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10021
Quick jump to procedure code: Printer Friendly Version
1002F

CPT® 10022: FINE NEEDLE ASPIRATION; WITH IMAGING GUIDANCE

Short Description: Fna w/image

--

CPT copyright 2015 American Medical Association. All rights reserved.


Medicare Reimbursement Information         Hide this section.

ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Marin/Napa/Solano
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Rest of North California
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-Rest of South California
COLORADO-Entire State
CONNECTICUT-Entire State
DELAWARE-Entire State
DIST of COL-DC + MD/VA Suburbs
FLORIDA-Ft Lauderdale
FLORIDA-Miami
FLORIDA-Rest of Florida
GEORGIA-Atlanta
GEORGIA-Rest of Georgia
HAWAII/GUAM-Entire State/Terr.
IDAHO-Entire State
ILLINOIS-East St. Louis
ILLINOIS-Suburban Chicago
ILLINOIS-Chicago
ILLINOIS-Rest of Illinois
INDIANA-Entire State
IOWA-Entire State
KANSAS-Entire State
KENTUCKY-Entire State
LOUISIANA-New Orleans
LOUISIANA-Rest of Louisiana
MAINE-Southern Maine
MAINE-Rest of Maine
MARYLAND-Baltimore and suburbs
MARYLAND-Rest of Maryland
MASSACHUSETTS-Boston
MASSACHUSETTS-Rest of Massachusetts
MICHIGAN-Detroit
MICHIGAN-Rest of Michigan
MINNESOTA-Entire State
MISSISSIPPI-Entire State
MISSOURI-Kansas City
MISSOURI-St. Louis
MISSOURI-Rest of Missouri
MONTANA-Entire State
NEBRASKA-Entire State
NEVADA-Entire State
NEW HAMPSHIRE-Entire State
NEW JERSEY-Northern NJ
NEW JERSEY-Rest of New Jersey
NEW MEXICO-Entire State
NEW YORK-Manhattan
NEW YORK-NYC Suburbs/LI
NEW YORK-Poughkpsie/No NYC Sub
NEW YORK-Rest of New York
NEW YORK-Queens
NORTH CAROLINA-Entire State
NORTH DAKOTA-Entire State
OHIO-Entire State
OKLAHOMA-Entire State
OREGON-Portland
OREGON-Rest of Oregon
PENNSYLVANIA-Philadelphia
PENNSYLVANIA-Rest of Pennsylvania
PUERTO RICO-Entire Territory
RHODE ISLAND-Entire State
SOUTH CAROLINA-Entire State
SOUTH DAKOTA-Entire State
TENNESSEE-Entire State
TEXAS-Brazoria
TEXAS-Dallas
TEXAS-Galveston
TEXAS-Houston
TEXAS-Beaumont
TEXAS-Fort Worth
TEXAS-Austin
TEXAS-Rest of Texas
UTAH-Entire State
VERMONT-Entire State
VIRGIN ISLANDS-Entire State
VIRGINIA-Entire State
WASHINGTON-Seattle (King County)
WASHINGTON-Rest of Washington
WEST VIRGINIA-Entire State
WISCONSIN-Entire State
WYOMING-Entire State

2016 Physician
Fee Schedule:

Global Non-Facility Fee
Global Facility Fee
$142.95
$ 67.36

2016 Wage Index Adjustment for Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payments
Zip Code:
2016 JulyUnadjusted OPPS Payment $480.64
2016 July Unadjusted ASC Payment $ 92.73


*Based on National 2013 Medicare Part B submitted claims.
Revenue Code(s):
490-Ambulatory surgical care-general classification


2016 APC Code: 5072
Level 2 Excision/ Biopsy/ Incision and Drainage

2016 OPPS Status Indicator: T

Effective April 1, 2013, and while sequestration is in effect, all CMS payments for services will be reduced by 2%. The fees above do not reflect this reduction. Click here for more information.

Commonly Associated Diagnosis Codes*            Hide this section.
PercentageICD-9ICD-10 Conversions
28.0% 241.0    Nontoxic uninodular goiter E04.1   Nontoxic single thyroid nodule
18.4% 241.1    Nontoxic multinodular goiter E04.2   Nontoxic multinodular goiter
3.3% 786.6    Swelling, mass, or lump in chest R22.2   Localized swelling, mass and lump, trunk
2.9% 785.6    Enlargement of lymph nodes R59.9   Enlarged lymph nodes, unspecified
2.7% 784.2    Swelling, mass, or lump in head and neck R22.0   Localized swelling, mass and lump, head
OR:
R22.1   Localized swelling, mass and lump, neck
2.7% 518.89    Other diseases of lung, not elsewhere classified J98.4   Other disorders of lung
2.5% 240.9    Goiter, unspecified E01.2   Iodine-deficiency related (endemic) goiter, unspecified
OR:
E04.9   Nontoxic goiter, unspecified
2.2% 241.9    Unspecified nontoxic nodular goiter E04.9   Nontoxic goiter, unspecified
2.1% 611.72    Lump or mass in breast N63   Unspecified lump in breast
1.3% 246.9    Unspecified disorder of thyroid E07.9   Disorder of thyroid, unspecified

* Commonly Associated ICD-10 codes derived from 2010 Physician Supplier Part B Medicare claims data and 2015 CMS General Equivalency Mapping Codes (GEM).
This data represents an analysis of 43 million claims processed for 1.7 million beneficiaries in 2010.

Medicare Coverage Policy Information         Hide this section.
No contractor selected.

10022 not found in an Local Coverage Determination (LCD) for your contractor. No other coverage policies found in database.

CCI and MUE Edits*         Hide this section.

CCI Edits for 10022
Denied Codes (1)
Effective
Modifier
Accepted (2)
0213T Njx paravert w/us cer/thor
07/01/2010 Yes
0216T Njx paravert w/us lumb/sac
07/01/2010 Yes
10021 Fna w/o image
01/01/2002 Yes
10035 Perq dev soft tiss 1st imag
01/01/2016 Yes
19281 Perq device breast 1st imag
01/01/2014 Yes
19283 Perq dev breast 1st strtctc
01/01/2014 Yes
19285 Perq dev breast 1st us imag
01/01/2014 Yes
19287 Perq dev breast 1st mr guide
01/01/2014 Yes
36000 Place needle in vein
10/01/2002 Yes
36410 Non-routine bl draw 3/> yrs
10/01/2002 Yes
36591 Draw blood off venous device
10/01/2015 No
36592 Collect blood from picc
10/01/2015 No
61650 Evasc prlng admn rx agnt 1st
01/01/2016 Yes
62318 Inject spine w/cath crv/thrc
10/01/2002 Yes
62319 Inject spine w/cath lmb/scrl
10/01/2002 Yes
64415 N block inj brachial plexus
10/01/2002 Yes
64416 N block cont infuse b plex
01/01/2003 Yes
64417 N block inj axillary
10/01/2002 Yes
64450 N block other peripheral
10/01/2002 Yes
64486 Tap block unil by injection
01/01/2015 Yes
64487 Tap block uni by infusion
01/01/2015 Yes
64488 Tap block bi injection
01/01/2015 Yes
64489 Tap block bi by infusion
01/01/2015 Yes
64490 Inj paravert f jnt c/t 1 lev
01/01/2010 Yes
64493 Inj paravert f jnt l/s 1 lev
01/01/2010 Yes
96360 Hydration iv infusion init
01/01/2009 Yes
96365 Ther/proph/diag iv inf init
01/01/2009 Yes
96372 Ther/proph/diag inj sc/im
01/01/2009 Yes
96374 Ther/proph/diag inj iv push
01/01/2009 Yes
96375 Tx/pro/dx inj new drug addon
01/01/2009 Yes
96376 Tx/pro/dx inj same drug adon
07/01/2009 Yes
J2001 Lidocaine injection
07/01/2004 Yes
11100 Biopsy skin lesion
04/01/2002 Yes
19081 Bx breast 1st lesion strtctc
01/01/2014 Yes
19082 Bx breast add lesion strtctc
01/01/2014 Yes
19083 Bx breast 1st lesion us imag
01/01/2014 Yes
19084 Bx breast add lesion us imag
01/01/2014 Yes
19085 Bx breast 1st lesion mr imag
01/01/2014 Yes
19086 Bx breast add lesion mr imag
01/01/2014 Yes
19100 Bx breast percut w/o image
04/01/2002 Yes
19101 Biopsy of breast open
04/01/2002 Yes
19110 Nipple exploration
01/01/2002 Yes
19112 Excise breast duct fistula
01/01/2002 Yes
19120 Removal of breast lesion
01/01/2002 Yes
19125 Excision breast lesion
01/01/2002 Yes
19300 Removal of breast tissue
01/01/2007 Yes
19301 Partial mastectomy
01/01/2007 Yes
19302 P-mastectomy w/ln removal
01/01/2007 Yes
19303 Mast simple complete
01/01/2007 Yes
19304 Mast subq
01/01/2007 Yes
19305 Mast radical
01/01/2007 Yes
19306 Mast rad urban type
01/01/2007 Yes
19307 Mast mod rad
01/01/2007 Yes
20200 Muscle biopsy
01/01/2002 Yes
20205 Deep muscle biopsy
01/01/2002 Yes
20206 Needle biopsy muscle
01/01/2002 Yes
21011 Exc face les sc <2 cm
07/01/2011 Yes
21012 Exc face les sbq 2 cm/>
07/01/2011 Yes
21013 Exc face tum deep < 2 cm
07/01/2011 Yes
21014 Exc face tum deep 2 cm/>
07/01/2011 Yes
21015 Resect face/scalp tum < 2 cm
07/01/2011 Yes
21016 Resect face/scalp tum 2 cm/>
07/01/2011 Yes
21550 Biopsy of neck/chest
04/01/2002 Yes
21552 Exc neck les sc 3 cm/>
01/01/2010 Yes
21554 Exc neck tum deep 5 cm/>
01/01/2010 Yes
21555 Exc neck les sc < 3 cm
04/01/2002 Yes
21556 Exc neck tum deep < 5 cm
04/01/2002 Yes
21557 Resect neck thorax tumor<5cm
07/01/2011 Yes
21558 Resect neck tumor 5 cm/>
07/01/2011 Yes
21930 Exc back les sc < 3 cm
07/01/2011 Yes
21931 Exc back les sc 3 cm/>
07/01/2011 Yes
21932 Exc back tum deep < 5 cm
07/01/2011 Yes
21933 Exc back tum deep 5 cm/>
07/01/2011 Yes
21935 Resect back tum < 5 cm
07/01/2011 Yes
21936 Resect back tum 5 cm/>
07/01/2011 Yes
22900 Exc abdl tum deep < 5 cm
07/01/2011 Yes
22901 Exc abdl tum deep 5 cm/>
07/01/2011 Yes
22902 Exc abd les sc < 3 cm
07/01/2011 Yes
22903 Exc abd les sc 3 cm/>
07/01/2011 Yes
22904 Radical resect abd tumor<5cm
07/01/2011 Yes
22905 Rad resect abd tumor 5 cm/>
07/01/2011 Yes
23065 Biopsy shoulder tissues
04/01/2002 Yes
23066 Biopsy shoulder tissues
04/01/2002 Yes
23071 Exc shoulder les sc 3 cm/>
07/01/2011 Yes
23073 Exc shoulder tum deep 5 cm/>
07/01/2011 Yes
23075 Exc shoulder les sc < 3 cm
07/01/2011 Yes
23076 Exc shoulder tum deep < 5 cm
07/01/2011 Yes
23077 Resect shoulder tumor < 5 cm
07/01/2011 Yes
23078 Resect shoulder tumor 5 cm/>
07/01/2011 Yes
23200 Resect clavicle tumor
07/01/2011 Yes
23210 Resect scapula tumor
07/01/2011 Yes
23220 Resect prox humerus tumor
07/01/2011 Yes
24065 Biopsy arm/elbow soft tissue
04/01/2002 Yes
24066 Biopsy arm/elbow soft tissue
04/01/2002 Yes
24071 Exc arm/elbow les sc 3 cm/>
07/01/2011 Yes
24073 Ex arm/elbow tum deep 5 cm/>
07/01/2011 Yes
24075 Exc arm/elbow les sc < 3 cm
07/01/2011 Yes
24076 Ex arm/elbow tum deep < 5 cm
07/01/2011 Yes
24077 Resect arm/elbow tum < 5 cm
07/01/2011 Yes
24079 Resect arm/elbow tum 5 cm/>
07/01/2011 Yes
24150 Resect distal humerus tumor
07/01/2011 Yes
24152 Resect radius tumor
07/01/2011 Yes
25065 Biopsy forearm soft tissues
04/01/2002 Yes
25066 Biopsy forearm soft tissues
04/01/2002 Yes
25071 Exc forearm les sc 3 cm/>
07/01/2011 Yes
25073 Exc forearm tum deep 3 cm/>
07/01/2011 Yes
25075 Exc forearm les sc < 3 cm
07/01/2011 Yes
25076 Exc forearm tum deep < 3 cm
07/01/2011 Yes
25077 Resect forearm/wrist tum<3cm
07/01/2011 Yes
25078 Resect forarm/wrist tum 3cm>
07/01/2011 Yes
25170 Resect radius/ulnar tumor
07/01/2011 Yes
26111 Exc hand les sc 1.5 cm/>
07/01/2011 Yes
26113 Exc hand tum deep 1.5 cm/>
07/01/2011 Yes
26115 Exc hand les sc < 1.5 cm
07/01/2011 Yes
26116 Exc hand tum deep < 1.5 cm
07/01/2011 Yes
26117 Rad resect hand tumor < 3 cm
07/01/2011 Yes
26118 Rad resect hand tumor 3 cm/>
07/01/2011 Yes
26250 Extensive hand surgery
07/01/2011 Yes
26260 Resect prox finger tumor
07/01/2011 Yes
26262 Resect distal finger tumor
07/01/2011 Yes
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
27040 Biopsy of soft tissues
04/01/2002 Yes
27041 Biopsy of soft tissues
04/01/2002 Yes
27043 Exc hip pelvis les sc 3 cm/>
07/01/2011 Yes
27045 Exc hip/pelv tum deep 5 cm/>
07/01/2011 Yes
27047 Exc hip/pelvis les sc < 3 cm
07/01/2011 Yes
27048 Exc hip/pelv tum deep < 5 cm
07/01/2011 Yes
27049 Resect hip/pelv tum < 5 cm
07/01/2011 Yes
27059 Resect hip/pelv tum 5 cm/>
07/01/2011 Yes
27075 Resect hip tumor
07/01/2011 Yes
27076 Resect hip tum incl acetabul
07/01/2011 Yes
27077 Resect hip tum w/innom bone
07/01/2011 Yes
27078 Rsect hip tum incl femur
07/01/2011 Yes
27323 Biopsy thigh soft tissues
04/01/2002 Yes
27324 Biopsy thigh soft tissues
04/01/2002 Yes
27327 Exc thigh/knee les sc < 3 cm
07/01/2011 Yes
27328 Exc thigh/knee tum deep <5cm
07/01/2011 Yes
27329 Resect thigh/knee tum < 5 cm
07/01/2011 Yes
27337 Exc thigh/knee les sc 3 cm/>
07/01/2011 Yes
27339 Exc thigh/knee tum dep 5cm/>
07/01/2011 Yes
27364 Resect thigh/knee tum 5 cm/>
07/01/2011 Yes
27365 Resect femur/knee tumor
07/01/2011 Yes
27613 Biopsy lower leg soft tissue
04/01/2002 Yes
27614 Biopsy lower leg soft tissue
04/01/2002 Yes
27615 Resect leg/ankle tum < 5 cm
07/01/2011 Yes
27616 Resect leg/ankle tum 5 cm/>
07/01/2011 Yes
27618 Exc leg/ankle tum < 3 cm
07/01/2011 Yes
27619 Exc leg/ankle tum deep <5 cm
07/01/2011 Yes
27632 Exc leg/ankle les sc 3 cm/>
07/01/2011 Yes
27634 Exc leg/ankle tum dep 5 cm/>
07/01/2011 Yes
27640 Partial removal of tibia
07/01/2011 Yes
27641 Partial removal of fibula
07/01/2011 Yes
27645 Resect tibia tumor
07/01/2011 Yes
27646 Resect fibula tumor
07/01/2011 Yes
27647 Resect talus/calcaneus tum
07/01/2011 Yes
28039 Exc foot/toe tum sc 1.5 cm/>
07/01/2011 Yes
28041 Exc foot/toe tum dep 1.5cm/>
07/01/2011 Yes
28043 Exc foot/toe tum sc < 1.5 cm
07/01/2011 Yes
28045 Exc foot/toe tum deep <1.5cm
07/01/2011 Yes
28046 Resect foot/toe tumor < 3 cm
07/01/2011 Yes
28047 Resect foot/toe tumor 3 cm/>
07/01/2011 Yes
28171 Resect tarsal tumor
07/01/2011 Yes
28173 Resect metatarsal tumor
07/01/2011 Yes
28175 Resect phalanx of toe tumor
07/01/2011 Yes
30100 Intranasal biopsy
04/01/2002 Yes
32096 Open wedge/bx lung infiltr
01/01/2012 Yes
32097 Open wedge/bx lung nodule
01/01/2012 Yes
32098 Open biopsy of lung pleura
01/01/2012 Yes
32400 Needle biopsy chest lining
01/01/2002 Yes
32405 Percut bx lung/mediastinum
01/01/2002 Yes
32607 Thoracoscopy w/bx infiltrate
01/01/2012 Yes
32608 Thoracoscopy w/bx nodule
01/01/2012 Yes
32609 Thoracoscopy w/bx pleura
01/01/2012 Yes
38500 Biopsy/removal lymph nodes
04/01/2002 Yes
38505 Needle biopsy lymph nodes
04/01/2002 Yes
38510 Biopsy/removal lymph nodes
04/01/2002 Yes
38520 Biopsy/removal lymph nodes
04/01/2002 Yes
38525 Biopsy/removal lymph nodes
04/01/2002 Yes
38530 Biopsy/removal lymph nodes
04/01/2002 Yes
39200 Resect mediastinal cyst
04/01/2002 Yes
40490 Biopsy of lip
04/01/2002 Yes
40808 Biopsy of mouth lesion
04/01/2002 Yes
41100 Biopsy of tongue
04/01/2002 Yes
41105 Biopsy of tongue
04/01/2002 Yes
41108 Biopsy of floor of mouth
04/01/2002 Yes
42100 Biopsy roof of mouth
04/01/2002 Yes
42400 Biopsy of salivary gland
01/01/2002 Yes
42405 Biopsy of salivary gland
04/01/2002 Yes
42800 Biopsy of throat
04/01/2002 Yes
42804 Biopsy of upper nose/throat
04/01/2002 Yes
42806 Biopsy of upper nose/throat
04/01/2002 Yes
43232 Esophagoscopy w/us needle bx
04/01/2002 Yes
43238 Egd us fine needle bx/aspir
01/01/2004 Yes
43240 Egd w/transmural drain cyst
04/01/2002 Yes
43242 Egd us fine needle bx/aspir
04/01/2002 Yes
43253 Egd us transmural injxn/mark
01/01/2014 Yes
43605 Biopsy of stomach
04/01/2002 Yes
44100 Biopsy of bowel
04/01/2002 Yes
44407 Colonoscopy w/ndl aspir/bx
01/01/2016 Yes
45100 Biopsy of rectum
04/01/2002 Yes
45342 Sigmoidoscopy w/us guide bx
04/01/2002 Yes
45392 Colonoscopy w/endoscopic fnb
01/01/2015 Yes
47000 Needle biopsy of liver
04/01/2002 Yes
47001 Needle biopsy liver add-on
04/01/2002 Yes
47100 Wedge biopsy of liver
04/01/2002 Yes
48100 Biopsy of pancreas open
04/01/2002 Yes
48102 Needle biopsy pancreas
04/01/2002 Yes
49000 Exploration of abdomen
04/01/2002 Yes
49010 Exploration behind abdomen
04/01/2002 Yes
49180 Biopsy abdominal mass
04/01/2002 Yes
50200 Renal biopsy perq
04/01/2002 Yes
50205 Renal biopsy open
04/01/2002 Yes
53200 Biopsy of urethra
04/01/2002 Yes
54100 Biopsy of penis
04/01/2002 Yes
54105 Biopsy of penis
04/01/2002 Yes
54500 Biopsy of testis
04/01/2002 Yes
54505 Biopsy of testis
04/01/2002 Yes
54800 Biopsy of epididymis
04/01/2002 Yes
55700 Biopsy of prostate
04/01/2002 Yes
55705 Biopsy of prostate
04/01/2002 Yes
55706 Prostate saturation sampling
04/01/2010 Yes
56605 Biopsy of vulva/perineum
04/01/2002 Yes
57100 Biopsy of vagina
04/01/2002 Yes
57105 Biopsy of vagina
04/01/2002 Yes
57500 Biopsy of cervix
04/01/2002 Yes
58100 Biopsy of uterus lining
04/01/2002 Yes
58900 Biopsy of ovary(s)
04/01/2002 Yes
60100 Biopsy of thyroid
01/01/2002 Yes
60300 Aspir/inj thyroid cyst
01/01/2008 Yes
62267 Interdiscal perq aspir dx
01/01/2009 Yes
62268 Drain spinal cord cyst
04/01/2002 Yes
62269 Needle biopsy spinal cord
04/01/2002 Yes
64795 Biopsy of nerve
04/01/2002 Yes
67346 Biopsy eye muscle
01/01/2007 Yes
67415 Aspiration orbital contents
04/01/2002 Yes
67810 Biopsy eyelid & lid margin
04/01/2002 Yes
68100 Biopsy of eyelid lining
04/01/2002 Yes
68510 Biopsy of tear gland
04/01/2002 Yes
68525 Biopsy of tear sac
04/01/2002 Yes
69100 Biopsy of external ear
04/01/2002 Yes
69105 Biopsy of external ear canal
04/01/2002 Yes
(1) These codes will be denied when submitted for payment on the same date of service as 10022.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.


Medically Unlikely Edits for 10022


Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: 4 4 Not Listed
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical Not Listed
Rationale: Clinical: Data Clinical: Data Not Listed

* The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse, or interpretation of information contained in this product.


   10022 Top 5 Ordering Providers National*
GERALD MINKOWITZ -BROOKLYN,NY 1,959
GREGORY POKRYWKA -KENSINGTON,MD 1,540
EMIL MIKHAIL -WILMINGTON,DE 1,008
ROBERT TESTA -LAKEWOOD,WA 734
KARMACHANDRA NAIR -HAVRE DE GRACE,MD 729

   10022 Top 5 Ordering Organizations National*
DCL PATHOLOGY LLC-IN 166
PATHKARE INC-CA 121
TOMS RIVER AMBULATORY SURGICAL CENTER-NJ 98
MEDICAL PLAZA IMAGING ASSOCIATES, LLC-MO 98
CONSOLIDATED PATHOLOGY CONSULTANTS, SC-IL 47

*Based on 2014 Medicare Fee-For Service Provider Utilization & Payment Data, Physician and Other Supplier, Public Use File



   Medicare Part B Utilization Data for 10022*         Hide this section.


Annual Procedures / Tests Performed / Denied


Total National Services (all modifiers) Submitted 2015: 210,721
Total Services Denied 2015: 17,379 (8.2%)
National Charges Submitted 2015: $ 64,173,588.00
National Charges Allowed 2015: $ 20,932,082.00
National Average (No Modifier) Fee Submitted 2015: $305.29
National Average (No Modifier) Fee Allowed 2015: $106.46
National Average (26) Fee Submitted 2015: $178.40
National Average (26) Fee Allowed 2015: $ 0.00


Top 5 Performing Specialties 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Diagnostic radiology 94,559 44.9% $316.72 6,340 6.7%
Endocrinology
(eff 5/92)
45,761 21.7% $301.74 3,873 8.5%
Pathology 14,426 6.8% $228.26 1,463 10.1%
General surgery 11,709 5.6% $333.19 1,195 10.2%
Otolaryngology 10,241 4.9% $335.57 922 9.0%

Top 5 Places of Service 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Office 108,459 51.5% $308.82 12,302 11.3%
Outpatient hospital 88,463 42.0% $286.25 5,677 6.4%
Inpatient hospital 9,855 4.7% $291.45 741 7.5%
Ambulatory surgical center 578 0.3% $710.55 79 13.7%
Independent laboratory 567 0.3% $333.29 153 27.0%

Top 5 Modifiers Submitted 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
No Modifier 141,957 67.4% $305.29 9,468 6.7%
59 - Distinct Procedural Service 31,572 15.0% $292.57 3,972 12.6%
RT - Right Side 8,914 4.2% $316.88 1,057 11.9%
LT - Left Side 8,227 3.9% $313.25 956 11.6%
76 - Repeat Procedure by Same Physician 6,724 3.2% $297.23 809 12.0%

Click here for more information on Custom CodeMap Medicare Utililation Reports.


*Utilization data is derived from analysis of the Physician Supplier Procedure Summary Master File (PSPSMF) which includes data from all Medicare Part B carriers. This data represents procedure-specific billing data for all physician/supplier services rendered to all Medicare beneficiaries during the calendar year named and processed by the Carriers through the six months of the following year.

Part B charge and utilization data for institutional services (hospital outpatient departments, home health agencies, comprehensive outpatient rehabilitation facilities, end-stage renal disease facilities, and rural health clinics) are processed by Medicare Part A fiscal intermediaries and are not included in this data. Data for services rendered to beneficiaries enrolled in risk-based Health Maintenance Organizations (HMOs) are also not included.


   CodeMap Compliance Briefings: Hide this section.

All information on this web site is compiled directly from information obtained from the Center for Medicare and Medicaid Services (CMS) and from its Contractors.

CodeMap® has made every reasonable effort to ensure the accuracy of the information contained on this web site. However, the ultimate responsibility for correct coding and claims submission lies with the provider of services. CodeMap® makes no representation, warranty, or guarantee that this compilation of Medicare information is error-free or that the use of this information will result in Medicare coverage and subsequent payment of claims. Final coverage and payment of claims are subject to many factors exclusively controlled by CMS and its contractors.

No part of this web page or data displayed may be redistibuted or used without the express written consent of Wheaton Partners, LLC.
09/29/2016 05:08:51 54.92.192.156

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