Part B Fee Schedules

Fee Schedule 55530-57511

CPT/HCPC Code	Medicare Location	Global Surgery Indicator	Multiple Surgery Indicator	Prevailing Charge Amount	Fee Schedule Amount	Site of Service Amount
55530	004	90	2	X	1,158.52	X
55530	001	90	2	X	1,265.99	X
55530	003	90	2	X	1,172.80	X
55530	002	90	2	X	1,247.85	X
55535	001	90	2	X	1,239.52	X
55535	004	90	2	X	1,145.65	X
55535	002	90	2	X	1,223.85	X
55535	003	90	2	X	1,258.99	X
55540	001	90	2	X	1,441.69	X
55540	004	90	2	X	1,740.84	X
55540	003	90	2	X	1,709.84	X
55540	002	90	2	X	1,796.87	X
55550	002	90	2	X	945.22	X
55550	003	90	2	X	945.22	X
55550	001	90	2	X	1,044.32	X
55550	004	90	2	X	945.22	X
55559		YYY	2	X	#	X
55600	002	90	2	X	1,211.83	X
55600	003	90	2	X	1,142.95	X
55600	001	90	2	X	1,228.52	X
55600	004	90	2	X	1,129.60	X
55605	004	90	2	X	1,422.84	X
55605	001	90	2	X	1,542.32	X
55605	002	90	2	X	1,522.37	X
55605	003	90	2	X	1,439.86	X
55650	001	90	2	X	2,149.18	X
55650	003	90	2	X	2,377.18	X
55650	002	90	2	X	2,122.61	X
55650	004	90	2	X	1,989.08	X
55680	004	90	2	X	990.44	X
55680	002	90	2	X	1,060.40	X
55680	003	90	2	X	1,002.80	X
55680	001	90	2	X	1,074.32	X
55700	003	0	2	X	399.74	X
55700	002	0	2	X	483.52	X
55700	004	0	2	X	398.00	X
55700	001	0	2	X	494.45	X
55705	001	10	2	X	1,183.67	X
55705	003	10	2	X	1,062.61	X
55705	002	10	2	X	1,178.81	X
55705	004	10	2	X	1,075.72	X
55706	004	10	2	X	686.56	X
55706	001	10	2	X	755.14	X
55706	002	10	2	X	686.56	X
55706	003	10	2	X	686.56	X
55720	003	90	2	X	1,196.69	X
55720	002	90	2	X	1,255.31	X
55720	004	90	2	X	1,183.31	X
55720	001	90	2	X	1,269.52	X
55725	003	90	2	X	1,448.21	X
55725	002	90	2	X	1,528.69	X
55725	001	90	2	X	1,548.12	X
55725	004	90	2	X	1,679.37	X
55801	002	90	2	X	3,368.48	X
55801	003	90	2	X	3,178.68	X
55801	004	90	2	X	3,140.87	X
55801	001	90	2	X	3,414.39	X
55810	002	90	2	X	4,580.92	X
55810	003	90	2	X	4,476.15	X
55810	004	90	2	X	4,211.06	X
55810	001	90	2	X	4,572.32	X
55812	003	90	2	X	4,731.55	X
55812	002	90	2	X	4,999.73	X
55812	001	90	2	X	5,064.59	X
55812	004	90	2	X	4,676.18	X
55815	004	90	2	X	5,777.36	X
55815	003	90	2	X	5,848.39	X
55815	002	90	2	X	6,193.03	X
55815	001	90	2	X	6,275.95	X
55821	002	90	2	X	3,089.12	X
55821	003	90	2	X	2,907.46	X
55821	004	90	2	X	2,929.70	X
55821	001	90	2	X	3,132.77	X
55831	003	90	2	X	3,155.30	X
55831	002	90	2	X	3,351.04	X
55831	004	90	2	X	3,116.34	X
55831	001	90	2	X	3,398.18	X
55840	001	90	2	X	4,405.21	X
55840	004	90	2	X	4,065.41	X
55840	002	90	2	X	4,348.75	X
55840	003	90	2	X	4,114.62	X
55842	004	90	2	X	4,863.51	X
55842	002	90	2	X	4,998.45	X
55842	003	90	2	X	4,886.62	X
55842	001	90	2	X	5,025.50	X
55845	002	90	2	X	5,996.15	X
55845	003	90	2	X	5,728.20	X
55845	001	90	2	X	6,078.17	X
55845	004	90	2	X	5,694.10	X
55860	002	90	2	X	2,328.47	X
55860	003	90	2	X	2,216.54	X
55860	004	90	2	X	2,191.22	X
55860	001	90	2	X	2,355.56	X
55862	002	90	2	X	3,306.17	X
55862	003	90	2	X	3,132.75	X
55862	001	90	2	X	3,348.17	X
55862	004	90	2	X	3,095.97	X
55865	001	90	2	X	5,428.08	X
55865	004	90	2	X	4,988.10	X
55865	002	90	2	X	5,383.64	X
55865	003	90	2	X	5,051.42	X
55866	001	90	2	X	3,775.15	X
55866	004	90	2	X	3,461.58	X
55866	002	90	2	X	3,461.58	X
55866	003	90	2	X	3,461.58	X
55867	001	90	2	X	1,289.95	X
55867	004	90	2	X	1,197.35	X
55867	003	90	2	X	1,197.35	X
55867	002	90	2	X	1,197.35	X
55870		0	2	X	*	X
55873	001	90	2	X	2,724.01	X
55873	004	90	2	X	2,471.13	X
55873	002	90	2	X	2,471.13	X
55873	003	90	2	X	2,471.13	X
55874	001	0	2	X	5,955.73	269.65
55874	003	0	2	X	5,204.41	248.96
55874	002	0	2	X	5,204.41	248.96
55874	004	0	2	X	5,204.41	248.96
55875	003	90	2	X	1,268.68	X
55875	002	90	2	X	1,268.68	X
55875	004	90	2	X	1,268.68	X
55875	001	90	2	X	1,412.80	X
55876	001	0	2	X	292.04	214.79
55876	004	0	2	X	249.89	186.74
55876	002	0	2	X	249.89	186.74
55876	003	0	2	X	249.89	186.74
55880	004	90	2	X	1,284.58	X
55880	001	90	2	X	1,390.86	X
55880	003	90	2	X	1,284.58	X
55880	002	90	2	X	1,284.58	X
55899		YYY	2	X	#	X
55920	004	0	2	X	758.28	X
55920	002	0	2	X	758.28	X
55920	001	0	2	X	830.95	X
55920	003	0	2	X	758.28	X
56405	001	10	2	X	313.25	X
56405	004	10	2	X	315.58	X
56405	003	10	2	X	317.69	X
56405	002	10	2	X	321.55	X
56420	001	10	2	X	303.16	X
56420	004	10	2	X	278.69	X
56420	003	10	2	X	293.75	X
56420	002	10	2	X	296.35	X
56440	002	10	2	X	668.72	X
56440	003	10	2	X	619.89	X
56440	001	10	2	X	680.52	X
56440	004	10	2	X	612.66	X
56441	004	10	2	X	398.84	X
56441	001	10	2	X	440.18	X
56441	002	10	2	X	433.00	X
56441	003	10	2	X	403.57	X
56442	004	0	2	X	78.11	X
56442	001	0	2	X	89.42	X
56442	002	0	2	X	78.11	X
56442	003	0	2	X	78.11	X
56501	004	10	2	X	280.25	246.15
56501	001	10	2	X	325.86	284.71
56501	003	10	2	X	261.85	229.28
56501	002	10	2	X	329.27	288.66
56515	002	10	2	X	1,014.20	X
56515	003	10	2	X	999.23	X
56515	001	10	2	X	1,027.60	X
56515	004	10	2	X	765.24	X
56605	004	0	2	X	247.20	X
56605	001	0	2	X	306.73	X
56605	003	0	2	X	258.03	X
56605	002	0	2	X	314.55	X
56606	003	ZZZ	0	X	88.92	X
56606	002	ZZZ	0	X	95.89	X
56606	004	ZZZ	0	X	87.82	X
56606	001	ZZZ	0	X	97.59	X
56620	004	90	2	X	1,549.34	X
56620	002	90	2	X	1,628.15	X
56620	003	90	2	X	1,541.36	X
56620	001	90	2	X	1,684.40	X
56625	002	90	2	X	2,167.24	X
56625	003	90	2	X	1,986.31	X
56625	004	90	2	X	1,962.69	X
56625	001	90	2	X	2,319.28	X
56630	003	90	2	X	4,420.93	X
56630	002	90	2	X	4,537.97	X
56630	004	90	2	X	2,925.47	X
56630	001	90	2	X	4,553.56	X
56631	003	90	2	X	4,040.17	X
56631	002	90	2	X	4,417.95	X
56631	001	90	2	X	4,509.54	X
56631	004	90	2	X	3,991.95	X
56632	002	90	2	X	4,813.49	X
56632	003	90	2	X	4,420.78	X
56632	004	90	2	X	4,367.79	X
56632	001	90	2	X	4,908.72	X
56633	001	90	2	X	4,704.85	X
56633	004	90	2	X	3,262.33	X
56633	003	90	2	X	4,565.93	X
56633	002	90	2	X	4,688.08	X
56634	004	90	2	X	4,348.57	X
56634	003	90	2	X	4,401.30	X
56634	002	90	2	X	4,793.22	X
56634	001	90	2	X	4,888.12	X
56637	004	90	2	X	4,584.70	X
56637	003	90	2	X	4,639.81	X
56637	002	90	2	X	5,038.20	X
56637	001	90	2	X	5,134.77	X
56640	001	90	2	X	5,108.83	X
56640	004	90	2	X	4,575.17	X
56640	002	90	2	X	5,015.20	X
56640	003	90	2	X	4,629.14	X
56700	003	10	2	X	479.45	X
56700	002	10	2	X	513.69	X
56700	001	10	2	X	521.96	X
56700	004	10	2	X	474.00	X
56740	004	10	2	X	746.05	X
56740	002	10	2	X	810.04	X
56740	003	10	2	X	733.36	X
56740	001	10	2	X	800.18	X
56800	001	10	2	X	822.96	X
56800	003	10	2	X	906.43	X
56800	002	10	2	X	936.64	X
56800	004	10	2	X	745.50	X
56805	001	90	2	X	3,209.13	X
56805	004	90	2	X	2,952.27	X
56805	002	90	2	X	3,166.06	X
56805	003	90	2	X	2,987.74	X
56810	001	10	2	X	911.84	X
56810	002	10	2	X	890.41	X
56810	003	10	2	X	861.68	X
56810	004	10	2	X	872.55	X
56820	003	0	2	X	251.74	176.66
56820	002	0	2	X	251.74	176.66
56820	004	0	2	X	251.74	176.66
56820	001	0	2	X	282.91	194.71
56821	001	0	2	X	366.15	268.12
56821	004	0	2	X	326.81	243.43
56821	003	0	2	X	326.81	243.43
56821	002	0	2	X	326.81	243.43
57000	003	10	2	X	350.45	X
57000	002	10	2	X	645.85	X
57000	004	10	2	X	546.83	X
57000	001	10	2	X	696.59	X
57010	001	90	2	X	954.31	X
57010	004	90	2	X	889.22	X
57010	003	90	2	X	898.99	X
57010	002	90	2	X	956.51	X
57020	001	0	2	X	259.00	X
57020	004	0	2	X	238.20	X
57020	002	0	2	X	255.35	X
57020	003	0	2	X	240.84	X
57022	001	10	2	X	404.57	X
57022	003	10	2	X	366.57	X
57022	002	10	2	X	366.57	X
57022	004	10	2	X	366.57	X
57023	001	10	2	X	404.57	X
57023	003	10	2	X	366.57	X
57023	002	10	2	X	366.57	X
57023	004	10	2	X	366.57	X
57061	002	10	2	X	324.37	X
57061	003	10	2	X	325.75	X
57061	001	10	2	X	334.26	X
57061	004	10	2	X	312.83	X
57065	004	10	2	X	1,051.32	X
57065	001	10	2	X	1,087.55	X
57065	003	10	2	X	1,054.76	X
57065	002	10	2	X	1,081.12	X
57100	003	0	2	X	315.87	260.27
57100	002	0	2	X	317.84	262.43
57100	004	0	2	X	306.75	252.35
57100	001	0	2	X	318.39	262.49
57105	004	10	2	X	395.75	X
57105	002	10	2	X	409.39	X
57105	003	10	2	X	391.77	X
57105	001	10	2	X	416.14	X
57106	002	90	2	X	806.85	X
57106	003	90	2	X	806.85	X
57106	004	90	2	X	806.85	X
57106	001	90	2	X	904.16	X
57107	001	90	2	X	3,015.04	2,997.73
57107	003	90	2	X	2,778.68	2,763.83
57107	002	90	2	X	2,778.68	2,763.83
57107	004	90	2	X	2,778.68	2,763.83
57109	001	90	2	X	3,714.26	3,671.87
57109	004	90	2	X	3,340.81	3,304.57
57109	003	90	2	X	3,340.81	3,304.57
57109	002	90	2	X	3,340.81	3,304.57
57110	002	90	2	X	2,327.33	X
57110	003	90	2	X	2,256.43	X
57110	004	90	2	X	2,245.16	X
57110	001	90	2	X	2,344.53	X
57111	001	90	2	X	3,678.62	3,745.10
57111	004	90	2	X	3,310.30	3,367.16
57111	003	90	2	X	3,310.30	3,367.16
57111	002	90	2	X	3,310.30	3,367.16
57120	003	90	2	X	1,840.42	X
57120	001	90	2	X	1,753.59	X
57120	002	90	2	X	1,721.19	X
57120	004	90	2	X	1,568.80	X
57130	001	10	2	X	642.23	X
57130	004	10	2	X	574.27	X
57130	002	10	2	X	652.08	X
57130	003	10	2	X	581.14	X
57135	004	10	2	X	510.89	X
57135	001	10	2	X	573.79	X
57135	003	10	2	X	516.86	X
57135	002	10	2	X	553.68	X
57150	004	0	2	X	121.90	112.42
57150	002	0	2	X	128.51	118.48
57150	003	0	2	X	123.03	113.45
57150	001	0	2	X	129.96	119.70
57155	004	0	2	X	827.17	X
57155	001	0	2	X	926.65	X
57155	002	0	2	X	827.17	X
57155	003	0	2	X	827.17	X
57156	001	0	2	X	280.81	191.47
57156	004	0	2	X	256.44	177.52
57156	002	0	2	X	256.44	177.52
57156	003	0	2	X	256.44	177.52
57160	002	0	2	X	121.93	109.40
57160	003	0	2	X	113.51	102.04
57160	004	0	2	X	115.29	103.92
57160	001	0	2	X	122.93	110.67
57170		0	2	X	*	X
57180	001	10	2	X	235.55	X
57180	004	10	2	X	225.10	X
57180	002	10	2	X	233.86	X
57180	003	10	2	X	226.56	X
57200	001	90	2	X	799.78	X
57200	002	90	2	X	786.27	X
57200	003	90	2	X	741.51	X
57200	004	90	2	X	746.08	X
57210	001	90	2	X	1,056.56	X
57210	004	90	2	X	980.05	X
57210	003	90	2	X	969.82	X
57210	002	90	2	X	1,016.13	X
57220	002	90	2	X	1,024.33	X
57220	003	90	2	X	1,067.58	X
57220	001	90	2	X	1,064.25	X
57220	004	90	2	X	936.83	X
57230	002	90	2	X	1,065.77	X
57230	003	90	2	X	1,068.93	X
57230	001	90	2	X	1,082.26	X
57230	004	90	2	X	986.45	X
57240	003	90	2	X	1,464.29	X
57240	002	90	2	X	1,599.44	X
57240	004	90	2	X	1,446.83	X
57240	001	90	2	X	1,632.22	X
57250	004	90	2	X	1,414.62	X
57250	001	90	2	X	1,712.33	X
57250	003	90	2	X	1,431.61	X
57250	002	90	2	X	1,570.28	X
57260	004	90	2	X	1,971.92	X
57260	002	90	2	X	2,089.70	X
57260	001	90	2	X	2,090.75	X
57260	003	90	2	X	1,887.10	X
57265	004	90	2	X	1,941.32	X
57265	001	90	2	X	2,187.18	X
57265	002	90	2	X	2,143.78	X
57265	003	90	2	X	1,964.66	X
57267	001	ZZZ	0	X	636.23	X
57267	003	ZZZ	0	X	570.68	X
57267	002	ZZZ	0	X	570.68	X
57267	004	ZZZ	0	X	570.68	X
57268	004	90	2	X	1,534.60	X
57268	002	90	2	X	1,659.38	X
57268	003	90	2	X	1,527.41	X
57268	001	90	2	X	1,691.39	X
57270	004	90	2	X	1,690.97	X
57270	003	90	2	X	1,669.87	X
57270	002	90	2	X	1,762.18	X
57270	001	90	2	X	1,794.03	X
57280	001	90	2	X	2,154.97	X
57280	003	90	2	X	1,951.59	X
57280	002	90	2	X	2,115.29	X
57280	004	90	2	X	1,928.75	X
57282	004	90	2	X	1,922.63	X
57282	001	90	2	X	2,151.90	X
57282	003	90	2	X	1,945.56	X
57282	002	90	2	X	2,111.58	X
57283	004	90	2	X	1,353.39	X
57283	001	90	2	X	1,502.65	X
57283	003	90	2	X	1,353.39	X
57283	002	90	2	X	1,353.39	X
57284	004	90	2	X	2,329.49	X
57284	002	90	2	X	2,499.42	X
57284	003	90	2	X	2,363.09	X
57284	001	90	2	X	2,593.73	X
57285	004	90	2	X	1,091.23	X
57285	003	90	2	X	1,091.23	X
57285	002	90	2	X	1,091.23	X
57285	001	90	2	X	1,195.92	X
57287	003	90	2	X	1,563.93	X
57287	002	90	2	X	1,563.93	X
57287	001	90	2	X	1,730.77	X
57287	004	90	2	X	1,563.93	X
57288	003	90	2	X	2,488.39	X
57288	001	90	2	X	2,637.65	X
57288	002	90	2	X	2,581.83	X
57288	004	90	2	X	2,494.76	X
57289	003	90	2	X	1,652.94	X
57289	002	90	2	X	1,775.30	X
57289	001	90	2	X	1,804.80	X
57289	004	90	2	X	1,632.26	X
57291	004	90	2	X	1,446.64	X
57291	001	90	2	X	1,599.50	X
57291	002	90	2	X	1,572.79	X
57291	003	90	2	X	1,463.08	X
57292	003	90	2	X	2,124.68	X
57292	002	90	2	X	2,263.94	X
57292	004	90	2	X	2,101.40	X
57292	001	90	2	X	2,297.83	X
57295	001	90	2	X	998.50	X
57295	004	90	2	X	886.28	X
57295	002	90	2	X	886.28	X
57295	003	90	2	X	886.28	X
57296	001	90	2	X	1,714.39	X
57296	004	90	2	X	1,529.25	X
57296	003	90	2	X	1,529.25	X
57296	002	90	2	X	1,529.25	X
57300	003	90	2	X	1,811.05	X
57300	002	90	2	X	1,898.38	X
57300	004	90	2	X	1,848.08	X
57300	001	90	2	X	1,972.18	X
57305	004	90	2	X	2,548.25	X
57305	001	90	2	X	2,037.74	X
57305	002	90	2	X	2,667.78	X
57305	003	90	2	X	1,858.05	X
57307	003	90	2	X	1,825.15	X
57307	002	90	2	X	1,950.62	X
57307	001	90	2	X	1,981.10	X
57307	004	90	2	X	2,906.27	X
57308	003	90	2	X	1,636.01	X
57308	002	90	2	X	1,636.01	X
57308	004	90	2	X	1,636.01	X
57308	001	90	2	X	1,861.20	X
57310	004	90	2	X	1,126.36	X
57310	001	90	2	X	2,126.82	X
57310	002	90	2	X	1,205.36	X
57310	003	90	2	X	1,139.72	X
57311	001	90	2	X	1,468.73	X
57311	004	90	2	X	1,362.38	X
57311	002	90	2	X	1,451.27	X
57311	003	90	2	X	1,379.03	X
57320	003	90	2	X	1,877.60	X
57320	002	90	2	X	2,400.52	X
57320	004	90	2	X	2,290.19	X
57320	001	90	2	X	2,479.83	X
57330	004	90	2	X	2,144.00	X
57330	001	90	2	X	2,318.63	X
57330	003	90	2	X	2,169.70	X
57330	002	90	2	X	2,289.70	X
57335	002	90	2	X	1,862.73	X
57335	003	90	2	X	1,757.69	X
57335	001	90	2	X	1,888.13	X
57335	004	90	2	X	1,736.92	X
57400	004	0	2	X	156.25	X
57400	001	0	2	X	144.42	X
57400	002	0	2	X	159.84	X
57400	003	0	2	X	156.84	X
57410	002	0	2	X	100.61	X
57410	003	0	2	X	128.42	X
57410	001	0	2	X	112.10	X
57410	004	0	2	X	98.21	X
57415	002	10	2	X	117.68	X
57415	003	10	2	X	145.11	X
57415	004	10	2	X	114.67	X
57415	001	10	2	X	146.73	X
57420	003	0	2	X	262.83	187.79
57420	002	0	2	X	262.83	187.79
57420	004	0	2	X	262.83	187.79
57420	001	0	2	X	294.82	206.61
57421	001	0	2	X	384.03	286.00
57421	003	0	2	X	343.49	260.08
57421	002	0	2	X	343.49	260.08
57421	004	0	2	X	343.49	260.08
57423	001	90	2	X	1,692.78	X
57423	003	90	2	X	1,525.64	X
57423	002	90	2	X	1,525.64	X
57423	004	90	2	X	1,525.64	X
57425	003	90	2	X	1,890.13	X
57425	002	90	2	X	1,890.13	X
57425	001	90	2	X	2,093.87	X
57425	004	90	2	X	1,890.13	X
57426	002	90	2	X	1,475.32	X
57426	003	90	2	X	1,475.32	X
57426	001	90	2	X	1,638.54	X
57426	004	90	2	X	1,475.32	X
57452	003	0	2	X	144.32	118.26
57452	002	0	2	X	199.50	164.25
57452	001	0	2	X	202.80	167.02
57452	004	0	2	X	184.13	151.44
57454	001	0	3	X	313.48	247.51
57454	004	0	3	X	281.41	220.93
57454	002	0	3	X	307.86	242.67
57454	003	0	3	X	284.64	223.15
57455	004	0	3	X	315.92	236.31
57455	001	0	3	X	354.03	260.44
57455	002	0	3	X	315.92	236.31
57455	003	0	3	X	315.92	236.31
57456	003	0	3	X	298.54	221.21
57456	002	0	3	X	298.54	221.21
57456	004	0	3	X	298.54	221.21
57456	001	0	3	X	335.22	244.36
57460	004	0	3	X	549.06	X
57460	002	0	3	X	597.60	X
57460	003	0	3	X	555.30	X
57460	001	0	3	X	607.82	X
57461	002	0	3	X	698.69	409.06
57461	003	0	3	X	698.69	409.06
57461	001	0	3	X	793.62	453.17
57461	004	0	3	X	698.69	409.06
57465	001	ZZZ	0	X	81.47	61.95
57465	004	ZZZ	0	X	74.00	57.06
57465	003	ZZZ	0	X	74.00	57.06
57465	002	ZZZ	0	X	74.00	57.06
57500	003	0	2	X	197.97	164.88
57500	002	0	2	X	231.09	192.09
57500	004	0	2	X	230.43	191.93
57500	001	0	2	X	274.48	228.17
57505	002	10	2	X	172.07	143.78
57505	003	10	2	X	164.69	137.12
57505	004	10	2	X	191.51	159.84
57505	001	10	2	X	173.84	145.14
57510	001	10	2	X	226.62	202.84
57510	003	10	2	X	212.62	190.59
57510	002	10	2	X	225.66	201.91
57510	004	10	2	X	223.14	200.64
57511	003	10	2	X	300.88	257.50
57511	002	10	2	X	319.01	273.09
57511	004	10	2	X	316.08	270.36
57511	001	10	2	X	323.44	276.94

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