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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 05/23/2016     

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17286
Quick jump to procedure code: Printer Friendly Version
17312

CPT® 17311: MOHS MICROGRAPHIC TECHNIQUE, INCLUDING REMOVAL OF ALL GROSS TUMOR, SURGICAL EXCISION OF TISSUE SPECIMENS, MAPPING, COLOR CODING OF SPECIMENS, MICROSCOPIC EXAMINATION OF SPECIMENS BY THE SURGEON, AND HISTOPATHOLOGIC PREPARATION INCLUDING ROUTINE STAIN(S) (EG, HEMATOXYLIN AND EOSIN, TOLUIDINE BLUE), HEAD, NECK, HANDS, FEET, GENITALIA, OR ANY LOCATION WITH SURGERY DIRECTLY INVOLVING MUSCLE, CARTILAGE, BONE, TENDON, MAJOR NERVES, OR VESSELS; FIRST STAGE, UP TO 5 TISSUE BLOCKS

Short Description: Mohs 1 stage h/n/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
$673.56
$391.96

2016 Wage Index Adjustment for Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payments
Zip Code:
2016 Unadjusted OPPS Payment $428.67
2016 Unadjusted ASC Payment $239.70


*Based on National 2013 Medicare Part B submitted claims.
2016 APC Code: 5053
Level 3 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.
PercentageICD-9ICD-10 Conversions
53.5% 173.3    No longer a valid ICD-9 code. Click here to search for current ICD-9 code.

No related ICD-10 codes.
9.5% 173.2    No longer a valid ICD-9 code. Click here to search for current ICD-9 code.

No related ICD-10 codes.
7.4% 173.4    No longer a valid ICD-9 code. Click here to search for current ICD-9 code.

No related ICD-10 codes.
6.6% 173.8    No longer a valid ICD-9 code. Click here to search for current ICD-9 code.

No related ICD-10 codes.
3.3% 173.1    No longer a valid ICD-9 code. Click here to search for current ICD-9 code.

No related ICD-10 codes.
3.2% 173.0    No longer a valid ICD-9 code. Click here to search for current ICD-9 code.

No related ICD-10 codes.
3.0% 238.2    Neoplasm of uncertain behavior of skin D48.5   Neoplasm of uncertain behavior of skin
2.4% 702.0    Actinic keratosis L57.0   Actinic keratosis
2.4% 173.6    No longer a valid ICD-9 code. Click here to search for current ICD-9 code.

No related ICD-10 codes.
1.1% V10.83    Personal history of malignant neoplasm, other malignant neoplasm of skin Z85.828   Personal history of other malignant neoplasm of skin

* 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.

17311 not found in an Local Coverage Determination (LCD) for your contractor. Other contractors covering 17311

CCI and MUE Edits*         Hide this section.

CCI Edits for 17311
Denied Codes (1)
Effective
Modifier
Accepted (2)
0213T Njx paravert w/us cer/thor
07/01/2010 No
0216T Njx paravert w/us lumb/sac
07/01/2010 No
0228T Njx tfrml eprl w/us cer/thor
10/01/2010 No
0230T Njx tfrml eprl w/us lumb/sac
10/01/2010 No
11010 Debride skin at fx site
04/01/2014 Yes
11011 Debride skin musc at fx site
04/01/2014 Yes
11012 Deb skin bone at fx site
04/01/2014 Yes
11100 Biopsy skin lesion
01/01/2007 Yes
11420 Exc h-f-nk-sp b9+marg 0.5/<
04/01/2014 Yes
11421 Exc h-f-nk-sp b9+marg 0.6-1
04/01/2014 Yes
11422 Exc h-f-nk-sp b9+marg 1.1-2
04/01/2014 Yes
11423 Exc h-f-nk-sp b9+marg 2.1-3
04/01/2014 Yes
11424 Exc h-f-nk-sp b9+marg 3.1-4
04/01/2014 Yes
11426 Exc h-f-nk-sp b9+marg >4 cm
04/01/2014 Yes
11440 Exc face-mm b9+marg 0.5 cm/<
04/01/2014 Yes
11441 Exc face-mm b9+marg 0.6-1 cm
04/01/2014 Yes
11442 Exc face-mm b9+marg 1.1-2 cm
04/01/2014 Yes
11443 Exc face-mm b9+marg 2.1-3 cm
04/01/2014 Yes
11444 Exc face-mm b9+marg 3.1-4 cm
04/01/2014 Yes
11446 Exc face-mm b9+marg >4 cm
04/01/2014 Yes
11470 Removal sweat gland lesion
04/01/2014 Yes
11471 Removal sweat gland lesion
04/01/2014 Yes
11600 Exc tr-ext mal+marg 0.5 cm/<
01/01/2007 Yes
11601 Exc tr-ext mal+marg 0.6-1 cm
01/01/2007 Yes
11602 Exc tr-ext mal+marg 1.1-2 cm
01/01/2007 Yes
11603 Exc tr-ext mal+marg 2.1-3 cm
01/01/2007 Yes
11604 Exc tr-ext mal+marg 3.1-4 cm
01/01/2007 Yes
11606 Exc tr-ext mal+marg >4 cm
01/01/2007 Yes
11620 Exc h-f-nk-sp mal+marg 0.5/<
01/01/2007 Yes
11621 Exc s/n/h/f/g mal+mrg 0.6-1
01/01/2007 Yes
11622 Exc s/n/h/f/g mal+mrg 1.1-2
01/01/2007 Yes
11623 Exc s/n/h/f/g mal+mrg 2.1-3
01/01/2007 Yes
11624 Exc s/n/h/f/g mal+mrg 3.1-4
01/01/2007 Yes
11626 Exc s/n/h/f/g mal+mrg >4 cm
01/01/2007 Yes
11640 Exc f/e/e/n/l mal+mrg 0.5cm<
01/01/2007 Yes
11641 Exc f/e/e/n/l mal+mrg 0.6-1
01/01/2007 Yes
11642 Exc f/e/e/n/l mal+mrg 1.1-2
01/01/2007 Yes
11643 Exc f/e/e/n/l mal+mrg 2.1-3
01/01/2007 Yes
11644 Exc f/e/e/n/l mal+mrg 3.1-4
01/01/2007 Yes
11646 Exc f/e/e/n/l mal+mrg >4 cm
01/01/2007 Yes
11750 Removal of nail bed
04/01/2014 Yes
11752 Remove nail bed/tip
04/01/2014 Yes
11765 Excision of nail fold toe
04/01/2014 Yes
15837 Excise excess skin arm/hand
04/01/2014 Yes
15838 Excise excess skin fat pad
04/01/2014 Yes
15920 Removal of tail bone ulcer
04/01/2014 Yes
17260 Destruction of skin lesions
01/01/2007 Yes
17261 Destruction of skin lesions
01/01/2007 Yes
17262 Destruction of skin lesions
01/01/2007 Yes
17263 Destruction of skin lesions
01/01/2007 Yes
17264 Destruction of skin lesions
01/01/2007 Yes
17266 Destruction of skin lesions
01/01/2007 Yes
17270 Destruction of skin lesions
01/01/2007 Yes
17271 Destruction of skin lesions
01/01/2007 Yes
17272 Destruction of skin lesions
01/01/2007 Yes
17273 Destruction of skin lesions
01/01/2007 Yes
17274 Destruction of skin lesions
01/01/2007 Yes
17276 Destruction of skin lesions
01/01/2007 Yes
17280 Destruction of skin lesions
01/01/2007 Yes
17281 Destruction of skin lesions
01/01/2007 Yes
17282 Destruction of skin lesions
01/01/2007 Yes
17283 Destruction of skin lesions
01/01/2007 Yes
17284 Destruction of skin lesions
01/01/2007 Yes
17286 Destruction of skin lesions
01/01/2007 Yes
30120 Revision of nose
04/01/2014 Yes
36000 Place needle in vein
01/01/2007 Yes
36400 Bl draw < 3 yrs fem/jugular
04/01/2009 Yes
36405 Bl draw <3 yrs scalp vein
04/01/2009 Yes
36406 Bl draw <3 yrs other vein
04/01/2009 Yes
36410 Non-routine bl draw 3/> yrs
01/01/2007 Yes
36420 Vein access cutdown < 1 yr
04/01/2009 Yes
36425 Vein access cutdown > 1 yr
04/01/2009 Yes
36430 Blood transfusion service
04/01/2009 Yes
36440 Bl push transfuse 2 yr/<
04/01/2009 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
04/01/2009 Yes
36640 Insertion catheter artery
04/01/2009 Yes
40510 Partial excision of lip
04/01/2014 Yes
40520 Partial excision of lip
04/01/2014 Yes
40525 Reconstruct lip with flap
04/01/2014 Yes
40527 Reconstruct lip with flap
04/01/2014 Yes
42810 Excision of neck cyst
04/01/2014 Yes
43752 Nasal/orogastric w/tube plmt
01/01/2007 Yes
51701 Insert bladder catheter
10/01/2007 Yes
51702 Insert temp bladder cath
10/01/2007 Yes
51703 Insert bladder cath complex
10/01/2007 Yes
62310 Inject spine cerv/thoracic
04/01/2009 No
62311 Inject spine lumbar/sacral
04/01/2009 No
62318 Inject spine w/cath crv/thrc
01/01/2007 No
62319 Inject spine w/cath lmb/scrl
01/01/2007 No
64400 N block inj trigeminal
04/01/2009 No
64402 N block inj facial
04/01/2009 No
64405 N block inj occipital
04/01/2009 No
64408 N block inj vagus
04/01/2009 No
64410 N block inj phrenic
04/01/2009 No
64413 N block inj cervical plexus
04/01/2009 No
64415 N block inj brachial plexus
01/01/2007 No
64416 N block cont infuse b plex
01/01/2007 No
64417 N block inj axillary
01/01/2007 No
64418 N block inj suprascapular
04/01/2009 No
64420 N block inj intercost sng
04/01/2009 No
64421 N block inj intercost mlt
04/01/2009 No
64425 N block inj ilio-ing/hypogi
04/01/2009 No
64430 N block inj pudendal
04/01/2009 No
64435 N block inj paracervical
04/01/2009 No
64445 N block inj sciatic sng
04/01/2009 No
64446 N blk inj sciatic cont inf
04/01/2009 No
64447 N block inj fem single
04/01/2009 No
64448 N block inj fem cont inf
04/01/2009 No
64449 N block inj lumbar plexus
04/01/2009 No
64450 N block other peripheral
01/01/2007 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
04/01/2009 No
64483 Inj foramen epidural l/s
04/01/2009 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
01/01/2010 No
64493 Inj paravert f jnt l/s 1 lev
01/01/2010 No
64505 N block spenopalatine gangl
04/01/2009 No
64508 N block carotid sinus s/p
04/01/2009 No
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
64510 N block stellate ganglion
04/01/2009 No
64517 N block inj hypogas plxs
04/01/2009 No
64520 N block lumbar/thoracic
04/01/2009 No
64530 N block inj celiac pelus
04/01/2009 No
67840 Remove eyelid lesion
04/01/2014 Yes
67961 Revision of eyelid
04/01/2014 Yes
67966 Revision of eyelid
04/01/2014 Yes
69110 Remove external ear partial
04/01/2014 Yes
69990 Microsurgery add-on
01/01/2007 No
88300 Surgical path gross
01/01/2007 Yes
88302 Tissue exam by pathologist
01/01/2007 Yes
88304 Tissue exam by pathologist
01/01/2007 Yes
88305 Tissue exam by pathologist
01/01/2007 Yes
88307 Tissue exam by pathologist
01/01/2007 Yes
88309 Tissue exam by pathologist
01/01/2007 Yes
88311 Decalcify tissue
01/01/2007 Yes
88312 Special stains group 1
01/01/2007 Yes
88313 Special stains group 2
01/01/2007 Yes
88314 Histochemical stains add-on
01/01/2007 Yes
88331 Path consult intraop 1 bloc
01/01/2007 Yes
88332 Path consult intraop addl
01/01/2007 Yes
88342 Immunohisto antb 1st stain
01/01/2007 Yes
88344 Immunohisto antibody slide
01/01/2015 Yes
92012 Eye exam establish patient
04/01/2014 Yes
92014 Eye exam&tx estab pt 1/>vst
04/01/2014 Yes
93000 Electrocardiogram complete
04/01/2009 Yes
93005 Electrocardiogram tracing
04/01/2009 Yes
93010 Electrocardiogram report
04/01/2009 Yes
93040 Rhythm ecg with report
04/01/2009 Yes
93041 Rhythm ecg tracing
04/01/2009 Yes
93042 Rhythm ecg report
04/01/2009 Yes
93318 Echo transesophageal intraop
04/01/2009 Yes
93355 Echo transesophageal (tee)
01/01/2015 Yes
94002 Vent mgmt inpat init day
04/01/2009 Yes
94200 Lung function test (mbc/mvv)
04/01/2009 Yes
94250 Expired gas collection
04/01/2009 Yes
94680 Exhaled air analysis o2
04/01/2009 Yes
94681 Exhaled air analysis o2/co2
04/01/2009 Yes
94690 Exhaled air analysis
04/01/2009 Yes
94770 Exhaled carbon dioxide test
04/01/2009 Yes
95812 Eeg 41-60 minutes
04/01/2009 Yes
95813 Eeg over 1 hour
04/01/2009 Yes
95816 Eeg awake and drowsy
04/01/2009 Yes
95819 Eeg awake and asleep
04/01/2009 Yes
95822 Eeg coma or sleep only
04/01/2009 Yes
95829 Surgery electrocorticogram
04/01/2009 Yes
95955 Eeg during surgery
04/01/2009 Yes
96360 Hydration iv infusion init
01/01/2009 Yes
96361 Hydrate iv infusion add-on
04/01/2016 Yes
96365 Ther/proph/diag iv inf init
01/01/2009 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
01/01/2009 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
04/01/2009 Yes
99148 Mod sed diff phys/qhp<5 yrs
10/01/2009 No
99149 Mod sed diff phys/qhp 5/>yrs
10/01/2009 No
99150 Mod sed diff phys/qhp add on
10/01/2009 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
G0416 Prostate biopsy, any mthd
01/01/2010 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
07/01/2010 Yes
J2001 Lidocaine injection
01/01/2007 Yes
(1) These codes will be denied when submitted for payment on the same date of service as 17311.

(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 17311


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.


   17311 Top 5 Ordering Providers National*
LAWRENCE CHANG -NORFOLK,VA 1,784
ROSS CAMPBELL -ATHENS,GA 1,684
JOHN CHUNG -DALTON,GA 1,649
THI TRAN -THE VILLAGES,FL 1,604
MARK CHASTAIN -MARIETTA,GA 1,603

   17311 Top 5 Ordering Organizations National*
OLIVER STREET DERMATOLOGY ASC LLC-TX 1,794
ZITELLI & BRODLAND PC-PA 635
SODERSTROM DERMATOLOGY CENTER S C-IL 603
ZITELLI & BRODLAND PC-PA 603
DERMATOLOGY & COSMETIC SURGERY CENTER PC-PA 401

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



   Medicare Part B Utilization Data for 17311*         Hide this section.


Annual Procedures / Tests Performed / Denied


Total National Services (all modifiers) Submitted 2014: 672,459
Total Services Denied 2014: 35,448 (5.3%)
National Charges Submitted 2014: $777,802,797.00
National Charges Allowed 2014: $340,612,901.00
National Average (No Modifier) Fee Submitted 2014: $1169.20
National Average (No Modifier) Fee Allowed 2014: $639.46


Top 5 Performing Specialties 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Dermatology 652,581 97.0% $1157.95 34,114 5.2%
Ambulatory surgical center
(formerly miscellaneous)
5,978 0.9% $1175.40 510 8.5%
Otolaryngology 3,891 0.6% $1252.44 129 3.3%
Plastic and reconstructive surgery 3,332 0.5% $1122.00 209 6.3%
Pathology 2,414 0.4% $921.65 37 1.5%

Top 5 Places of Service 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Office 615,980 91.6% $1136.23 31,875 5.2%
Outpatient hospital 44,427 6.6% $1451.09 2,713 6.1%
Ambulatory surgical center 12,031 1.8% $1115.58 849 7.1%
Skilled nursing facility 5 0.0% $1092.40 5 100.0%
Inpatient hospital 4 0.0% $1604.78 1 25.0%

Top 5 Modifiers Submitted 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
No Modifier 360,895 53.7% $1169.20 22,849 6.3%
51 - Multiple Procedures 154,332 23.0% $1146.11 2,389 1.5%
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period 77,052 11.5% $1083.55 3,562 4.6%
59 - Distinct Procedural Service 41,572 6.2% $1173.78 3,746 9.0%
76 - Repeat Procedure by Same Physician 20,713 3.1% $1092.73 1,981 9.6%

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.

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.

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