |
12,710 |
$161K |
| 76830 |
Ultrasound, transvaginal |
3,272 |
3,209 |
$155K |
| 95810 |
Polysomnography; sleep staging with 4 or more additional parameters |
313 |
310 |
$154K |
| 87591 |
Infectious agent detection by nucleic acid; Neisseria gonorrhoeae, amplified probe |
12,501 |
12,241 |
$153K |
| 80053 |
Comprehensive metabolic panel |
59,934 |
54,461 |
$151K |
| 72148 |
Magnetic resonance imaging, lumbar spine; without contrast material |
1,407 |
1,396 |
$142K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
109,790 |
91,114 |
$140K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
4,958 |
4,822 |
$136K |
| 97162 |
|
2,459 |
2,387 |
$131K |
| 71275 |
Computed tomographic angiography, chest, with contrast material |
3,010 |
2,909 |
$129K |
| 43235 |
|
356 |
344 |
$126K |
| 76801 |
|
2,961 |
2,711 |
$126K |
| 76700 |
Ultrasound, abdominal, real time with image documentation; complete |
1,846 |
1,832 |
$124K |
| 78815 |
Positron emission tomography (PET) for limited area imaging |
152 |
152 |
$118K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
2,731 |
2,650 |
$116K |
| 76805 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation |
1,901 |
1,888 |
$114K |
| 97112 |
Therapeutic procedure, each 15 minutes; neuromuscular reeducation of movement, balance, coordination |
5,762 |
1,800 |
$107K |
| 96366 |
Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour |
4,480 |
3,243 |
$104K |
| 87635 |
Infectious agent detection by nucleic acid; SARS-CoV-2 (COVID-19), amplified probe |
8,535 |
7,893 |
$102K |
| 76815 |
Ultrasound, pregnant uterus, real time with image documentation, limited |
2,426 |
2,341 |
$101K |
| 70496 |
|
1,541 |
1,509 |
$99K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
5,382 |
1,820 |
$97K |
| 93970 |
|
1,153 |
1,137 |
$95K |
| 71260 |
Computed tomography, thorax, diagnostic; with contrast material |
1,168 |
1,145 |
$91K |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
21,600 |
16,846 |
$77K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
7,751 |
7,653 |
$76K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
5,492 |
5,422 |
$74K |
| 99385 |
|
1,142 |
1,140 |
$74K |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
16,242 |
15,051 |
$70K |
| 58661 |
|
26 |
26 |
$70K |
| 72141 |
|
557 |
553 |
$68K |
| 76536 |
|
1,257 |
1,236 |
$64K |
| C8929 |
Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography |
433 |
424 |
$63K |
| 86900 |
|
7,773 |
7,400 |
$63K |
| 80048 |
Basic metabolic panel (calcium, ionized) |
47,802 |
37,920 |
$60K |
| U0003 |
Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, making use of high throughput technologies as described by cms-2020-01-r |
1,650 |
1,621 |
$60K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
19,392 |
17,789 |
$59K |
| 93971 |
|
1,358 |
1,326 |
$56K |
| 83036 |
Hemoglobin; glycosylated (A1C) |
17,393 |
17,157 |
$55K |
| 88175 |
Cytopathology, cervical or vaginal, any reporting system; collected in preservative fluid, automated thin layer |
4,272 |
4,256 |
$54K |
| 87624 |
Infectious agent detection by nucleic acid; human papillomavirus (HPV), high-risk types |
4,011 |
3,973 |
$53K |
| 87070 |
|
14,816 |
14,168 |
$51K |
| 84439 |
|
15,949 |
15,552 |
$51K |
| 99381 |
|
808 |
808 |
$50K |
| 93005 |
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report |
34,045 |
29,481 |
$49K |
| 87390 |
|
6,091 |
6,021 |
$47K |
| G0145 |
Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under physician supervision |
3,855 |
3,797 |
$44K |
| 99291 |
Critical care, evaluation and management of the critically ill patient, first 30-74 minutes |
92 |
90 |
$44K |
| 77063 |
Screening digital breast tomosynthesis, bilateral |
3,417 |
3,410 |
$43K |
| 90686 |
|
3,847 |
3,827 |
$43K |
| 70486 |
|
1,809 |
1,764 |
$42K |
| G0008 |
Administration of influenza virus vaccine |
4,192 |
4,170 |
$41K |
| 76816 |
Ultrasound, pregnant uterus, real time with image documentation, follow-up |
707 |
682 |
$39K |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
614 |
590 |
$38K |
| 71250 |
|
721 |
711 |
$38K |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
6,197 |
5,928 |
$36K |
| 87808 |
|
7,595 |
7,450 |
$36K |
| 73130 |
|
4,575 |
3,983 |
$35K |
| 82607 |
|
7,046 |
6,920 |
$35K |
| 73610 |
|
3,375 |
3,118 |
$34K |
| 73630 |
|
3,996 |
3,666 |
$34K |
| 84702 |
|
9,874 |
8,362 |
$33K |
| 82728 |
|
7,120 |
6,946 |
$33K |
| 94060 |
|
234 |
232 |
$31K |
| 84703 |
|
22,531 |
20,771 |
$30K |
| 73030 |
|
3,128 |
2,869 |
$29K |
| 86702 |
|
6,244 |
6,170 |
$29K |
| 70498 |
|
1,624 |
1,592 |
$27K |
| 73562 |
|
2,735 |
2,488 |
$27K |
| 76642 |
|
660 |
631 |
$26K |
| 73721 |
Magnetic resonance imaging, any joint of lower extremity; without contrast material |
192 |
181 |
$26K |
| 86780 |
|
3,519 |
3,459 |
$26K |
| 20553 |
|
267 |
221 |
$25K |
| 45378 |
Colonoscopy, flexible; diagnostic, including collection of specimen(s) |
74 |
71 |
$25K |
| 82670 |
|
2,170 |
2,150 |
$24K |
| 36415 |
Collection of venous blood by venipuncture |
44,159 |
39,672 |
$24K |
| 10060 |
|
313 |
301 |
$24K |
| 84403 |
|
2,410 |
2,369 |
$23K |
| 73110 |
|
2,490 |
2,241 |
$23K |
| 86701 |
|
6,235 |
6,163 |
$23K |
| 86803 |
|
4,830 |
4,779 |
$23K |
| 72100 |
|
1,630 |
1,611 |
$22K |
| 93017 |
|
1,850 |
1,793 |
$22K |
| 70551 |
Magnetic resonance imaging, brain; without contrast material |
191 |
190 |
$22K |
| 73502 |
|
1,689 |
1,597 |
$21K |
| 87502 |
Infectious agent detection by nucleic acid, influenza virus, for multiple types or subtypes, includes all targets |
5,558 |
5,414 |
$21K |
| 83001 |
|
2,581 |
2,556 |
$20K |
| 97035 |
|
3,465 |
1,085 |
$20K |
| 71271 |
|
307 |
307 |
$18K |
| G0009 |
Administration of pneumococcal vaccine |
2,286 |
2,284 |
$18K |
| 84144 |
|
2,212 |
2,098 |
$18K |
| 83550 |
|
5,894 |
5,750 |
$18K |
| 99383 |
|
259 |
258 |
$17K |
| 83002 |
|
2,216 |
2,192 |
$17K |
| 87636 |
Infectious agent detection by nucleic acid; SARS-CoV-2 and influenza virus types A and B |
252 |
249 |
$17K |
| 90671 |
|
67 |
67 |
$17K |
| 83540 |
|
7,598 |
7,372 |
$17K |
| 72125 |
Computed tomography, cervical spine; without contrast material |
3,069 |
2,974 |
$17K |
| 76817 |
Ultrasound, pregnant uterus, real time with image documentation, transvaginal |
3,121 |
2,823 |
$17K |
| G0482 |
Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 15-21 drug class(es), including metabolite(s) if performed |
645 |
630 |
$16K |
| 80074 |
|
967 |
961 |
$16K |
| 73564 |
|
1,439 |
1,297 |
$16K |
| 76775 |
|
827 |
793 |
$16K |
| 87340 |
|
4,008 |
3,954 |
$16K |
| 70491 |
|
189 |
183 |
$15K |
| 72131 |
|
544 |
538 |
$15K |
| 82746 |
|
2,943 |
2,893 |
$15K |
| 87186 |
|
5,118 |
4,922 |
$15K |
| 77334 |
|
34 |
27 |
$14K |
| 72110 |
|
607 |
606 |
$14K |
| 84481 |
|
2,051 |
2,021 |
$14K |
| 84146 |
|
1,701 |
1,664 |
$13K |
| G0103 |
Prostate cancer screening; prostate specific antigen test (psa) |
1,816 |
1,808 |
$13K |
| 86376 |
|
2,259 |
2,249 |
$13K |
| 82105 |
|
1,752 |
1,734 |
$13K |
| 81001 |
|
28,504 |
26,333 |
$12K |
| 77336 |
|
186 |
95 |
$12K |
| 86762 |
|
2,424 |
2,387 |
$12K |
| 87077 |
|
5,127 |
4,930 |
$11K |
| 86038 |
|
2,722 |
2,691 |
$11K |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
10,708 |
10,239 |
$11K |
| G0480 |
Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed |
9,850 |
7,476 |
$11K |
| 86800 |
|
1,661 |
1,650 |
$11K |
| 85027 |
|
8,091 |
7,428 |
$11K |
| 62321 |
|
28 |
26 |
$10K |
| 74018 |
|
1,055 |
1,010 |
$10K |
| 82270 |
|
189 |
177 |
$10K |
| 84480 |
|
1,675 |
1,653 |
$9K |
| 83516 |
|
795 |
749 |
$9K |
| 87661 |
Infectious agent detection by nucleic acid; Trichomonas vaginalis, amplified probe |
873 |
863 |
$9K |
| 86235 |
|
398 |
393 |
$9K |
| 81025 |
|
3,744 |
3,639 |
$9K |
| 87081 |
|
3,849 |
3,737 |
$8K |
| 87634 |
|
1,266 |
1,248 |
$8K |
| 73590 |
|
1,717 |
1,572 |
$8K |
| 88342 |
|
648 |
631 |
$8K |
| 76770 |
|
149 |
148 |
$8K |
| 82247 |
|
4,848 |
4,310 |
$8K |
| 83735 |
|
12,517 |
10,933 |
$8K |
| 90670 |
|
2,514 |
2,505 |
$8K |
| 87880 |
Infectious agent antigen detection by immunoassay; Streptococcus, group A |
1,672 |
1,609 |
$7K |
| 86140 |
|
5,589 |
5,189 |
$7K |
| G0481 |
Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (any type, single or tandem and excluding immunoassays (e.g., ia, eia, elisa, emit, fpia) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 8-14 drug class(es), including metabolite(s) if performed |
329 |
323 |
$7K |
| 73080 |
|
1,137 |
1,069 |
$7K |
| 83655 |
|
1,727 |
1,712 |
$7K |
| 86787 |
|
1,499 |
1,474 |
$7K |
| 82785 |
|
883 |
864 |
$7K |
| 86003 |
|
241 |
198 |
$7K |
| 74178 |
|
38 |
38 |
$7K |
| 73090 |
|
1,291 |
1,173 |
$6K |
| 81003 |
|
10,125 |
9,923 |
$6K |
| 69210 |
|
809 |
791 |
$6K |
| 83880 |
|
4,285 |
4,037 |
$6K |
| 86696 |
|
672 |
629 |
$6K |
| 87653 |
|
463 |
449 |
$6K |
| G0121 |
Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk |
13 |
13 |
$6K |
| 84402 |
|
716 |
707 |
$6K |
| 87147 |
|
2,862 |
2,757 |
$6K |
| 90620 |
|
259 |
258 |
$6K |
| 82043 |
|
3,032 |
2,991 |
$6K |
| 82570 |
|
2,963 |
2,803 |
$6K |
| 94640 |
Pressurized or nonpressurized inhalation treatment for acute airway obstruction |
7,842 |
5,505 |
$6K |
| 96367 |
|
635 |
573 |
$6K |
| 88307 |
|
275 |
268 |
$5K |
| 83970 |
|
353 |
337 |
$5K |
| 80055 |
|
295 |
295 |
$5K |
| 84450 |
|
8,733 |
8,129 |
$5K |
| 95811 |
|
12 |
12 |
$5K |
| 99382 |
|
77 |
77 |
$5K |
| 99386 |
|
87 |
86 |
$5K |
| 97116 |
|
813 |
441 |
$5K |
| 82950 |
|
2,127 |
2,110 |
$5K |
| 86592 |
|
1,903 |
1,890 |
$5K |
| 77080 |
|
82 |
80 |
$5K |
| 97014 |
|
652 |
204 |
$5K |
| 83690 |
|
15,248 |
13,922 |
$5K |
| 85652 |
|
6,108 |
5,676 |
$4K |
| 87075 |
|
1,946 |
1,687 |
$4K |
| 82565 |
|
3,531 |
3,273 |
$4K |
| 95819 |
|
105 |
97 |
$4K |
| 84484 |
|
15,029 |
10,475 |
$4K |
| U0005 |
Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within 2 calendar days from date of specimen collection (list separately in addition to either hcpcs code u0003 or u0004) as described by cms-2020-01-r2 |
492 |
484 |
$4K |
| 86850 |
|
4,444 |
4,268 |
$4K |
| G0328 |
Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous |
693 |
688 |
$4K |
| M0245 |
Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring |
22 |
22 |
$4K |
| 74022 |
|
2,781 |
2,651 |
$4K |
| 99384 |
|
63 |
62 |
$4K |
| 85610 |
|
14,209 |
12,781 |
$4K |
| 87660 |
|
358 |
354 |
$4K |
| 87480 |
|
358 |
354 |
$4K |
| 84460 |
|
8,572 |
8,001 |
$4K |
| 80076 |
|
2,129 |
1,933 |
$4K |
| 86695 |
|
594 |
561 |
$4K |
| 90474 |
|
981 |
979 |
$4K |
| 88304 |
|
1,136 |
1,089 |
$4K |
| 72170 |
|
1,219 |
1,183 |
$4K |
| 93975 |
|
38 |
36 |
$4K |
| 31500 |
|
87 |
76 |
$3K |
| 84153 |
|
521 |
504 |
$3K |
| Q9969 |
Tc-99m from non-highly enriched uranium source, full cost recovery add-on, per study dose |
413 |
410 |
$3K |
| 86901 |
|
7,764 |
7,391 |
$3K |
| 84075 |
|
2,898 |
2,706 |
$3K |
| 95713 |
|
12 |
12 |
$3K |
| 77470 |
|
12 |
12 |
$3K |
| 84550 |
|
1,832 |
1,683 |
$3K |
| J3490 |
Unclassified drugs |
19,089 |
9,943 |
$3K |
| 87510 |
|
283 |
279 |
$3K |
| 82550 |
|
4,412 |
3,975 |
$3K |
| 97166 |
|
100 |
96 |
$3K |
| 85730 |
|
10,501 |
9,593 |
$3K |
| 82150 |
|
2,921 |
2,812 |
$3K |
| 90688 |
|
163 |
163 |
$3K |
| 83721 |
|
759 |
749 |
$3K |
| 84520 |
|
2,888 |
2,654 |
$3K |
| 86431 |
|
1,497 |
1,484 |
$3K |
| 83525 |
|
471 |
470 |
$3K |
| 93351 |
|
12 |
12 |
$3K |
| 82248 |
|
8,716 |
7,930 |
$3K |
| 11042 |
Debridement, subcutaneous tissue (includes epidermis, dermis, and subcutaneous tissue); first 20 sq cm |
19 |
13 |
$2K |
| 86200 |
|
544 |
538 |
$2K |
| 86769 |
|
147 |
143 |
$2K |
| 90656 |
|
107 |
107 |
$2K |
| 86706 |
|
633 |
622 |
$2K |
| 72040 |
|
196 |
196 |
$2K |
| 12001 |
|
501 |
489 |
$2K |
| 87205 |
|
2,293 |
2,017 |
$2K |
| 84100 |
|
2,731 |
2,321 |
$2K |
| 10061 |
|
15 |
12 |
$2K |
| 86160 |
|
176 |
173 |
$2K |
| 86300 |
|
153 |
127 |
$2K |
| 95700 |
|
25 |
25 |
$2K |
| 74183 |
|
12 |
12 |
$2K |
| Q9950 |
Injection, sulfur hexafluoride lipid microspheres, per ml |
474 |
453 |
$2K |
| 87804 |
Infectious agent antigen detection by immunoassay; Influenza, each type |
375 |
259 |
$2K |
| 83615 |
|
1,301 |
1,193 |
$2K |
| 80051 |
|
2,571 |
2,315 |
$2K |
| G2066 |
Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular physiologic monitor system, implantable loop recorder system, or subcutaneous cardiac rhythm monitor system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results |
83 |
83 |
$2K |
| 76811 |
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, detailed |
13 |
13 |
$2K |
| M0247 |
Intravenous infusion, sotrovimab, includes infusion and post administration monitoring |
12 |
12 |
$2K |
| Q9957 |
Injection, perflutren lipid microspheres, per ml |
49 |
49 |
$2K |
| 94760 |
|
1,795 |
1,130 |
$2K |
| 73552 |
|
241 |
226 |
$2K |
| A9270 |
Non-covered item or service |
80,126 |
20,708 |
$2K |
| Q3014 |
Telehealth originating site facility fee |
300 |
281 |
$2K |
| 84165 |
|
407 |
402 |
$2K |
| G0279 |
Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066) |
128 |
127 |
$1K |
| 90651 |
|
1,015 |
1,012 |
$1K |
| 74019 |
|
615 |
590 |
$1K |
| 86225 |
|
239 |
237 |
$1K |
| 80164 |
|
1,052 |
914 |
$1K |
| G0297 |
Low dose ct scan (ldct) for lung cancer screening |
40 |
40 |
$1K |
| 86308 |
|
510 |
499 |
$1K |
| 90734 |
|
626 |
625 |
$1K |
| 86480 |
|
38 |
38 |
$1K |
| 82533 |
|
181 |
162 |
$1K |
| 76870 |
|
108 |
104 |
$1K |
| 87801 |
Infectious agent detection by nucleic acid; amplified probe, multiple organisms |
135 |
133 |
$1K |
| 73560 |
|
83 |
72 |
$1K |
| 82784 |
|
121 |
115 |
$1K |
| 12002 |
|
160 |
156 |
$1K |
| 84445 |
|
42 |
41 |
$1K |
| 99406 |
|
64 |
63 |
$994.79 |
| 96376 |
|
11,956 |
6,701 |
$961.45 |
| 83605 |
|
5,610 |
4,784 |
$919.49 |
| 82977 |
|
337 |
332 |
$879.45 |
| 84156 |
|
669 |
599 |
$867.79 |
| 90716 |
|
538 |
537 |
$861.76 |
| A9585 |
Injection, gadobutrol, 0.1 ml |
2,400 |
2,337 |
$810.00 |
| 95861 |
|
12 |
12 |
$796.94 |
| 82140 |
|
807 |
699 |
$781.48 |
| 87046 |
|
174 |
168 |
$706.14 |
| 97161 |
|
14 |
14 |
$695.57 |
| 73700 |
|
12 |
12 |
$605.76 |
| 84436 |
|
183 |
182 |
$603.00 |
| J2272 |
Injection, morphine sulfate (fresenius kabi), not therapeutically equivalent to j2270, up to 10 mg |
1,671 |
1,122 |
$594.01 |
| G0123 |
Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision |
50 |
50 |
$585.36 |
| 82077 |
|
8,714 |
7,576 |
$554.31 |
| 82627 |
|
67 |
67 |
$513.93 |
| 73070 |
|
27 |
24 |
$505.73 |
| 85379 |
|
4,807 |
4,633 |
$504.59 |
| 82040 |
|
355 |
346 |
$496.89 |
| 90791 |
Psychiatric diagnostic evaluation |
23 |
23 |
$478.65 |
| 86141 |
|
110 |
104 |
$474.53 |
| 87045 |
|
173 |
168 |
$465.10 |
| 80143 |
|
7,061 |
6,487 |
$464.97 |
| 96380 |
|
34 |
34 |
$462.64 |
| 86364 |
|
45 |
45 |
$441.24 |
| 87807 |
|
116 |
108 |
$430.22 |
| 85046 |
|
313 |
279 |
$418.56 |
| 80179 |
|
6,906 |
6,364 |
$414.15 |
| 12011 |
|
168 |
166 |
$405.00 |
| 97022 |
|
60 |
14 |
$399.82 |
| 93010 |
Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only |
100 |
82 |
$394.29 |
| 88112 |
|
50 |
50 |
$392.18 |
| 73060 |
|
138 |
130 |
$355.80 |
| 71101 |
|
28 |
27 |
$347.64 |
| 72128 |
|
27 |
27 |
$332.31 |
| 81015 |
|
974 |
915 |
$326.83 |
| 83520 |
|
54 |
53 |
$323.86 |
| 86665 |
|
25 |
25 |
$316.86 |
| 82652 |
|
42 |
42 |
$297.85 |
| 72050 |
|
12 |
12 |
$286.28 |
| C9803 |
Hospital outpatient clinic visit specimen collection for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), any specimen source |
20 |
20 |
$281.34 |
| 87427 |
|
118 |
114 |
$270.84 |
| 82962 |
|
327 |
290 |
$247.84 |
| J2359 |
Injection, olanzapine, 0.5 mg |
408 |
239 |
$234.47 |
| 87651 |
Infectious agent detection by nucleic acid; Streptococcus, group A, amplified probe |
710 |
701 |
$231.53 |
| 58300 |
|
12 |
12 |
$216.73 |
| 84466 |
|
59 |
59 |
$216.55 |
| 90710 |
|
334 |
333 |
$208.10 |
| 85613 |
|
42 |
36 |
$194.31 |
| 86765 |
|
41 |
39 |
$188.35 |
| 72070 |
|
13 |
13 |
$180.11 |
| 72072 |
|
18 |
17 |
$177.69 |
| 70480 |
|
12 |
12 |
$173.97 |
| 29125 |
|
315 |
304 |
$167.37 |
| 87798 |
Infectious agent detection by nucleic acid; not otherwise specified, amplified probe, each organism |
12 |
12 |
$161.77 |
| J2785 |
Injection, regadenoson, 0.1 mg |
260 |
259 |
$161.51 |
| 86735 |
|
27 |
25 |
$153.70 |
| G0238 |
Therapeutic procedures to improve respiratory function, other than described by g0237, one on one, face to face, per 15 minutes (includes monitoring) |
31 |
24 |
$148.50 |
| 96127 |
|
18 |
18 |
$147.98 |
| 73600 |
|
40 |
37 |
$144.02 |
| 87040 |
|
2,677 |
1,914 |
$133.83 |
| 99024 |
|
33 |
31 |
$129.00 |
| 76000 |
|
17 |
17 |
$124.16 |
| 97535 |
Self-care/home management training, each 15 minutes |
55 |
50 |
$119.03 |
| 86694 |
|
15 |
15 |
$118.22 |
| 86704 |
|
52 |
52 |
$106.04 |
| 73000 |
|
16 |
13 |
$89.44 |
| 85384 |
|
70 |
62 |
$86.97 |
| J2358 |
Injection, olanzapine, long-acting, 1 mg |
151 |
112 |
$84.82 |
| 80178 |
|
132 |
124 |
$77.65 |
| 85651 |
|
110 |
108 |
$54.02 |
| 87493 |
|
13 |
12 |
$51.36 |
| 86705 |
|
12 |
12 |
$47.88 |
| 98928 |
|
29 |
26 |
$40.56 |
| 87209 |
|
26 |
26 |
$36.42 |
| 90715 |
|
2,974 |
2,949 |
$34.81 |
| 82378 |
|
12 |
12 |
$31.77 |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
2,119 |
1,933 |
$31.50 |
| J7120 |
Ringers lactate infusion, up to 1000 cc |
10,295 |
9,312 |
$30.00 |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
15 |
15 |
$25.36 |
| 89055 |
|
27 |
25 |
$21.19 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
15,523 |
12,813 |
$18.20 |
| 87177 |
|
26 |
26 |
$18.03 |
| 87185 |
|
14 |
14 |
$15.75 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
5,489 |
5,185 |
$13.57 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
15,101 |
13,366 |
$12.00 |
| 82310 |
|
25 |
25 |
$11.70 |
| 81002 |
|
119 |
113 |
$10.63 |
| J2930 |
Injection, methylprednisolone sodium succinate, up to 125 mg |
1,437 |
1,296 |
$10.20 |
| J0665 |
Injection, bupivicaine, not otherwise specified, 0.5 mg |
176 |
151 |
$9.31 |
| 87449 |
|
283 |
274 |
$7.89 |
| J7030 |
Infusion, normal saline solution , 1000 cc |
18,360 |
14,876 |
$7.15 |
| Q0163 |
Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen |
144 |
118 |
$7.00 |
| J2060 |
Injection, lorazepam, 2 mg |
4,580 |
3,056 |
$5.42 |
| 82010 |
|
28 |
26 |
$4.78 |
| 85018 |
|
109 |
67 |
$4.34 |
| J0689 |
Injection, cefazolin sodium (baxter), not therapeutically equivalent to j0690, 500 mg |
33 |
33 |
$2.78 |
| J1815 |
Injection, insulin, per 5 units |
637 |
300 |
$0.83 |
| J2270 |
Injection, morphine sulfate, up to 10 mg |
8,192 |
5,670 |
$0.82 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
6,748 |
6,345 |
$0.23 |
| 90461 |
|
2,728 |
2,714 |
$0.18 |
| J1644 |
Injection, heparin sodium, per 1000 units |
1,416 |
707 |
$0.00 |
| 90633 |
|
1,140 |
1,137 |
$0.00 |
| J2710 |
Injection, neostigmine methylsulfate, up to 0.5 mg |
1,163 |
1,148 |
$0.00 |
| C1894 |
Introducer/sheath, other than guiding, other than intracardiac electrophysiological, non-laser |
162 |
157 |
$0.00 |
| J3370 |
Injection, vancomycin hcl, 500 mg |
325 |
216 |
$0.00 |
| 99152 |
|
1,417 |
1,321 |
$0.00 |
| 90707 |
|
577 |
576 |
$0.00 |
| 90681 |
|
991 |
989 |
$0.00 |
| 90700 |
|
420 |
420 |
$0.00 |
| C9113 |
Injection, pantoprazole sodium, per vial |
3,042 |
1,761 |
$0.00 |
| C1713 |
Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) |
263 |
251 |
$0.00 |
| 85014 |
|
27 |
14 |
$0.00 |
| J0295 |
Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm |
348 |
194 |
$0.00 |
| J1200 |
Injection, diphenhydramine hcl, up to 50 mg |
3,652 |
3,180 |
$0.00 |
| J1953 |
Injection, levetiracetam, 10 mg |
71 |
62 |
$0.00 |
| J1650 |
Injection, enoxaparin sodium, 10 mg |
734 |
381 |
$0.00 |
| J3301 |
Injection, triamcinolone acetonide, not otherwise specified, 10 mg |
690 |
673 |
$0.00 |
| J7040 |
Infusion, normal saline solution, sterile (500 ml = 1 unit) |
2,170 |
1,953 |
$0.00 |
| A9552 |
Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries |
126 |
126 |
$0.00 |
| J0702 |
Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg |
30 |
18 |
$0.00 |
| J3475 |
Injection, magnesium sulfate, per 500 mg |
949 |
883 |
$0.00 |
| 98927 |
|
29 |
24 |
$0.00 |
| J2310 |
Injection, naloxone hydrochloride, per 1 mg |
12 |
12 |
$0.00 |
| J2919 |
Injection, methylprednisolone sodium succinate, 5 mg |
276 |
189 |
$0.00 |
| 90685 |
|
16 |
16 |
$0.00 |
| 84145 |
|
31 |
30 |
$0.00 |
| J1171 |
Injection, hydromorphone, 0.1 mg |
61 |
57 |
$0.00 |
| 93356 |
|
13 |
13 |
$0.00 |
| A9502 |
Technetium tc-99m tetrofosmin, diagnostic, per study dose |
12 |
12 |
$0.00 |
| J7510 |
Prednisolone oral, per 5 mg |
13 |
12 |
$0.00 |
| J1596 |
Injection, glycopyrrolate, 0.1 mg |
53 |
53 |
$0.00 |
| Q0144 |
Azithromycin dihydrate, oral, capsules/powder, 1 gram |
15 |
15 |
$0.00 |
| 90647 |
|
1,949 |
1,943 |
$0.00 |
| J1170 |
Injection, hydromorphone, up to 4 mg |
2,430 |
2,092 |
$0.00 |
| 90723 |
|
1,738 |
1,735 |
$0.00 |
| J0690 |
Injection, cefazolin sodium, 500 mg |
2,519 |
2,154 |
$0.00 |
| J2001 |
Injection, lidocaine hcl for intravenous infusion, 10 mg |
4,207 |
3,975 |
$0.00 |
| J0696 |
Injection, ceftriaxone sodium, per 250 mg |
3,695 |
3,003 |
$0.00 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
5,492 |
5,032 |
$0.00 |
| J2765 |
Injection, metoclopramide hcl, up to 10 mg |
2,787 |
2,458 |
$0.00 |
| J1040 |
Injection, methylprednisolone acetate, 80 mg |
1,092 |
1,059 |
$0.00 |
| J7050 |
Infusion, normal saline solution, 250 cc |
1,232 |
956 |
$0.00 |
| J1790 |
Injection, droperidol, up to 5 mg |
46 |
41 |
$0.00 |
| C1769 |
Guide wire |
433 |
421 |
$0.00 |
| G0283 |
Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care |
1,038 |
313 |
$0.00 |
| 96368 |
|
248 |
228 |
$0.00 |
| J3420 |
Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg |
896 |
748 |
$0.00 |
| J2371 |
Injection, phenylephrine hydrochloride, 20 micrograms |
261 |
257 |
$0.00 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
13 |
13 |
$0.00 |
| 97010 |
|
1,699 |
586 |
$0.00 |
| J2704 |
Injection, propofol, 10 mg |
5,469 |
5,340 |
$0.00 |
| J2370 |
Injection, phenylephrine hcl, up to 1 ml |
430 |
424 |
$0.00 |
| 99153 |
Mod sedat endo service >5yrs |
27 |
26 |
$0.00 |
| J2470 |
Injection, pantoprazole sodium, 40 mg |
255 |
175 |
$0.00 |
| J2795 |
Injection, ropivacaine hydrochloride, 1 mg |
24 |
24 |
$0.00 |
| 99459 |
|
200 |
195 |
$0.00 |
| 90696 |
|
292 |
291 |
$0.00 |
| A9500 |
Technetium tc-99m sestamibi, diagnostic, per study dose |
599 |
575 |
$0.00 |
| J2003 |
Injection, lidocaine hydrochloride, 1 mg |
17 |
17 |
$0.00 |
| J1010 |
Injection, methylprednisolone acetate, 1 mg |
61 |
59 |
$0.00 |
| J1741 |
Injection, ibuprofen, 100 mg |
14 |
13 |
$0.00 |
| J1630 |
Injection, haloperidol, up to 5 mg |
55 |
49 |
$0.00 |
| 90632 |
|
42 |
42 |
$0.00 |
| A9579 |
Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml |
16 |
14 |
$0.00 |
| C1889 |
Implantable/insertable device, not otherwise classified |
112 |
112 |
$0.00 |
| J0360 |
Injection, hydralazine hcl, up to 20 mg |
52 |
49 |
$0.00 |
| 36416 |
|
22 |
22 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
56 |
55 |
$0.00 |
| 95886 |
|
12 |
12 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
103 |
100 |
$0.00 |
| J3360 |
Injection, diazepam, up to 5 mg |
25 |
18 |
$0.00 |
| 64484 |
|
13 |
12 |
$0.00 |