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2016 Lab Fee Schedule Updated     


2016 Physican Fee Schedule Updated 2/1/2016     


2016 OPPS Fee Schedule Updated     


2016 ASC Fee Schedule Updated     


2016 APC Codes Updated     


Q2 2016 ASP Drug Pricing Updated     


Q2 2016 CCI Edits Loaded     


Q2 2016 MUE Edits Loaded     


LCD Database Current Through 06/20/2016     

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15274
Quick jump to procedure code: Printer Friendly Version
15276

CPT® 15275: APPLICATION OF SKIN SUBSTITUTE GRAFT TO FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET, AND/OR MULTIPLE DIGITS, TOTAL WOUND SURFACE AREA UP TO 100 SQ CM; FIRST 25 SQ CM OR LESS WOUND SURFACE AREA

Short Description: Skin sub graft face/nk/hf/g

--

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
$151.55
$ 98.53

2016 Wage Index Adjustment for Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payments
Zip Code:
2016 Unadjusted OPPS Payment $1411.21
2016 Unadjusted ASC Payment $789.12


*Based on National 2013 Medicare Part B submitted claims.
2016 APC Code: 5054
Level 4 Skin Procedures

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.
No ICD-9 claims data for this code.

* 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.

15275 not found in an Local Coverage Determination (LCD) for your contractor. Other contractors covering 15275

CCI and MUE Edits*         Hide this section.

CCI Edits for 15275
Denied Codes (1)
Effective
Modifier
Accepted (2)
01951 Anesth burn less 4 percent
01/01/2012 No
01952 Anesth burn 4-9 percent
01/01/2012 No
0213T Njx paravert w/us cer/thor
01/01/2012 No
0216T Njx paravert w/us lumb/sac
01/01/2012 No
0228T Njx tfrml eprl w/us cer/thor
01/01/2012 No
0230T Njx tfrml eprl w/us lumb/sac
01/01/2012 No
11000 Debride infected skin
01/01/2012 Yes
11042 Deb subq tissue 20 sq cm/<
01/01/2012 Yes
12001 Rpr s/n/ax/gen/trnk 2.5cm/<
01/01/2012 Yes
12002 Rpr s/n/ax/gen/trnk2.6-7.5cm
01/01/2012 Yes
12004 Rpr s/n/ax/gen/trk7.6-12.5cm
01/01/2012 Yes
12005 Rpr s/n/a/gen/trk12.6-20.0cm
01/01/2012 Yes
12006 Rpr s/n/a/gen/trk20.1-30.0cm
01/01/2012 Yes
12007 Rpr s/n/ax/gen/trnk >30.0 cm
01/01/2012 Yes
12011 Rpr f/e/e/n/l/m 2.5 cm/<
01/01/2012 Yes
12013 Rpr f/e/e/n/l/m 2.6-5.0 cm
01/01/2012 Yes
12014 Rpr f/e/e/n/l/m 5.1-7.5 cm
01/01/2012 Yes
12015 Rpr f/e/e/n/l/m 7.6-12.5 cm
01/01/2012 Yes
12016 Rpr fe/e/en/l/m 12.6-20.0 cm
01/01/2012 Yes
12017 Rpr fe/e/en/l/m 20.1-30.0 cm
01/01/2012 Yes
12018 Rpr f/e/e/n/l/m >30.0 cm
01/01/2012 Yes
12020 Closure of split wound
01/01/2012 Yes
12021 Closure of split wound
01/01/2012 Yes
12031 Intmd rpr s/a/t/ext 2.5 cm/<
01/01/2012 Yes
12032 Intmd rpr s/a/t/ext 2.6-7.5
01/01/2012 Yes
12034 Intmd rpr s/tr/ext 7.6-12.5
01/01/2012 Yes
12035 Intmd rpr s/a/t/ext 12.6-20
01/01/2012 Yes
12036 Intmd rpr s/a/t/ext 20.1-30
01/01/2012 Yes
12037 Intmd rpr s/tr/ext >30.0 cm
01/01/2012 Yes
12041 Intmd rpr n-hf/genit 2.5cm/<
01/01/2012 Yes
12042 Intmd rpr n-hf/genit2.6-7.5
01/01/2012 Yes
12044 Intmd rpr n-hf/genit7.6-12.5
01/01/2012 Yes
12045 Intmd rpr n-hf/genit12.6-20
01/01/2012 Yes
12046 Intmd rpr n-hf/genit20.1-30
01/01/2012 Yes
12047 Intmd rpr n-hf/genit >30.0cm
01/01/2012 Yes
12051 Intmd rpr face/mm 2.5 cm/<
01/01/2012 Yes
12052 Intmd rpr face/mm 2.6-5.0 cm
01/01/2012 Yes
12053 Intmd rpr face/mm 5.1-7.5 cm
01/01/2012 Yes
12054 Intmd rpr face/mm 7.6-12.5cm
01/01/2012 Yes
12055 Intmd rpr face/mm 12.6-20 cm
01/01/2012 Yes
12056 Intmd rpr face/mm 20.1-30.0
01/01/2012 Yes
12057 Intmd rpr face/mm >30.0 cm
01/01/2012 Yes
13100 Cmplx rpr trunk 1.1-2.5 cm
10/01/2012 Yes
13101 Cmplx rpr trunk 2.6-7.5 cm
10/01/2012 Yes
13102 Cmplx rpr trunk addl 5cm/<
10/01/2012 Yes
13120 Cmplx rpr s/a/l 1.1-2.5 cm
01/01/2012 Yes
13121 Cmplx rpr s/a/l 2.6-7.5 cm
01/01/2012 Yes
13122 Cmplx rpr s/a/l addl 5 cm/>
10/01/2012 Yes
13131 Cmplx rpr f/c/c/m/n/ax/g/h/f
01/01/2012 Yes
13132 Cmplx rpr f/c/c/m/n/ax/g/h/f
01/01/2012 Yes
13133 Cmplx rpr f/c/c/m/n/ax/g/h/f
10/01/2012 Yes
13151 Cmplx rpr e/n/e/l 1.1-2.5 cm
01/01/2012 Yes
13152 Cmplx rpr e/n/e/l 2.6-7.5 cm
01/01/2012 Yes
13153 Cmplx rpr e/n/e/l addl 5cm/<
10/01/2012 Yes
15278 Skn sub grft f/n/hf/g ch add
01/01/2012 No
15777 Acellular derm matrix implt
01/01/2012 Yes
15852 Dressing change not for burn
01/01/2012 Yes
16020 Dress/debrid p-thick burn s
01/01/2012 Yes
16025 Dress/debrid p-thick burn m
01/01/2012 Yes
16030 Dress/debrid p-thick burn l
01/01/2012 Yes
29000 Application of body cast
01/01/2012 Yes
29010 Application of body cast
01/01/2012 Yes
29015 Application of body cast
01/01/2012 Yes
29035 Application of body cast
01/01/2012 Yes
29040 Application of body cast
01/01/2012 Yes
29044 Application of body cast
01/01/2012 Yes
29046 Application of body cast
01/01/2012 Yes
29049 Application of figure eight
01/01/2012 Yes
29055 Application of shoulder cast
01/01/2012 Yes
29058 Application of shoulder cast
01/01/2012 Yes
29065 Application of long arm cast
01/01/2012 Yes
29075 Application of forearm cast
01/01/2012 Yes
29085 Apply hand/wrist cast
01/01/2012 Yes
29086 Apply finger cast
01/01/2012 Yes
29105 Apply long arm splint
01/01/2012 Yes
29125 Apply forearm splint
01/01/2012 Yes
29126 Apply forearm splint
01/01/2012 Yes
29130 Application of finger splint
01/01/2012 Yes
29131 Application of finger splint
01/01/2012 Yes
29200 Strapping of chest
01/01/2012 Yes
29240 Strapping of shoulder
01/01/2012 Yes
29260 Strapping of elbow or wrist
01/01/2012 Yes
29280 Strapping of hand or finger
01/01/2012 Yes
29305 Application of hip cast
01/01/2012 Yes
29325 Application of hip casts
01/01/2012 Yes
29345 Application of long leg cast
01/01/2012 Yes
29355 Application of long leg cast
01/01/2012 Yes
29358 Apply long leg cast brace
01/01/2012 Yes
29365 Application of long leg cast
01/01/2012 Yes
29405 Apply short leg cast
01/01/2012 Yes
29425 Apply short leg cast
01/01/2012 Yes
29435 Apply short leg cast
01/01/2012 Yes
29440 Addition of walker to cast
01/01/2012 Yes
29445 Apply rigid leg cast
01/01/2012 Yes
29450 Application of leg cast
01/01/2012 Yes
29505 Application long leg splint
01/01/2012 Yes
29515 Application lower leg splint
01/01/2012 Yes
29520 Strapping of hip
01/01/2012 Yes
29530 Strapping of knee
01/01/2012 Yes
29540 Strapping of ankle and/or ft
01/01/2012 Yes
29550 Strapping of toes
01/01/2012 Yes
29580 Application of paste boot
01/01/2012 Yes
29581 Apply multlay comprs lwr leg
01/01/2012 Yes
29582 Apply multlay comprs upr leg
01/01/2012 Yes
29583 Apply multlay comprs upr arm
01/01/2012 Yes
29584 Appl multlay comprs arm/hand
01/01/2012 Yes
36000 Place needle in vein
01/01/2012 Yes
36400 Bl draw < 3 yrs fem/jugular
01/01/2012 Yes
36405 Bl draw <3 yrs scalp vein
01/01/2012 Yes
36406 Bl draw <3 yrs other vein
01/01/2012 Yes
36410 Non-routine bl draw 3/> yrs
01/01/2012 Yes
36420 Vein access cutdown < 1 yr
01/01/2012 Yes
36425 Vein access cutdown > 1 yr
01/01/2012 Yes
36430 Blood transfusion service
01/01/2012 Yes
36440 Bl push transfuse 2 yr/<
01/01/2012 Yes
36591 Draw blood off venous device
10/01/2015 No
36592 Collect blood from picc
10/01/2015 No
36600 Withdrawal of arterial blood
01/01/2012 Yes
36640 Insertion catheter artery
01/01/2012 Yes
43752 Nasal/orogastric w/tube plmt
01/01/2012 Yes
51701 Insert bladder catheter
01/01/2012 Yes
51702 Insert temp bladder cath
01/01/2012 Yes
51703 Insert bladder cath complex
01/01/2012 Yes
62310 Inject spine cerv/thoracic
01/01/2012 No
62311 Inject spine lumbar/sacral
01/01/2012 No
62318 Inject spine w/cath crv/thrc
01/01/2012 No
62319 Inject spine w/cath lmb/scrl
01/01/2012 No
64400 N block inj trigeminal
01/01/2012 No
64402 N block inj facial
01/01/2012 No
64405 N block inj occipital
01/01/2012 No
64408 N block inj vagus
01/01/2012 No
64410 N block inj phrenic
01/01/2012 No
64413 N block inj cervical plexus
01/01/2012 No
64415 N block inj brachial plexus
01/01/2012 No
64416 N block cont infuse b plex
01/01/2012 No
64417 N block inj axillary
01/01/2012 No
64418 N block inj suprascapular
01/01/2012 No
64420 N block inj intercost sng
01/01/2012 No
64421 N block inj intercost mlt
01/01/2012 No
64425 N block inj ilio-ing/hypogi
01/01/2012 No
64430 N block inj pudendal
01/01/2012 No
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
64435 N block inj paracervical
01/01/2012 No
64445 N block inj sciatic sng
01/01/2012 No
64446 N blk inj sciatic cont inf
01/01/2012 No
64447 N block inj fem single
01/01/2012 No
64448 N block inj fem cont inf
01/01/2012 No
64449 N block inj lumbar plexus
01/01/2012 No
64450 N block other peripheral
01/01/2012 Yes
64461 Pvb thoracic single inj site
01/01/2016 No
64463 Pvb thoracic cont infusion
01/01/2016 No
64479 Inj foramen epidural c/t
01/01/2012 No
64483 Inj foramen epidural l/s
01/01/2012 No
64486 Tap block unil by injection
01/01/2015 No
64487 Tap block uni by infusion
01/01/2015 No
64488 Tap block bi injection
01/01/2015 No
64489 Tap block bi by infusion
01/01/2015 No
64490 Inj paravert f jnt c/t 1 lev
01/01/2012 No
64493 Inj paravert f jnt l/s 1 lev
01/01/2012 No
64505 N block spenopalatine gangl
01/01/2012 No
64508 N block carotid sinus s/p
01/01/2012 No
64510 N block stellate ganglion
01/01/2012 No
64517 N block inj hypogas plxs
01/01/2012 No
64520 N block lumbar/thoracic
01/01/2012 No
64530 N block inj celiac pelus
01/01/2012 No
69990 Microsurgery add-on
01/01/2012 No
92012 Eye exam establish patient
04/01/2014 Yes
92014 Eye exam&tx estab pt 1/>vst
04/01/2014 Yes
93000 Electrocardiogram complete
01/01/2012 Yes
93005 Electrocardiogram tracing
01/01/2012 Yes
93010 Electrocardiogram report
01/01/2012 Yes
93040 Rhythm ecg with report
01/01/2012 Yes
93041 Rhythm ecg tracing
01/01/2012 Yes
93042 Rhythm ecg report
01/01/2012 Yes
93318 Echo transesophageal intraop
01/01/2012 Yes
93355 Echo transesophageal (tee)
01/01/2015 Yes
94002 Vent mgmt inpat init day
01/01/2012 Yes
94200 Lung function test (mbc/mvv)
01/01/2012 Yes
94250 Expired gas collection
01/01/2012 Yes
94680 Exhaled air analysis o2
01/01/2012 Yes
94681 Exhaled air analysis o2/co2
01/01/2012 Yes
94690 Exhaled air analysis
01/01/2012 Yes
94770 Exhaled carbon dioxide test
01/01/2012 Yes
95812 Eeg 41-60 minutes
01/01/2012 Yes
95813 Eeg over 1 hour
01/01/2012 Yes
95816 Eeg awake and drowsy
01/01/2012 Yes
95819 Eeg awake and asleep
01/01/2012 Yes
95822 Eeg coma or sleep only
01/01/2012 Yes
95829 Surgery electrocorticogram
01/01/2012 Yes
95955 Eeg during surgery
01/01/2012 Yes
96360 Hydration iv infusion init
01/01/2012 Yes
96361 Hydrate iv infusion add-on
04/01/2016 Yes
96365 Ther/proph/diag iv inf init
01/01/2012 Yes
96366 Ther/proph/diag iv inf addon
04/01/2016 Yes
96367 Tx/proph/dg addl seq iv inf
04/01/2016 Yes
96368 Ther/diag concurrent inf
04/01/2016 Yes
96372 Ther/proph/diag inj sc/im
01/01/2012 Yes
96374 Ther/proph/diag inj iv push
01/01/2012 Yes
96375 Tx/pro/dx inj new drug addon
01/01/2012 Yes
96376 Tx/pro/dx inj same drug adon
01/01/2012 Yes
97597 Rmvl devital tis 20 cm/<
01/01/2012 Yes
97598 Rmvl devital tis addl 20cm/<
01/01/2012 Yes
97602 Wound(s) care non-selective
01/01/2012 Yes
97605 Neg press wound tx
01/01/2012 Yes
97606 Neg press wound tx >50 cm
01/01/2012 Yes
97607 Neg press wnd tx
01/01/2015 Yes
97608 Neg press wound tx >50 cm
01/01/2015 Yes
99148 Mod sed diff phys/qhp<5 yrs
01/01/2012 No
99149 Mod sed diff phys/qhp 5/>yrs
01/01/2012 No
99150 Mod sed diff phys/qhp add on
01/01/2012 No
99211 Office/outpatient visit est
07/01/2013 Yes
99212 Office/outpatient visit est
07/01/2013 Yes
99213 Office/outpatient visit est
07/01/2013 Yes
99214 Office/outpatient visit est
07/01/2013 Yes
99215 Office/outpatient visit est
07/01/2013 Yes
99217 Observation care discharge
07/01/2013 Yes
99218 Initial observation care
07/01/2013 Yes
99219 Initial observation care
07/01/2013 Yes
99220 Initial observation care
07/01/2013 Yes
99221 Initial hospital care
07/01/2013 Yes
99222 Initial hospital care
07/01/2013 Yes
99223 Initial hospital care
07/01/2013 Yes
99231 Subsequent hospital care
07/01/2013 Yes
99232 Subsequent hospital care
07/01/2013 Yes
99233 Subsequent hospital care
07/01/2013 Yes
99234 Observ/hosp same date
07/01/2013 Yes
99235 Observ/hosp same date
07/01/2013 Yes
99236 Observ/hosp same date
07/01/2013 Yes
99238 Hospital discharge day
07/01/2013 Yes
99239 Hospital discharge day
07/01/2013 Yes
99241 Office consultation
07/01/2013 Yes
99242 Office consultation
07/01/2013 Yes
99243 Office consultation
07/01/2013 Yes
99244 Office consultation
07/01/2013 Yes
99245 Office consultation
07/01/2013 Yes
99251 Inpatient consultation
07/01/2013 Yes
99252 Inpatient consultation
07/01/2013 Yes
99253 Inpatient consultation
07/01/2013 Yes
99254 Inpatient consultation
07/01/2013 Yes
99255 Inpatient consultation
07/01/2013 Yes
99291 Critical care first hour
07/01/2013 Yes
99292 Critical care addl 30 min
07/01/2013 Yes
99304 Nursing facility care init
07/01/2013 Yes
99305 Nursing facility care init
07/01/2013 Yes
99306 Nursing facility care init
07/01/2013 Yes
99307 Nursing fac care subseq
07/01/2013 Yes
99308 Nursing fac care subseq
07/01/2013 Yes
99309 Nursing fac care subseq
07/01/2013 Yes
99310 Nursing fac care subseq
07/01/2013 Yes
99315 Nursing fac discharge day
07/01/2013 Yes
99316 Nursing fac discharge day
07/01/2013 Yes
99334 Domicil/r-home visit est pat
07/01/2013 Yes
99335 Domicil/r-home visit est pat
07/01/2013 Yes
99336 Domicil/r-home visit est pat
07/01/2013 Yes
99337 Domicil/r-home visit est pat
07/01/2013 Yes
99347 Home visit est patient
07/01/2013 Yes
99348 Home visit est patient
07/01/2013 Yes
99349 Home visit est patient
07/01/2013 Yes
99350 Home visit est patient
07/01/2013 Yes
99374 Home health care supervision
07/01/2013 Yes
99375 Home health care supervision
07/01/2013 Yes
99377 Hospice care supervision
07/01/2013 Yes
99378 Hospice care supervision
07/01/2013 Yes
99446 Interprof phone/online 5-10
01/01/2014 No
99447 Interprof phone/online 11-20
01/01/2014 No
99448 Interprof phone/online 21-30
01/01/2014 No
99449 Interprof phone/online 31/>
01/01/2014 No
99495 Trans care mgmt 14 day disch
01/01/2014 Yes
99496 Trans care mgmt 7 day disch
01/01/2014 Yes
C5275 Low cost skin substitute app
07/01/2014 No
C5276 Low cost skin substitute app
07/01/2014 No
C5278 Low cost skin substitute app
07/01/2014 No
G0168 Wound closure by adhesive
01/01/2012 Yes
G0463 Hospital outpt clinic visit
07/01/2014 Yes
G0471 Ven blood coll snf/hha
07/01/2015 Yes
J0670 Inj mepivacaine hcl/10 ml
01/01/2012 Yes
J2001 Lidocaine injection
01/01/2012 Yes
15277 Skn sub grft f/n/hf/g child
01/01/2012 No
26121 Release palm contracture
01/01/2012 Yes
26123 Release palm contracture
01/01/2012 Yes
37760 Ligate leg veins radical
01/01/2012 Yes
C5277 Low cost skin substitute app
07/01/2014 No
(1) These codes will be denied when submitted for payment on the same date of service as 15275.

(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 15275


Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: 1 1 Not Listed
Adjudication Indicator: 2 Date of Service Edit: Policy 2 Date of Service Edit: Policy Not Listed
Rationale: Code Descriptor / CPT Instruction Code Descriptor / CPT Instruction 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.


   15275 Top 5 Ordering Providers National*
KAZUO SUZUKI -LOS ANGELES,CA 2,399
JEFFREY STEINBERG -WASHINGTON,DC 705
WILLIAM NAMEN -JACKSONVILLE BEACH,FL 380
STEVEN BLACK -LANCASTER,CA 378
LIVIU PASABOC -BAKERSFIELD,CA 332

   15275 Top 5 Ordering Organizations National*
MILFORD PODIATRY ASSOCIATES PC-CT 258
TOWER OUTPATIENT SURGERY CENTER-CA 118
PHYSICIANS OF WINTER HAVEN LLC-FL 116
TAMPA BAY SURGERY CENTER ASSOCIATES, LTD.-FL 114
GALLERIA SURGERY CENTER LLC-MD 105

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



   Medicare Part B Utilization Data for 15275*         Hide this section.


Annual Procedures / Tests Performed / Denied


Total National Services (all modifiers) Submitted 2014: 87,767
Total Services Denied 2014: 11,139 (12.7%)
National Charges Submitted 2014: $ 39,270,382.00
National Charges Allowed 2014: $ 9,495,097.00
National Average (No Modifier) Fee Submitted 2014: $432.79
National Average (No Modifier) Fee Allowed 2014: $128.43


Top 5 Performing Specialties 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Podiatry 54,432 62.0% $417.25 8,190 15.0%
General surgery 6,522 7.4% $390.39 637 9.8%
Dermatology 4,071 4.6% $331.01 339 8.3%
Family practice 3,835 4.4% $366.02 231 6.0%
Internal medicine 2,756 3.1% $321.14 126 4.6%

Top 5 Places of Service 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Outpatient hospital 46,581 53.1% $358.14 4,529 9.7%
Office 29,054 33.1% $406.05 4,771 16.4%
Ambulatory surgical center 7,560 8.6% $1173.47 988 13.1%
Inpatient hospital 3,965 4.5% $429.46 725 18.3%
Skilled nursing facility 178 0.2% $190.72 10 5.6%

Top 5 Modifiers Submitted 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
No Modifier 41,708 47.5% $432.80 4,842 11.6%
59 - Distinct Procedural Service 8,382 9.6% $619.86 1,682 20.1%
58 - Staged or Related Procedure or Service by the Same Physician During the Postoperative Period 7,289 8.3% $430.08 563 7.7%
KX 6,488 7.4% $388.37 885 13.6%
RT - Right Side 6,178 7.0% $411.97 1,071 17.3%

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.



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