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53660
Quick jump to procedure code: Printer Friendly Version
53665

CPT® 53661: DILATION OF FEMALE URETHRA INCLUDING SUPPOSITORY AND/OR INSTILLATION; SUBSEQUENT

Short Description: Dilation of urethra

--

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
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IOWA-Entire State
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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
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NEW YORK-Queens
NORTH CAROLINA-Entire State
NORTH DAKOTA-Entire State
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OREGON-Portland
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PUERTO RICO-Entire Territory
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TEXAS-Rest of Texas
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VERMONT-Entire State
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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
$ 70.22
$ 41.56

2016 Wage Index Adjustment for Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payments
Zip Code:
2016 October Unadjusted OPPS Payment $ 91.18


*Based on National 2013 Medicare Part B submitted claims.
2016 APC Code: 5734
Level 4 Minor Procedures

2016 OPPS Status Indicator: Q1

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
33.0% 598.9    Urethral stricture, unspecified N35.9   Urethral stricture, unspecified
7.7% 599.0    Urinary tract infection, site not specified N39.0   Urinary tract infection, site not specified
7.5% 597.81    Urethral syndrome N34.3   Urethral syndrome, unspecified
4.0% 788.21    Incomplete bladder emptying R39.14   Feeling of incomplete bladder emptying
3.4% 597.80    Urethritis, unspecified N34.1   Nonspecific urethritis
OR:
N34.2   Other urethritis
3.2% 598.00    Urethral stricture due to unspecified infection N35.111   Postinfective urethral stricture, not elsewhere classified, male, meatal
2.5% 598.8    Other specified causes of urethral stricture N35.8   Other urethral stricture
2.5% 788.41    Urinary frequency R35.0   Frequency of micturition
2.3% 788.20    Retention of urine, unspecified R33.9   Retention of urine, unspecified
2.0% 788.43    Nocturia R35.1   Nocturia

* 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.

53661 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 53661
Denied Codes (1)
Effective
Modifier
Accepted (2)
50947 Laparo new ureter/bladder
04/01/2002 Yes
50948 Laparo new ureter/bladder
04/01/2002 Yes
51840 Attach bladder/urethra
01/01/1996 Yes
51845 Repair bladder neck
01/01/1996 Yes
52000 Cystoscopy
10/01/2001 No
52001 Cystoscopy removal of clots
10/01/2002 No
52005 Cystoscopy & ureter catheter
01/01/1996 No
52007 Cystoscopy and biopsy
01/01/1996 No
52010 Cystoscopy & duct catheter
01/01/1996 No
52204 Cystoscopy w/biopsy(s)
01/01/1996 No
52214 Cystoscopy and treatment
01/01/1996 No
52224 Cystoscopy and treatment
01/01/1996 No
52234 Cystoscopy and treatment
01/01/1996 No
52235 Cystoscopy and treatment
01/01/1996 No
52240 Cystoscopy and treatment
01/01/1996 No
52250 Cystoscopy and radiotracer
01/01/1996 No
52260 Cystoscopy and treatment
01/01/1996 No
52265 Cystoscopy and treatment
01/01/1996 No
52270 Cystoscopy & revise urethra
01/01/1996 No
52275 Cystoscopy & revise urethra
01/01/1996 No
52276 Cystoscopy and treatment
01/01/1996 No
52277 Cystoscopy and treatment
01/01/1996 No
52281 Cystoscopy and treatment
01/01/1996 No
52282 Cystoscopy implant stent
10/01/2001 No
52283 Cystoscopy and treatment
01/01/1996 No
52285 Cystoscopy and treatment
01/01/1996 No
52287 Cystoscopy chemodenervation
01/01/2013 No
52290 Cystoscopy and treatment
01/01/1996 No
52300 Cystoscopy and treatment
01/01/1996 No
52301 Cystoscopy and treatment
10/01/1997 No
52305 Cystoscopy and treatment
01/01/1996 No
52310 Cystoscopy and treatment
10/01/2001 No
52315 Cystoscopy and treatment
10/01/2001 No
52317 Remove bladder stone
01/01/1996 No
52318 Remove bladder stone
01/01/1996 No
52320 Cystoscopy and treatment
01/01/1996 No
52325 Cystoscopy stone removal
01/01/1996 No
52327 Cystoscopy inject material
10/01/2001 No
52330 Cystoscopy and treatment
01/01/1996 No
52332 Cystoscopy and treatment
01/01/1996 No
52334 Create passage to kidney
01/01/1996 No
52341 Cysto w/ureter stricture tx
07/01/2001 No
52342 Cysto w/up stricture tx
07/01/2001 No
52343 Cysto w/renal stricture tx
07/01/2001 No
52344 Cysto/uretero stricture tx
07/01/2001 No
52345 Cysto/uretero w/up stricture
07/01/2001 No
52346 Cystouretero w/renal strict
07/01/2001 No
52351 Cystouretero & or pyeloscope
07/01/2001 No
52352 Cystouretero w/stone remove
07/01/2001 No
52353 Cystouretero w/lithotripsy
07/01/2001 No
52354 Cystouretero w/biopsy
07/01/2001 No
52355 Cystouretero w/excise tumor
07/01/2001 No
52356 Cysto/uretero w/lithotripsy
01/01/2014 No
52400 Cystouretero w/congen repr
07/01/2001 No
52402 Cystourethro cut ejacul duct
01/01/2005 Yes
52441 Cystourethro w/implant
01/01/2015 No
52442 Cystourethro w/addl implant
01/01/2015 Yes
52647 Laser surgery of prostate
04/01/2006 No
52648 Laser surgery of prostate
04/01/2006 No
52649 Prostate laser enucleation
01/01/2008 No
53500 Urethrlys transvag w/ scope
01/01/2004 Yes
53600 Dilate urethra stricture
04/01/2010 Yes
53601 Dilate urethra stricture
04/01/2010 Yes
53605 Dilate urethra stricture
04/01/2010 Yes
53620 Dilate urethra stricture
04/01/2010 Yes
53660 Dilation of urethra
01/01/1996 Yes
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
0421T Waterjet prostate abltj cmpl
01/01/2016 No
12001 Rpr s/n/ax/gen/trnk 2.5cm/<
10/01/2012 Yes
12002 Rpr s/n/ax/gen/trnk2.6-7.5cm
10/01/2012 Yes
12004 Rpr s/n/ax/gen/trk7.6-12.5cm
10/01/2012 Yes
12005 Rpr s/n/a/gen/trk12.6-20.0cm
10/01/2012 Yes
12006 Rpr s/n/a/gen/trk20.1-30.0cm
10/01/2012 Yes
12007 Rpr s/n/ax/gen/trnk >30.0 cm
10/01/2012 Yes
12011 Rpr f/e/e/n/l/m 2.5 cm/<
10/01/2012 Yes
12013 Rpr f/e/e/n/l/m 2.6-5.0 cm
10/01/2012 Yes
12014 Rpr f/e/e/n/l/m 5.1-7.5 cm
10/01/2012 Yes
12015 Rpr f/e/e/n/l/m 7.6-12.5 cm
10/01/2012 Yes
12016 Rpr fe/e/en/l/m 12.6-20.0 cm
10/01/2012 Yes
12017 Rpr fe/e/en/l/m 20.1-30.0 cm
10/01/2012 Yes
12018 Rpr f/e/e/n/l/m >30.0 cm
10/01/2012 Yes
12020 Closure of split wound
10/01/2012 Yes
12021 Closure of split wound
10/01/2012 Yes
12031 Intmd rpr s/a/t/ext 2.5 cm/<
10/01/2012 Yes
12032 Intmd rpr s/a/t/ext 2.6-7.5
10/01/2012 Yes
12034 Intmd rpr s/tr/ext 7.6-12.5
10/01/2012 Yes
12035 Intmd rpr s/a/t/ext 12.6-20
10/01/2012 Yes
12036 Intmd rpr s/a/t/ext 20.1-30
10/01/2012 Yes
12037 Intmd rpr s/tr/ext >30.0 cm
10/01/2012 Yes
12041 Intmd rpr n-hf/genit 2.5cm/<
10/01/2012 Yes
12042 Intmd rpr n-hf/genit2.6-7.5
10/01/2012 Yes
12044 Intmd rpr n-hf/genit7.6-12.5
10/01/2012 Yes
12045 Intmd rpr n-hf/genit12.6-20
10/01/2012 Yes
12046 Intmd rpr n-hf/genit20.1-30
10/01/2012 Yes
12047 Intmd rpr n-hf/genit >30.0cm
10/01/2012 Yes
12051 Intmd rpr face/mm 2.5 cm/<
10/01/2012 Yes
12052 Intmd rpr face/mm 2.6-5.0 cm
10/01/2012 Yes
12053 Intmd rpr face/mm 5.1-7.5 cm
10/01/2012 Yes
12054 Intmd rpr face/mm 7.6-12.5cm
10/01/2012 Yes
12055 Intmd rpr face/mm 12.6-20 cm
10/01/2012 Yes
12056 Intmd rpr face/mm 20.1-30.0
10/01/2012 Yes
12057 Intmd rpr face/mm >30.0 cm
10/01/2012 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
10/01/2012 Yes
13121 Cmplx rpr s/a/l 2.6-7.5 cm
10/01/2012 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
10/01/2012 Yes
13132 Cmplx rpr f/c/c/m/n/ax/g/h/f
10/01/2012 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
10/01/2012 Yes
13152 Cmplx rpr e/n/e/l 2.6-7.5 cm
10/01/2012 Yes
13153 Cmplx rpr e/n/e/l addl 5cm/<
10/01/2012 Yes
36000 Place needle in vein
10/01/2002 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
10/01/2002 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
43752 Nasal/orogastric w/tube plmt
04/01/2009 Yes
51700 Irrigation of bladder
01/01/1996 No
51701 Insert bladder catheter
01/01/2003 No
51702 Insert temp bladder cath
01/01/2003 No
51703 Insert bladder cath complex
10/01/2007 Yes
53000 Incision of urethra
10/01/2011 No
53010 Incision of urethra
10/01/2011 No
53020 Incision of urethra
10/01/2011 No
53025 Incision of urethra
10/01/2011 No
53080 Drainage of urinary leakage
01/01/1997 Yes
04/01/2009 No
04/01/2009 No
10/01/2002 No
10/01/2002 No
64400 N block inj trigeminal
04/01/2009 No
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
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
10/01/2002 No
64416 N block cont infuse b plex
01/01/2003 No
64417 N block inj axillary
10/01/2002 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
10/01/2002 No
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
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
69990 Microsurgery add-on
06/05/2000 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
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
10/01/2009 No
10/01/2009 No
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
G0463 Hospital outpt clinic visit
07/01/2014 Yes
G0471 Ven blood coll snf/hha
07/01/2015 No
J0670 Inj mepivacaine hcl/10 ml
07/01/2010 Yes
J2001 Lidocaine injection
07/01/2004 Yes
P9612 Catheterize for urine spec
09/05/2000 No
53665 Dilation of urethra
04/01/2010 Yes
53855 Insert prost urethral stent
01/01/2010 Yes
53860 Transurethral rf treatment
07/01/2012 Yes
55873 Cryoablate prostate
07/01/2001 Yes
C9739 Cystoscopy prostatic imp 1-3
10/01/2014 No
C9740 Cysto impl 4 or more
10/01/2014 No
(1) These codes will be denied when submitted for payment on the same date of service as 53661.

(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 53661


Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: 1 1 Not Listed
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical Not Listed
Rationale: Anatomic Consideration Anatomic Consideration 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.


   53661 Top 5 Ordering Providers National*
JANE TIJERINA -PARIS,TX 1,034
ARTHUR TIJERINA -PARIS,TX 304
STONE HALLQUIST -TULSA,OK 291
CHARLES WILSON -FLORENCE,AL 251
HENRY WAGNER -WEBSTER,TX 222

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



   Medicare Part B Utilization Data for 53661*         Hide this section.


Annual Procedures / Tests Performed / Denied


Total National Services (all modifiers) Submitted 2015: 19,314
Total Services Denied 2015: 814 (4.2%)
National Charges Submitted 2015: $ 3,459,690.00
National Charges Allowed 2015: $ 1,239,499.00
National Average (No Modifier) Fee Submitted 2015: $180.03
National Average (No Modifier) Fee Allowed 2015: $ 67.29


Top 5 Performing Specialties 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Urology 16,779 86.9% $182.60 721 4.3%
Nurse practitioner 1,576 8.2% $137.70 49 3.1%
Physician assistant
(eff 5/92)
394 2.0% $170.74 15 3.8%
Obstetrics/gynecology 228 1.2% $174.83 12 5.3%
General surgery 138 0.7% $217.66 6 4.3%

Top 5 Places of Service 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Office 18,453 95.5% $179.64 769 4.2%
Outpatient hospital 817 4.2% $155.93 29 3.5%
Ambulatory surgical center 26 0.1% $538.23 8 30.8%
Inpatient hospital 7 0.0% $348.43 3 42.9%
Mobile Unit (eff. 1/1/03) 4 0.0% $ 65.13 3 75.0%

Top 5 Modifiers Submitted 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
No Modifier 18,679 96.7% $180.03 742 4.0%
AQ 202 1.0% $ 98.95 6 3.0%
59 - Distinct Procedural Service 201 1.0% $173.50 33 16.4%
51 - Multiple Procedures 144 0.7% $174.67 22 15.3%
GW 19 0.1% $181.08 0 0.0%

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.

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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