Part B Fee Schedules

Fee Schedule 26567-27178

CPT/HCPC Code	Medicare Location	Global Surgery Indicator	Multiple Surgery Indicator	Prevailing Charge Amount	Fee Schedule Amount	Site of Service Amount
26567	003	90	2	X	1,200.80	X
26567	002	90	2	X	1,276.49	X
26567	004	90	2	X	1,187.09	X
26567	001	90	2	X	1,294.85	X
26568	004	90	2	X	1,870.00	X
26568	001	90	2	X	2,048.55	X
26568	002	90	2	X	1,908.74	X
26568	003	90	2	X	1,892.97	X
26580	002	90	2	X	3,939.27	X
26580	003	90	2	X	3,679.23	X
26580	004	90	2	X	3,628.59	X
26580	001	90	2	X	4,062.40	X
26587	003	90	2	X	1,503.11	X
26587	002	90	2	X	1,606.73	X
26587	004	90	2	X	1,485.89	X
26587	001	90	2	X	1,631.87	X
26590	002	90	2	X	1,173.58	X
26590	003	90	2	X	1,099.54	X
26590	004	90	2	X	1,086.45	X
26590	001	90	2	X	1,191.52	X
26591	002	90	2	X	622.73	X
26591	003	90	2	X	582.41	X
26591	004	90	2	X	575.66	X
26591	001	90	2	X	632.46	X
26593	001	90	2	X	1,103.00	X
26593	003	90	2	X	1,013.59	X
26593	002	90	2	X	1,085.53	X
26593	004	90	2	X	1,001.74	X
26596	003	90	2	X	1,900.26	X
26596	002	90	2	X	2,038.23	X
26596	001	90	2	X	2,071.67	X
26596	004	90	2	X	1,877.65	X
26600	004	90	2	X	368.09	290.77
26600	003	90	2	X	378.53	298.68
26600	002	90	2	X	397.18	313.85
26600	001	90	2	X	403.10	318.76
26605	004	90	2	X	548.64	X
26605	002	90	2	X	591.21	X
26605	003	90	2	X	552.02	X
26605	001	90	2	X	559.97	X
26607	001	90	2	X	1,044.67	X
26607	003	90	2	X	966.64	X
26607	002	90	2	X	1,029.43	X
26607	004	90	2	X	955.57	X
26608	002	90	2	X	1,029.43	X
26608	003	90	2	X	966.64	X
26608	004	90	2	X	955.57	X
26608	001	90	2	X	1,044.67	X
26615	001	90	2	X	1,233.12	X
26615	004	90	2	X	1,117.80	X
26615	003	90	2	X	1,131.27	X
26615	002	90	2	X	1,213.22	X
26641	002	90	2	X	430.41	X
26641	003	90	2	X	524.40	X
26641	001	90	2	X	553.20	X
26641	004	90	2	X	408.67	X
26645	001	90	2	X	757.72	X
26645	004	90	2	X	699.91	X
26645	003	90	2	X	707.83	X
26645	002	90	2	X	691.61	X
26650	001	90	2	X	1,178.01	X
26650	004	90	2	X	1,115.09	X
26650	003	90	2	X	1,059.21	X
26650	002	90	2	X	1,182.01	X
26665	001	90	2	X	1,661.90	X
26665	002	90	2	X	1,782.31	X
26665	003	90	2	X	1,736.03	X
26665	004	90	2	X	1,689.00	X
26670	001	90	2	X	508.73	X
26670	004	90	2	X	420.34	X
26670	003	90	2	X	484.07	X
26670	002	90	2	X	477.74	X
26675	001	90	2	X	1,061.53	X
26675	004	90	2	X	966.20	X
26675	003	90	2	X	978.02	X
26675	002	90	2	X	821.04	X
26676	004	90	2	X	1,114.56	X
26676	002	90	2	X	1,204.12	X
26676	003	90	2	X	1,128.04	X
26676	001	90	2	X	1,222.45	X
26685	002	90	2	X	1,473.62	X
26685	003	90	2	X	1,377.30	X
26685	004	90	2	X	1,361.04	X
26685	001	90	2	X	1,496.86	X
26686	001	90	2	X	1,681.71	X
26686	004	90	2	X	1,529.00	X
26686	002	90	2	X	1,655.48	X
26686	003	90	2	X	1,547.16	X
26700	004	90	2	X	343.67	X
26700	001	90	2	X	360.28	X
26700	003	90	2	X	367.53	X
26700	002	90	2	X	426.00	X
26705	001	90	2	X	649.75	X
26705	002	90	2	X	640.17	X
26705	003	90	2	X	625.40	X
26705	004	90	2	X	625.99	X
26706	004	90	2	X	1,065.64	X
26706	002	90	2	X	1,156.24	X
26706	001	90	2	X	1,175.14	X
26706	003	90	2	X	1,078.48	X
26715	001	90	2	X	1,162.37	X
26715	004	90	2	X	1,060.99	X
26715	003	90	2	X	1,073.35	X
26715	002	90	2	X	1,145.00	X
26720	004	90	2	X	290.12	235.09
26720	002	90	2	X	311.47	252.23
26720	003	90	2	X	293.52	237.59
26720	001	90	2	X	315.83	255.81
26725	003	90	2	X	473.39	X
26725	002	90	2	X	505.01	X
26725	004	90	2	X	477.81	X
26725	001	90	2	X	503.70	X
26727	001	90	2	X	1,071.48	X
26727	003	90	2	X	811.70	X
26727	002	90	2	X	1,066.76	X
26727	004	90	2	X	941.50	X
26735	001	90	2	X	1,169.85	X
26735	003	90	2	X	1,052.01	X
26735	002	90	2	X	1,119.33	X
26735	004	90	2	X	1,084.68	X
26740	004	90	2	X	258.77	X
26740	003	90	2	X	326.87	X
26740	002	90	2	X	273.31	X
26740	001	90	2	X	275.58	X
26742	002	90	2	X	602.94	X
26742	003	90	2	X	551.66	X
26742	004	90	2	X	574.85	X
26742	001	90	2	X	609.72	X
26746	004	90	2	X	1,201.11	X
26746	002	90	2	X	1,275.89	X
26746	003	90	2	X	1,185.82	X
26746	001	90	2	X	1,260.20	X
26750	004	90	2	X	262.27	X
26750	001	90	2	X	282.67	X
26750	002	90	2	X	279.28	X
26750	003	90	2	X	265.28	X
26755	001	90	2	X	458.57	X
26755	003	90	2	X	396.18	X
26755	002	90	2	X	413.06	X
26755	004	90	2	X	398.90	X
26756	003	90	2	X	673.39	X
26756	002	90	2	X	711.64	X
26756	004	90	2	X	665.96	X
26756	001	90	2	X	721.00	X
26765	004	90	2	X	857.23	X
26765	002	90	2	X	952.59	X
26765	003	90	2	X	746.79	X
26765	001	90	2	X	1,008.49	X
26770	001	90	2	X	373.69	X
26770	003	90	2	X	350.96	X
26770	002	90	2	X	389.79	X
26770	004	90	2	X	338.05	X
26775	003	90	2	X	414.09	X
26775	002	90	2	X	515.01	X
26775	004	90	2	X	500.12	X
26775	001	90	2	X	431.28	X
26776	002	90	2	X	753.04	X
26776	003	90	2	X	736.59	X
26776	001	90	2	X	788.11	X
26776	004	90	2	X	728.55	X
26785	001	90	2	X	852.35	X
26785	004	90	2	X	778.37	X
26785	003	90	2	X	787.46	X
26785	002	90	2	X	839.78	X
26820	002	90	2	X	1,733.13	X
26820	003	90	2	X	1,621.36	X
26820	001	90	2	X	1,760.20	X
26820	004	90	2	X	1,602.24	X
26841	001	90	2	X	1,585.33	X
26841	004	90	2	X	1,487.49	X
26841	002	90	2	X	1,560.21	X
26841	003	90	2	X	1,494.72	X
26842	004	90	2	X	1,821.88	X
26842	002	90	2	X	1,983.45	X
26842	003	90	2	X	1,844.20	X
26842	001	90	2	X	2,017.10	X
26843	001	90	2	X	1,668.93	X
26843	004	90	2	X	1,513.20	X
26843	003	90	2	X	1,531.22	X
26843	002	90	2	X	1,642.02	X
26844	002	90	2	X	1,873.48	X
26844	003	90	2	X	1,749.65	X
26844	001	90	2	X	1,903.44	X
26844	004	90	2	X	1,728.97	X
26850	004	90	2	X	1,235.38	X
26850	002	90	2	X	1,390.11	X
26850	003	90	2	X	1,309.68	X
26850	001	90	2	X	1,403.93	X
26852	003	90	2	X	1,535.02	X
26852	002	90	2	X	1,596.72	X
26852	004	90	2	X	1,517.36	X
26852	001	90	2	X	1,664.32	X
26860	004	90	2	X	1,063.91	X
26860	002	90	2	X	1,058.67	X
26860	003	90	2	X	1,060.18	X
26860	001	90	2	X	1,128.78	X
26861	002	ZZZ	0	X	766.18	X
26861	003	ZZZ	0	X	749.14	X
26861	004	ZZZ	0	X	472.14	X
26861	001	ZZZ	0	X	527.68	X
26862	004	90	2	X	1,350.41	X
26862	001	90	2	X	1,931.57	X
26862	003	90	2	X	1,574.28	X
26862	002	90	2	X	1,457.33	X
26863	001	ZZZ	0	X	891.13	X
26863	003	ZZZ	0	X	818.31	X
26863	002	ZZZ	0	X	876.93	X
26863	004	ZZZ	0	X	808.77	X
26910	004	90	2	X	1,476.74	X
26910	003	90	2	X	1,475.49	X
26910	002	90	2	X	1,523.37	X
26910	001	90	2	X	1,533.14	X
26951	001	90	2	X	896.27	X
26951	004	90	2	X	803.85	X
26951	003	90	2	X	813.13	X
26951	002	90	2	X	866.05	X
26952	001	90	2	X	1,464.91	X
26952	003	90	2	X	1,426.54	X
26952	002	90	2	X	1,457.36	X
26952	004	90	2	X	1,421.16	X
26989		YYY	2	X	#	X
26990	004	90	2	X	866.88	X
26990	001	90	2	X	950.44	X
26990	002	90	2	X	945.22	X
26990	003	90	2	X	911.83	X
26991	002	90	2	X	638.40	X
26991	003	90	2	X	615.07	X
26991	004	90	2	X	848.39	X
26991	001	90	2	X	551.82	X
26992	001	90	2	X	2,132.80	X
26992	004	90	2	X	1,917.05	X
26992	002	90	2	X	2,115.20	X
26992	003	90	2	X	2,018.92	X
27000	001	90	2	X	818.56	X
27000	004	90	2	X	764.90	X
27000	002	90	2	X	809.69	X
27000	003	90	2	X	773.28	X
27001	004	90	2	X	1,024.47	X
27001	003	90	2	X	1,039.50	X
27001	002	90	2	X	1,069.67	X
27001	001	90	2	X	1,161.90	X
27003	004	90	2	X	1,479.96	X
27003	001	90	2	X	1,636.25	X
27003	003	90	2	X	1,497.97	X
27003	002	90	2	X	1,608.65	X
27005	002	90	2	X	1,427.15	X
27005	003	90	2	X	1,356.79	X
27005	004	90	2	X	1,342.30	X
27005	001	90	2	X	1,444.26	X
27006	002	90	2	X	1,654.00	X
27006	003	90	2	X	1,563.63	X
27006	001	90	2	X	1,676.02	X
27006	004	90	2	X	1,546.34	X
27025	001	90	2	X	1,950.97	X
27025	003	90	2	X	1,961.63	X
27025	002	90	2	X	1,923.51	X
27025	004	90	2	X	1,790.02	X
27027	003	90	2	X	1,417.04	X
27027	002	90	2	X	1,417.04	X
27027	004	90	2	X	1,417.04	X
27027	001	90	2	X	1,579.85	X
27030	004	90	2	X	2,613.34	X
27030	001	90	2	X	3,028.42	X
27030	003	90	2	X	2,644.86	X
27030	002	90	2	X	3,009.08	X
27033	004	90	2	X	2,932.34	X
27033	001	90	2	X	3,045.92	X
27033	002	90	2	X	3,026.35	X
27033	003	90	2	X	2,685.28	X
27035	002	90	2	X	3,331.55	X
27035	003	90	2	X	3,111.27	X
27035	001	90	2	X	3,384.99	X
27035	004	90	2	X	3,075.56	X
27036	001	90	2	X	2,921.07	X
27036	003	90	2	X	2,543.23	X
27036	002	90	2	X	2,613.40	X
27036	004	90	2	X	2,543.23	X
27040	003	10	2	X	302.91	X
27040	002	10	2	X	324.07	X
27040	001	10	2	X	313.60	X
27040	004	10	2	X	296.08	X
27041	004	90	2	X	817.14	X
27041	002	90	2	X	875.53	X
27041	003	90	2	X	824.41	X
27041	001	90	2	X	879.25	X
27043	001	90	2	X	887.49	X
27043	004	90	2	X	790.07	X
27043	003	90	2	X	790.07	X
27043	002	90	2	X	790.07	X
27045	003	90	2	X	1,256.05	X
27045	002	90	2	X	1,256.05	X
27045	004	90	2	X	1,256.05	X
27045	001	90	2	X	1,409.09	X
27047	003	90	2	X	779.55	X
27047	002	90	2	X	826.64	X
27047	001	90	2	X	858.28	X
27047	004	90	2	X	976.01	X
27048	001	90	2	X	928.90	X
27048	003	90	2	X	1,133.48	X
27048	002	90	2	X	917.36	X
27048	004	90	2	X	864.78	X
27049	001	90	2	X	2,234.20	X
27049	003	90	2	X	2,561.04	X
27049	002	90	2	X	2,208.45	X
27049	004	90	2	X	2,531.36	X
27050	001	90	2	X	1,129.60	X
27050	003	90	2	X	1,023.69	X
27050	002	90	2	X	1,109.05	X
27050	004	90	2	X	1,011.12	X
27052	001	90	2	X	2,349.68	X
27052	003	90	2	X	1,660.05	X
27052	002	90	2	X	2,282.87	X
27052	004	90	2	X	1,639.35	X
27054	002	90	2	X	3,241.99	X
27054	003	90	2	X	3,007.32	X
27054	004	90	2	X	2,274.43	X
27054	001	90	2	X	3,446.54	X
27057	004	90	2	X	1,556.77	X
27057	002	90	2	X	1,556.77	X
27057	003	90	2	X	1,556.77	X
27057	001	90	2	X	1,717.01	X
27059	003	90	2	X	3,089.73	X
27059	002	90	2	X	3,089.73	X
27059	004	90	2	X	3,089.73	X
27059	001	90	2	X	3,449.27	X
27060	004	90	2	X	963.24	X
27060	002	90	2	X	1,008.55	X
27060	003	90	2	X	974.54	X
27060	001	90	2	X	1,060.72	X
27062	002	90	2	X	1,081.12	X
27062	003	90	2	X	1,009.00	X
27062	004	90	2	X	997.08	X
27062	001	90	2	X	1,098.64	X
27065	004	90	2	X	1,179.85	X
27065	002	90	2	X	1,575.77	X
27065	003	90	2	X	1,329.41	X
27065	001	90	2	X	1,307.02	X
27066	003	90	2	X	1,916.29	X
27066	002	90	2	X	2,123.01	X
27066	004	90	2	X	2,037.50	X
27066	001	90	2	X	2,149.80	X
27067	001	90	2	X	2,977.30	X
27067	002	90	2	X	2,944.54	X
27067	003	90	2	X	2,732.13	X
27067	004	90	2	X	2,699.80	X
27070	004	90	2	X	1,878.47	X
27070	001	90	2	X	2,060.40	X
27070	002	90	2	X	1,960.97	X
27070	003	90	2	X	1,900.55	X
27071	002	90	2	X	2,319.03	X
27071	003	90	2	X	2,092.91	X
27071	004	90	2	X	2,081.38	X
27071	001	90	2	X	2,291.06	X
27075	001	90	2	X	3,603.90	X
27075	002	90	2	X	3,546.58	X
27075	003	90	2	X	3,309.91	X
27075	004	90	2	X	3,271.16	X
27076	004	90	2	X	3,803.53	X
27076	001	90	2	X	4,188.45	X
27076	003	90	2	X	3,849.18	X
27076	002	90	2	X	4,122.33	X
27077	001	90	2	X	4,947.73	X
27077	003	90	2	X	4,539.57	X
27077	002	90	2	X	4,868.20	X
27077	004	90	2	X	4,486.15	X
27078	002	90	2	X	2,700.69	X
27078	003	90	2	X	2,373.88	X
27078	001	90	2	X	3,288.60	X
27078	004	90	2	X	2,346.49	X
27080	004	90	2	X	1,163.10	X
27080	002	90	2	X	1,262.75	X
27080	003	90	2	X	1,176.78	X
27080	001	90	2	X	1,283.66	X
27086	003	10	2	X	237.53	X
27086	002	10	2	X	237.75	X
27086	001	10	2	X	274.47	X
27086	004	10	2	X	229.54	X
27087	001	90	2	X	1,187.21	X
27087	003	90	2	X	1,135.67	X
27087	002	90	2	X	1,177.21	X
27087	004	90	2	X	1,269.41	X
27090	001	90	2	X	2,551.22	X
27090	003	90	2	X	2,355.36	X
27090	002	90	2	X	2,513.05	X
27090	004	90	2	X	2,328.10	X
27091	003	90	2	X	5,263.37	X
27091	002	90	2	X	6,389.47	X
27091	004	90	2	X	5,573.16	X
27091	001	90	2	X	6,448.15	X
27093	004	0	2	X	230.07	X
27093	002	0	2	X	242.25	X
27093	003	0	2	X	221.37	X
27093	001	0	2	X	239.12	X
27095	001	0	2	X	269.17	X
27095	004	0	2	X	247.94	X
27095	002	0	2	X	265.61	X
27095	003	0	2	X	249.64	X
27096	001	0	2	X	1,083.58	145.94
27096	004	0	2	X	934.38	132.80
27096	002	0	2	X	934.38	132.80
27096	003	0	2	X	934.38	132.80
27097	001	90	2	X	1,937.76	X
27097	004	90	2	X	1,756.32	X
27097	003	90	2	X	1,777.51	X
27097	002	90	2	X	1,906.51	X
27098	001	90	2	X	1,937.76	X
27098	003	90	2	X	1,777.51	X
27098	002	90	2	X	1,906.51	X
27098	004	90	2	X	1,756.32	X
27100	001	90	2	X	2,411.78	X
27100	004	90	2	X	2,033.39	X
27100	003	90	2	X	2,420.68	X
27100	002	90	2	X	2,200.43	X
27105	001	90	2	X	2,105.21	X
27105	003	90	2	X	1,941.59	X
27105	002	90	2	X	2,073.22	X
27105	004	90	2	X	1,920.50	X
27110	001	90	2	X	2,838.11	X
27110	004	90	2	X	2,574.79	X
27110	003	90	2	X	2,665.42	X
27110	002	90	2	X	3,137.09	X
27111	003	90	2	X	2,575.66	X
27111	002	90	2	X	3,121.77	X
27111	004	90	2	X	2,544.48	X
27111	001	90	2	X	2,800.09	X
27120	003	90	2	X	3,901.83	X
27120	002	90	2	X	4,319.75	X
27120	004	90	2	X	4,000.56	X
27120	001	90	2	X	4,344.72	X
27122	001	90	2	X	4,222.43	X
27122	004	90	2	X	3,760.07	X
27122	002	90	2	X	4,088.58	X
27122	003	90	2	X	3,750.77	X
27125	003	90	2	X	3,749.15	X
27125	002	90	2	X	4,017.59	X
27125	004	90	2	X	3,693.79	X
27125	001	90	2	X	4,082.58	X
27130	001	90	2	X	6,203.37	X
27130	004	90	2	X	5,597.13	X
27130	003	90	2	X	5,725.12	X
27130	002	90	2	X	6,091.89	X
27132	002	90	2	X	6,765.05	X
27132	003	90	2	X	6,321.90	X
27132	004	90	2	X	5,709.28	X
27132	001	90	2	X	6,376.96	X
27134	003	90	2	X	7,445.20	X
27134	002	90	2	X	7,901.57	X
27134	004	90	2	X	7,276.09	X
27134	001	90	2	X	7,855.38	X
27137	003	90	2	X	5,878.18	X
27137	002	90	2	X	6,256.54	X
27137	001	90	2	X	6,312.57	X
27137	004	90	2	X	5,838.93	X
27138	001	90	2	X	5,568.06	X
27138	004	90	2	X	5,073.93	X
27138	003	90	2	X	5,113.86	X
27138	002	90	2	X	5,500.26	X
27140	001	90	2	X	2,745.16	X
27140	004	90	2	X	2,491.33	X
27140	003	90	2	X	2,235.34	X
27140	002	90	2	X	2,535.52	X
27146	002	90	2	X	2,874.96	X
27146	003	90	2	X	2,707.87	X
27146	004	90	2	X	2,675.80	X
27146	001	90	2	X	2,915.41	X
27147	004	90	2	X	3,843.37	X
27147	002	90	2	X	4,128.92	X
27147	003	90	2	X	3,889.74	X
27147	001	90	2	X	4,241.42	X
27151	001	90	2	X	4,454.95	X
27151	004	90	2	X	4,037.42	X
27151	002	90	2	X	4,383.02	X
27151	003	90	2	X	4,086.13	X
27156	001	90	2	X	4,722.70	X
27156	004	90	2	X	4,282.26	X
27156	002	90	2	X	4,646.89	X
27156	003	90	2	X	4,333.43	X
27158	004	90	2	X	3,629.18	X
27158	001	90	2	X	3,998.72	X
27158	003	90	2	X	3,671.62	X
27158	002	90	2	X	3,934.87	X
27161	001	90	2	X	3,615.14	X
27161	004	90	2	X	3,278.77	X
27161	002	90	2	X	3,557.28	X
27161	003	90	2	X	3,318.23	X
27165	002	90	2	X	3,979.94	X
27165	003	90	2	X	3,707.92	X
27165	004	90	2	X	3,663.25	X
27165	001	90	2	X	4,045.71	X
27170	003	90	2	X	3,899.51	X
27170	002	90	2	X	4,185.58	X
27170	004	90	2	X	3,945.17	X
27170	001	90	2	X	4,286.39	X
27175	002	90	2	X	941.87	X
27175	003	90	2	X	907.29	X
27175	004	90	2	X	898.24	X
27175	001	90	2	X	950.38	X
27176	002	90	2	X	2,570.42	X
27176	003	90	2	X	2,396.17	X
27176	001	90	2	X	2,612.58	X
27176	004	90	2	X	2,367.64	X
27177	003	90	2	X	2,940.97	X
27177	002	90	2	X	3,722.40	X
27177	004	90	2	X	2,906.27	X
27177	001	90	2	X	3,202.71	X
27178	003	90	2	X	2,373.78	X
27178	002	90	2	X	2,540.90	X
27178	001	90	2	X	2,581.24	X
27178	004	90	2	X	2,345.26	X

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