NYS DOH APG‐Based Weights History File (yellow highlight indicates period with full reweighting)
Revised for January 1, 2016 Updates:
APG
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
20
21
22
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
60
61
62
63
64
65
66
67
80
81
82
83
84
85
86
87
88
APG Description
PHOTOCHEMOTHERAPY
SUPERFICIAL NEEDLE BIOPSY AND ASPIRATION
LEVEL I SKIN INCISION AND DRAINAGE
LEVEL II SKIN INCISION AND DRAINAGE
NAIL PROCEDURES
LEVEL I SKIN DEBRIDEMENT AND DESTRUCTION
LEVEL II SKIN DEBRIDEMENT AND DESTRUCTION
LEVEL III SKIN DEBRIDEMENT AND DESTRUCTION
LEVEL I EXCISION AND BIOPSY OF SKIN AND SOFT TISSUE
LEVEL II EXCISION AND BIOPSY OF SKIN AND SOFT TISSUE
LEVEL III EXCISION AND BIOPSY OF SKIN AND SOFT TISSUE
LEVEL I SKIN REPAIR
LEVEL II SKIN REPAIR
LEVEL III SKIN REPAIR
LEVEL IV SKIN REPAIR
LEVEL I BREAST PROCEDURES
LEVEL II BREAST PROCEDURES
LEVEL III BREAST PROCEDURES
LEVEL I MUSCULOSKELETAL PROCEDURES EXCLUDING HAND AND FOOT
LEVEL II MUSCULOSKELETAL PROCEDURES EXCLUDING HAND AND FOOT
LEVEL III MUSCULOSKELETAL PROCEDURES EXCLUDING HAND AND FOOT
LEVEL I HAND PROCEDURES
LEVEL II HAND PROCEDURES
LEVEL I FOOT PROCEDURES
LEVEL II FOOT PROCEDURES
LEVEL I ARTHROSCOPY
LEVEL II ARTHROSCOPY
REPLACEMENT OF CAST
SPLINT, STRAPPING AND CAST REMOVAL
CLOSED TREATMENT FX & DISLOCATION OF FINGER, TOE & TRUNK
CLOSED TREATMENT FX & DISLOCATION EXC FINGER, TOE & TRUNK
OPEN OR PERCUTANEOUS TREATMENT OF FRACTURES
BONE OR JOINT MANIPULATION UNDER ANESTHESIA
BUNION PROCEDURES
LEVEL I ARTHROPLASTY
LEVEL II ARTHROPLASTY
HAND AND FOOT TENOTOMY
ARTHROCENTESIS AND LIGAMENT OR TENDON INJECTION
PULMONARY TESTS
NEEDLE AND CATHETER BIOPSY, ASPIRATION, LAVAGE AND INTUBATION
LEVEL I ENDOSCOPY OF THE UPPER AIRWAY
LEVEL II ENDOSCOPY OF THE UPPER AIRWAY
ENDOSCOPY OF THE LOWER AIRWAY
RESPIRATORY THERAPY
PULMONARY REHABILITATION
VENTILATION ASSISTANCE AND MANAGEMENT
EXERCISE TOLERANCE TESTS
ECHOCARDIOGRAPHY
CARDIAC ELECTROPHYSIOLOGIC TESTS
PLACEMENT OF TRANSVENOUS CATHETERS
DIAGNOSTIC CARDIAC CATHETERIZATION
ANGIOPLASTY AND TRANSCATHETER PROCEDURES
PACEMAKER INSERTION AND REPLACEMENT
REMOVAL AND REVISION OF PACEMAKER AND VASCULAR DEVICE
LEVEL I CARDIOTHORACIC PROCEDURES
Dec 1
2008
Jan 1
2010
Apr 1
2010
Jul 1
2010
Oct 1
2010
Jan 1
2011
Apr 1
2011
July 1 2011
Oct 1 2011
Jan 1 2012
Apr 1 2012
July 1 2012
Oct 1 2012
0.4974
5.7662
2.2638
6.3519
0.8389
1.5306
5.6395
6.0904
4.1402
7.7910
13.4426
2.0269
10.5571
10.5571
10.8329
9.8221
12.7319
18.3671
8.3113
10.3281
13.1830
7.8928
10.7450
10.1117
10.2147
11.5379
17.9246
1.6870
1.6166
3.4623
2.8556
12.3224
6.5896
14.8239
8.1577
8.1597
9.4465
1.6853
1.0413
5.8355
2.2767
11.1571
7.8804
‐
‐
2.5126
1.1689
2.6278
11.5958
9.5834
12.6153
14.0636
32.3512
23.0197
10.8885
0.6402
3.2448
1.8962
2.7968
0.7008
1.3672
2.6624
3.9132
3.6788
4.6370
7.9567
0.4352
3.1648
5.6896
6.6746
5.7790
7.4250
8.2280
6.7781
7.3495
8.8413
5.4577
7.5820
6.4428
6.9384
10.3002
26.6662
1.3745
0.9264
1.3420
1.3734
10.6160
2.8085
9.6670
6.4879
7.9149
4.5256
1.7976
0.9756
3.8018
1.6063
7.0115
6.9414
‐
‐
0.9890
0.9157
1.6428
5.0790
8.0168
10.8688
14.1670
32.3317
8.0808
6.5873
0.6402
3.2448
1.8962
2.7968
0.7008
1.3672
2.6624
3.9132
3.6788
4.6370
7.9567
0.4352
3.1648
5.6896
6.6746
5.7790
7.4250
8.2280
6.7781
7.3495
8.8413
5.4577
7.5820
6.4428
6.9384
10.3002
26.6662
1.3745
0.9264
1.3420
1.3734
10.6160
2.8085
9.6670
6.4879
7.9149
4.5256
1.7976
0.9756
3.8018
1.6063
7.0115
6.9414
‐
‐
0.9890
0.9157
1.6428
5.0790
8.0168
10.8688
14.1670
32.3317
8.0808
6.5873
0.5526
2.8086
1.5061
2.9590
0.7414
1.4465
4.0338
4.1402
3.2478
7.1495
12.7186
0.9985
3.1296
5.3798
7.0617
6.1142
7.5861
10.7030
7.1713
9.1805
12.3148
5.7742
9.1580
6.8165
10.3719
9.0281
19.3575
1.5815
0.9801
2.0644
2.2275
11.2317
2.9714
10.2277
11.5457
14.1222
3.5130
1.3448
1.5150
4.1065
1.6995
9.1971
7.3440
‐
‐
1.0464
0.9688
1.9381
8.0131
6.7333
11.4992
11.3118
25.7335
10.0427
12.9732
0.5526
2.8086
1.5061
2.9590
0.7414
1.4465
4.0338
4.1402
3.2478
7.1495
12.7186
0.9985
3.1296
5.3798
7.0617
6.1142
7.5861
10.7030
7.1713
9.1805
12.3148
5.7742
9.1580
6.8165
10.3719
9.0281
19.3575
1.5815
0.9801
2.0644
2.2275
11.2317
2.9714
10.2277
11.5457
14.1222
3.5130
1.3448
1.5150
4.1065
1.6995
9.1971
7.3440
‐
‐
1.0464
0.9688
1.9381
8.0131
6.7333
11.4992
11.3118
25.7335
10.0427
12.9732
0.5526
2.8086
1.5061
2.9590
0.7414
1.4465
4.0338
4.1402
3.2478
7.1495
12.7186
0.9985
3.1296
5.3798
7.0617
6.1142
7.5861
10.7030
7.1713
9.1805
12.3148
5.7742
9.1580
6.8165
10.3719
9.0281
19.3575
1.5815
0.9801
2.0644
2.2275
11.2317
2.9714
10.2277
11.5457
14.1222
3.5130
1.3448
1.5150
4.1065
1.6995
9.1971
7.3440
‐
‐
1.0464
0.9688
1.9381
8.0131
6.7333
11.4992
11.3118
25.7335
10.0427
12.9732
0.5526
2.8086
1.5061
2.9590
0.7414
1.4465
4.0338
4.1402
3.2478
7.1495
12.7186
0.9985
3.1296
5.3798
7.0617
6.1142
7.5861
10.7030
7.1713
9.1805
12.3148
5.7742
9.1580
6.8165
10.3719
9.0281
19.3575
1.5815
0.9801
2.0644
2.2275
11.2317
2.9714
10.2277
11.5457
14.1222
3.5130
1.3448
1.5150
4.1065
1.6995
9.1971
7.3440
‐
‐
1.0464
0.9688
1.9381
8.0131
6.7333
11.4992
11.3118
25.7335
10.0427
12.9732
0.5526
2.8086
1.5197
2.0377
0.5901
1.3236
4.3784
5.9044
3.2478
6.4547
9.9538
1.3110
3.7575
6.2866
9.3960
7.6666
9.8812
14.0747
8.0298
10.2397
13.3392
6.4438
11.4221
7.6554
11.3823
8.6157
17.0797
1.5815
0.9801
2.2203
2.4086
13.2871
2.9714
11.5262
13.4720
14.1222
3.1577
1.3448
1.3870
3.8204
1.6995
9.1971
6.4476
‐
‐
1.2430
0.9085
1.6079
5.0296
6.8735
10.6636
12.1175
26.3230
10.0427
14.2213
0.5526
2.8086
1.5197
2.0377
0.5901
1.3236
4.3784
5.9044
3.2478
6.4547
9.9538
1.3110
3.7575
6.2866
9.3960
7.6666
9.8812
14.0747
8.0298
10.2397
13.3392
6.4438
11.4221
7.6554
11.3823
8.6157
17.0797
1.5815
0.9801
2.2203
2.4086
13.2871
2.9714
11.5262
13.4720
14.1222
3.1577
1.3448
1.3870
3.8204
1.6995
9.1971
6.4476
‐
‐
1.2430
0.9085
1.6079
5.0296
6.8735
10.6636
12.1175
26.3230
10.0427
14.2213
0.5526
2.8086
1.5197
2.0377
0.5901
1.3236
4.3784
5.9044
3.2478
6.4547
9.9538
1.3110
3.7575
6.2866
9.3960
7.6666
9.8812
14.0747
8.0298
10.2397
13.3392
6.4438
11.4221
7.6554
11.3823
8.6157
17.0797
1.5815
0.9801
2.2203
2.4086
13.2871
2.9714
11.5262
13.4720
14.1222
3.1577
1.3448
1.3870
3.8204
1.6995
9.1971
6.4476
‐
‐
1.2430
0.9085
1.6079
5.0296
6.8735
10.6636
12.1175
26.3230
10.0427
14.2213
0.5526
2.8086
1.5197
2.0377
0.5901
1.3236
4.3784
5.9044
3.2478
6.4547
9.9538
1.3110
3.7575
6.2866
9.3960
7.6666
9.8812
14.0747
8.0298
10.2397
13.3392
6.4438
11.4221
7.6554
11.3823
8.6157
17.0797
1.5815
0.9801
2.2203
2.4086
13.2871
2.9714
11.5262
13.4720
14.1222
3.1577
1.3448
1.3870
3.8204
1.6995
9.1971
6.4476
‐
‐
1.2430
0.9085
1.6079
5.0296
6.8735
10.6636
12.1175
26.3230
10.0427
14.2213
0.5526
2.7636
1.7565
3.3245
0.5009
1.2998
4.3784
5.7434
3.4361
6.7476
11.3125
1.6991
4.1388
7.0338
8.6250
8.5721
12.1046
17.3364
9.4188
10.2397
15.0668
6.9057
11.4221
8.8955
11.3823
9.9509
18.9106
1.5815
1.1572
2.7434
2.8302
16.1779
5.0556
12.2733
16.5949
19.0650
3.7618
1.5996
1.4912
3.2899
2.0823
9.1971
6.3946
‐
‐
1.0267
0.9085
1.7687
5.0296
7.5690
9.8204
14.5669
34.6743
12.3879
11.5643
0.5526
2.7636
1.7565
3.3245
0.5009
1.2998
4.3784
5.7434
3.4361
6.7476
11.3125
1.6991
4.1388
7.0338
8.6250
8.5721
12.1046
17.3364
9.4188
10.2397
15.0668
6.9057
11.4221
8.8955
11.3823
9.9509
18.9106
1.5815
1.1572
2.7434
2.8302
16.1779
5.0556
12.2733
16.5949
19.0650
3.7618
1.5996
1.4912
3.2899
2.0823
9.1971
6.3946
‐
‐
1.0267
0.9085
1.7687
5.0296
7.5690
9.8204
14.5669
34.6743
12.3879
11.5643
Page 1 of 29
APG
89
90
91
92
93
94
95
96
97
99
110
111
112
113
114
115
116
117
118
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
160
161
162
163
164
165
166
167
168
169
180
181
182
183
184
185
190
191
192
APG Description
LEVEL II CARDIOTHORACIC PROCEDURES
SECONDARY VARICOSE VEINS AND VASCULAR INJECTION
VASCULAR LIGATION AND RECONSTRUCTION
RESUSCITATION
CARDIOVERSION
CARDIAC REHABILITATION
THROMBOLYSIS
ATRIAL AND VENTRICULAR RECORDING AND PACING
AICD IMPLANT
CORONARY ANGIOPLASTY
PHARMACOTHERAPY BY EXTENDED INFUSION
PHARMACOTHERAPY EXCEPT BY EXTENDED INFUSION
PHLEBOTOMY
LEVEL I BLOOD AND BLOOD PRODUCT EXCHANGE
LEVEL II BLOOD AND BLOOD PRODUCT EXCHANGE
DEEP LYMPH STRUCTURE AND THYROID PROCEDURES
ALLERGY TESTS
HOME INFUSION
NUTRITION THERAPY
ALIMENTARY TESTS AND SIMPLE TUBE PLACEMENT
ESOPHAGEAL DILATION WITHOUT ENDOSCOPY
ANOSCOPY WITH BIOPSY AND DIAGNOSTIC PROCTOSIGMOIDOSCOPY
PROCTOSIGMOIDOSCOPY WITH EXCISION OR BIOPSY
DIAGNOSTIC UPPER GI ENDOSCOPY OR INTUBATION
THERAPEUTIC UPPER GI ENDOSCOPY OR INTUBATION
DIAGNOSTIC LOWER GASTROINTESTINAL ENDOSCOPY
THERAPEUTIC COLONOSCOPY
ERCP AND MISCELLANEOUS GI ENDOSCOPY PROCEDURES
LEVEL I HERNIA REPAIR
LEVEL II HERNIA REPAIR
LEVEL I ANAL AND RECTAL PROCEDURES
LEVEL II ANAL AND RECTAL PROCEDURES
LEVEL I GASTROINTESTINAL PROCEDURES
LEVEL II GASTROINTESTINAL PROCEDURES
LEVEL I LAPAROSCOPY
LEVEL II LAPAROSCOPY
LEVEL III LAPAROSCOPY
LEVEL IV LAPAROSCOPY
SCREENING COLORECTAL SERVICES
EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY
URINARY STUDIES AND PROCEDURES
URINARY CATHETERIZATION AND DILATATION
LEVEL I BLADDER AND KIDNEY PROCEDURES
LEVEL II BLADDER AND KIDNEY PROCEDURES
LEVEL III BLADDER AND KIDNEY PROCEDURES
LEVEL I URETHRA AND PROSTATE PROCEDURES
LEVEL II URETHRA AND PROSTATE PROCEDURES
HEMODIALYSIS
PERITONEAL DIALYSIS
TESTICULAR AND EPIDIDYMAL PROCEDURES
CIRCUMCISION
INSERTION OF PENILE PROSTHESIS
LEVEL I PENILE AND PROSTATE PROCEDURES
LEVEL II PENILE AND PROSTATE PROCEDURES
PROSTATE NEEDLE AND PUNCH BIOPSY
ARTIFICIAL FERTILIZATION
LEVEL I FETAL PROCEDURES
LEVEL II FETAL PROCEDURES
Dec 1
2008
Jan 1
2010
Apr 1
2010
Jul 1
2010
Oct 1
2010
Jan 1
2011
Apr 1
2011
July 1 2011
Oct 1 2011
Jan 1 2012
Apr 1 2012
July 1 2012
Oct 1 2012
15.6179
2.8374
13.4829
2.1938
4.9369
‐
1.6870
7.2120
39.6069
14.0707
5.8693
9.9140
1.2138
2.5540
0.2075
1.3001
5.5577
66.2866
14.0707
5.8693
9.9140
1.2138
2.5540
0.2075
1.3001
5.5577
66.2866
15.3453
6.2097
10.4890
3.3235
4.1141
0.2075
0.9474
2.2625
70.1312
15.3453
6.2097
10.4890
3.3235
4.1141
0.2075
0.9474
2.2625
70.1312
15.3453
6.2097
10.4890
3.3235
4.1141
0.2075
0.9474
2.2625
76.0817
15.3453
6.2097
10.4890
3.3235
4.1141
0.2075
0.9474
2.2625
76.0817
15.0988
7.4931
12.3823
3.3235
4.1141
0.2075
0.9474
2.5897
77.1746
15.0988
7.4931
12.3823
3.3235
4.1141
0.2075
0.9474
2.5897
77.1746
15.0988
7.4931
12.3823
3.3235
4.1141
0.2075
0.9474
2.5897
77.1746
15.0988
7.4931
12.3823
3.3235
4.1141
0.2075
0.9474
2.5897
77.1746
15.7299
5.7167
13.9477
3.1285
2.9021
0.2075
1.1450
2.9256
82.3742
15.7299
5.7167
13.9477
3.1285
2.9021
0.2075
1.1450
2.9256
82.3742
2.1341
1.7606
0.9094
2.6812
3.3584
10.2770
1.9176
‐
‐
2.8788
4.3770
4.8839
6.5527
6.5767
6.2914
6.5160
7.1153
11.5255
11.6891
11.7609
6.3398
10.0036
5.7638
12.9141
9.9064
11.3295
14.1128
14.1128
2.7427
1.7078
0.7423
2.5089
7.6143
4.9538
1.3107
‐
‐
2.6993
2.7583
2.0351
4.1000
4.0352
5.4853
4.1844
4.5928
6.4631
12.4526
12.4526
3.8551
9.7035
5.2580
5.7503
7.0638
9.8872
12.0727
17.5662
2.7427
1.7078
0.7423
2.5089
7.6143
4.9538
1.3107
‐
‐
2.6993
2.7583
2.0351
4.1000
4.0352
5.4853
4.1844
4.5928
6.4631
12.4526
12.4526
3.8551
9.7035
5.2580
5.7503
7.0638
9.8872
12.0727
17.5662
2.9018
1.3423
0.7853
3.1114
8.0560
5.2411
1.8184
‐
‐
2.8558
2.9182
3.1008
4.3378
4.2693
5.8034
4.4271
4.8592
6.8380
10.0007
10.1181
4.0787
9.5788
5.5630
8.3903
8.1624
12.4996
12.6160
15.7699
2.9018
1.3423
0.7853
3.1114
8.0560
5.2411
1.8184
‐
‐
2.8558
2.9182
3.1008
4.3378
4.2693
5.8034
4.4271
4.8592
6.8380
10.0007
10.1181
4.0787
9.5788
5.5630
8.3903
8.1624
12.4996
12.6160
15.7699
2.9018
1.3423
0.7853
3.1114
8.0560
5.2411
1.8184
‐
‐
2.8558
2.9182
3.1008
4.3378
4.2693
5.8034
4.4271
4.8592
6.8380
10.0007
10.1181
4.0787
9.5788
5.5630
8.3903
8.1624
12.4996
12.6160
15.7699
2.9018
1.3423
0.7853
3.1114
8.0560
5.2411
1.8184
‐
‐
2.8558
2.9182
3.1008
4.3378
4.2693
5.8034
4.4271
4.8592
6.8380
10.0007
10.1181
4.0787
9.5788
5.5630
8.3903
8.1624
12.4996
12.6160
15.7699
3.2356
1.3423
0.7853
3.1794
11.1540
6.4715
1.3799
‐
‐
2.8677
3.3375
3.6013
4.1099
4.1571
5.1885
4.2662
4.4524
5.6179
10.5706
11.0670
5.0387
7.3039
6.3918
9.4580
8.1624
11.4778
12.3343
14.6699
3.2356
1.3423
0.7853
3.1794
11.1540
6.4715
1.3799
‐
‐
2.8677
3.3375
3.6013
4.1099
4.1571
5.1885
4.2662
4.4524
5.6179
10.5706
11.0670
5.0387
7.3039
6.3918
9.4580
8.1624
11.4778
12.3343
14.6699
3.2356
1.3423
0.7853
3.1794
11.1540
6.4715
1.3799
‐
‐
2.8677
3.3375
3.6013
4.1099
4.1571
5.1885
4.2662
4.4524
5.6179
10.5706
11.0670
5.0387
7.3039
6.3918
9.4580
8.1624
11.4778
12.3343
14.6699
3.2356
1.3423
0.7853
3.1794
11.1540
6.4715
1.3799
‐
‐
2.8677
3.3375
3.6013
4.1099
4.1571
5.1885
4.2662
4.4524
5.6179
10.5706
11.0670
5.0387
7.3039
6.3918
9.4580
8.1624
11.4778
12.3343
14.6699
3.9048
1.4624
0.5657
2.9598
11.1540
7.8415
1.3799
‐
‐
2.7399
3.3375
3.0084
4.2463
4.3955
5.0274
4.2224
4.7839
7.1026
11.1445
13.6513
5.9480
8.3716
6.5720
13.1905
10.1423
13.7456
14.3530
17.6039
3.9048
1.4624
0.5657
2.9598
11.1540
7.8415
1.3799
‐
‐
2.7399
3.3375
3.0084
4.2463
4.3955
5.0274
4.2224
4.7839
7.1026
11.1445
13.6513
5.9480
8.3716
6.5720
13.1905
10.1423
13.7456
14.3530
17.6039
21.4139
2.5668
2.2016
7.3162
11.1336
17.1732
4.2392
12.7219
1.0803
0.4644
9.0792
6.6820
20.4846
6.0136
9.5554
6.9950
‐
1.4708
1.4708
14.2444
1.8084
0.9654
3.7694
6.3523
9.0051
5.8862
7.4458
1.1155
0.4795
7.2405
4.3799
19.8701
7.4393
11.0816
4.4243
‐
0.6073
1.1036
14.2444
1.8084
0.9654
3.7694
6.3523
9.0051
5.8862
7.4458
1.1155
0.4795
7.2405
4.3799
19.8701
7.4393
11.0816
4.4243
‐
0.6073
1.1036
13.2611
2.1090
1.1703
3.9881
8.2431
10.3039
6.2277
10.8055
1.2199
0.5228
6.7450
5.3238
21.0226
4.0092
12.7489
4.6809
‐
1.2969
1.2969
13.2611
2.1090
1.1703
3.9881
8.2431
10.3039
6.2277
10.8055
1.2199
0.5228
6.7450
5.3238
21.0226
4.0092
12.7489
4.6809
‐
1.2969
1.2969
13.2611
2.1090
1.1703
3.9881
8.2431
10.3039
6.2277
10.8055
1.2199
0.5228
6.7450
5.3238
21.0226
4.0092
12.7489
4.6809
‐
1.2969
1.2969
13.2611
2.1090
1.1703
3.9881
8.2431
10.3039
6.2277
10.8055
1.2199
0.5228
6.7450
5.3238
21.0226
4.0092
12.7489
4.6809
‐
1.2969
1.2969
12.2328
2.1090
1.5154
4.4703
9.0583
10.3039
5.5248
12.0122
1.2504
0.5359
6.6134
5.3238
21.0226
4.0092
12.7489
4.6809
‐
1.2969
1.7721
12.2328
2.1090
1.5154
4.4703
9.0583
10.3039
5.5248
12.0122
1.2504
0.5359
6.6134
5.3238
21.0226
4.0092
12.7489
4.6809
‐
1.2969
1.7721
12.2328
2.1090
1.5154
4.4703
9.0583
10.3039
5.5248
12.0122
1.3254
0.5680
6.6134
5.3238
21.0226
4.0092
12.7489
4.6809
‐
1.2969
1.7721
12.2328
2.1090
1.5154
4.4703
9.0583
10.3039
5.5248
12.0122
1.3254
0.5680
6.6134
5.3238
21.0226
4.0092
12.7489
4.6809
‐
1.2969
1.7721
14.0419
2.3199
1.7376
4.9167
10.7891
11.3343
5.4761
13.8140
1.3651
0.5851
7.0959
6.4683
28.8569
5.1617
14.6991
5.6782
‐
1.2969
3.8856
14.0419
2.3199
1.7376
4.9167
10.7891
11.3343
5.4761
13.8140
1.3651
0.5851
7.0959
6.4683
28.8569
5.1617
14.6991
5.6782
‐
1.2969
3.8856
Page 2 of 29
APG
193
194
195
196
197
198
199
200
201
210
211
212
213
214
215
216
217
218
219
220
221
222
223
224
230
231
232
233
234
235
236
237
238
239
240
241
250
251
252
253
254
255
256
257
270
271
272
273
274
275
280
281
282
283
284
285
286
287
APG Description
TREATMENT OF INCOMPLETE ABORTION
THERAPEUTIC ABORTION
VAGINAL DELIVERY
LEVEL I FEMALE REPRODUCTIVE PROCEDURES
LEVEL II FEMALE REPRODUCTIVE PROCEDURES
LEVEL III FEMALE REPRODUCTIVE PROCEDURES
DILATION AND CURETTAGE
HYSTEROSCOPY
COLPOSCOPY
EXTENDED EEG STUDIES
ELECTROENCEPHALOGRAM
ELECTROCONVULSIVE THERAPY
NERVE AND MUSCLE TESTS
LEVEL I NERVOUS SYSTEM INJECTIONS, STIMULATIONS OR CRANIAL TAP
LEVEL I REVISION OR REMOVAL OF NEUROLOGICAL DEVICE
LEVEL II REVISION OR REMOVAL OF NEUROLOGICAL DEVICE
LEVEL I NERVE PROCEDURES
LEVEL II NERVE PROCEDURES
SPINAL TAP
LEVEL II NERVOUS SYSTEM INJECTIONS, STIMULATIONS OR CRANIAL TAP
LAMINOTOMY AND LAMINECTOMY
SLEEP STUDIES
LEVEL III NERVE PROCEDURES
LEVEL IV NERVE PROCEDURES
MINOR OPHTHALMOLOGICAL TESTS AND PROCEDURES
FITTING OF CONTACT LENSES
LASER EYE PROCEDURES
CATARACT PROCEDURES
LEVEL I ANTERIOR SEGMENT EYE PROCEDURES
LEVEL II ANTERIOR SEGMENT EYE PROCEDURES
LEVEL III ANTERIOR SEGMENT EYE PROCEDURES
LEVEL I POSTERIOR SEGMENT EYE PROCEDURES
LEVEL II POSTERIOR SEGMENT EYE PROCEDURES
STRABISMUS AND MUSCLE EYE PROCEDURES
LEVEL I REPAIR AND PLASTIC PROCEDURES OF EYE
LEVEL II REPAIR AND PLASTIC PROCEDURES OF EYE
COCHLEAR DEVICE IMPLANTATION
OTORHINOLARYNGOLOGIC FUNCTION TESTS
LEVEL I FACIAL AND ENT PROCEDURES
LEVEL II FACIAL AND ENT PROCEDURES
LEVEL III FACIAL AND ENT PROCEDURES
LEVEL IV FACIAL AND ENT PROCEDURES
TONSIL AND ADENOID PROCEDURES
AUDIOMETRY
OCCUPATIONAL THERAPY
PHYSICAL THERAPY
SPEECH THERAPY AND EVALUATION
MANIPULATION THERAPY
PHYSICAL THERAPY, GROUP
SPEECH THERAPY & EVALUATION, GROUP
VASCULAR RADIOLOGY EXCEPT VENOGRAPHY OF EXTREMITY
MAGNETIC RESONANCE ANGIOGRAPHY ‐ HEAD AND/OR NECK
MAGNETIC RESONANCE ANGIOGRAPHY ‐ CHEST
MAGNETIC RESONANCE ANGIOGRAPHY ‐ OTHER SITES
MYELOGRAPHY
MISCELLANEOUS RADIOLOGICAL PROCEDURES WITH CONTRAST
MAMMOGRAPHY & OTHER RELATED PROCEDURES
DIGESTIVE RADIOLOGY
Dec 1
2008
Jan 1
2010
Apr 1
2010
Jul 1
2010
Oct 1
2010
Jan 1
2011
Apr 1
2011
July 1 2011
Oct 1 2011
Jan 1 2012
Apr 1 2012
July 1 2012
Oct 1 2012
8.9442
6.4533
5.2543
4.8933
10.7605
11.6407
7.5730
9.5395
2.1330
3.9568
1.5873
1.6691
0.2671
4.4348
15.6821
22.3865
6.8137
33.9919
5.7197
4.5493
21.2239
3.3322
‐
‐
0.8903
0.6789
2.5744
11.3881
8.9944
11.4464
11.6685
5.9604
13.4878
9.2203
3.8145
11.2306
95.0639
0.8766
5.7932
7.3266
11.3140
14.4004
7.3579
0.5955
0.6220
0.3497
0.3699
0.3987
‐
‐
10.7456
1.9022
2.5831
2.3248
7.9443
1.7444
1.0933
1.6779
5.0348
4.0229
9.1031
2.2269
5.2127
8.4636
4.9685
6.7490
1.4842
1.8041
1.0161
1.5803
0.7067
4.5475
25.5981
29.0071
8.5920
60.4926
2.4132
3.5031
8.3188
4.5940
‐
‐
1.0119
0.6585
3.7703
9.7756
4.3076
9.3164
11.3184
3.3451
11.7830
6.9180
3.2368
8.7718
130.1036
0.6581
3.6978
5.4026
9.1044
10.5997
5.8818
0.4211
0.7241
0.6827
0.6620
0.2765
0.2414
0.1931
3.5374
3.0749
3.3887
3.1315
7.7060
1.5734
0.6181
0.8985
5.0348
4.0229
9.1031
2.2269
5.2127
8.4636
4.9685
6.7490
1.4842
1.8041
1.0161
1.5803
0.7067
4.5475
25.5981
29.0071
8.5920
60.4926
2.4132
3.5031
8.3188
4.5940
‐
‐
1.0119
0.6585
3.7703
9.7756
4.3076
9.3164
11.3184
3.3451
11.7830
6.9180
3.2368
8.7718
130.1036
0.6581
3.6978
5.4026
9.1044
10.5997
5.8818
0.4211
0.7241
0.6827
0.6620
0.2765
0.2414
0.1931
3.5374
3.0749
3.3887
3.1315
7.7060
1.5734
0.6181
0.8985
5.9290
4.1476
9.1031
4.8830
8.3792
9.4765
5.2567
7.6123
1.5703
1.9087
1.0751
2.0988
0.7477
3.6211
19.1376
24.3616
6.4249
60.4926
2.5532
2.8742
15.0004
4.8605
‐
‐
1.0706
0.5113
3.7703
9.7756
6.6744
9.1418
12.2092
2.3897
12.4664
7.3192
3.4246
9.2806
140.9532
0.6963
5.1205
6.2265
10.1500
15.1805
6.2230
0.4211
0.7241
0.6827
0.6620
0.2765
0.2414
0.1931
3.7426
3.2533
3.5853
3.3132
5.3654
1.6646
0.7193
1.1491
5.9290
4.1476
9.1031
4.8830
8.3792
9.4765
5.2567
7.6123
1.5703
1.9087
1.0751
2.0988
0.7477
3.6211
19.1376
24.3616
6.4249
60.4926
2.5532
2.8742
15.0004
4.8605
‐
‐
1.0706
0.5113
3.7703
9.7756
6.6744
9.1418
12.2092
2.3897
12.4664
7.3192
3.4246
9.2806
155.3196
0.6963
5.1205
6.2265
10.1500
15.1805
6.2230
0.4211
0.7241
0.6827
0.6620
0.2765
0.2414
0.1931
3.7426
3.2533
3.5853
3.3132
5.3654
1.6646
0.7193
1.1491
5.9290
4.1476
9.1031
4.8830
8.3792
9.4765
5.2567
7.6123
1.5703
1.9087
1.0751
2.0988
0.7477
3.6211
19.1376
24.3616
7.0335
19.3408
2.5532
2.8742
15.0004
4.8605
77.4190
‐
1.0706
0.5113
3.7703
9.7756
6.6744
9.1418
12.2092
2.3897
12.4664
7.3192
3.4246
9.2806
168.4364
0.6963
5.1205
6.2265
10.1500
15.1805
6.2230
0.4211
0.7241
0.6827
0.6620
0.2765
0.2414
0.1931
3.7426
3.0248
3.3334
3.0805
5.3654
1.6646
0.6688
1.0684
5.9290
4.1476
9.1031
4.8830
8.3792
9.4765
5.2567
7.6123
1.5703
1.9087
1.0751
2.0988
0.7477
3.6211
19.1376
24.3616
7.0335
19.3408
2.5532
2.8742
15.0004
4.8605
77.4190
‐
1.0706
0.5113
3.7703
9.7756
6.6744
9.1418
12.2092
2.3897
12.4664
7.3192
3.4246
9.2806
168.4364
0.6963
5.1205
6.2265
10.1500
15.1805
6.2230
0.4211
0.7241
0.6827
0.6620
0.2765
0.2414
0.1931
3.7426
3.0248
3.3334
3.0805
5.3654
1.6646
0.6688
1.0684
6.5883
4.1476
9.1031
4.8830
8.3792
10.1790
5.2567
7.6123
1.8582
1.7589
0.9093
2.0988
0.7477
3.0056
19.1376
24.3616
6.3346
19.3408
2.5532
2.6229
15.8503
4.8605
77.4190
‐
1.0706
0.6328
2.9509
11.0466
8.6668
10.8447
15.2937
2.9001
13.3194
9.3724
4.0722
9.2806
168.4364
0.5467
5.9643
7.4378
11.5891
16.7518
6.7598
0.4211
0.7241
0.6827
0.6620
0.2765
0.2414
0.1931
3.7426
3.0248
3.0012
3.0805
3.9562
1.7890
0.6688
0.9163
6.5883
4.1476
9.1031
4.8830
8.3792
10.1790
5.2567
7.6123
1.8582
1.7589
0.9093
2.0988
0.7477
3.0056
19.1376
24.3616
6.3346
19.3408
2.5532
2.6229
15.8503
4.8605
77.4190
‐
1.0706
0.6328
2.9509
11.0466
8.6668
10.8447
15.2937
2.9001
13.3194
9.3724
4.0722
9.2806
168.4364
0.5467
5.9643
7.4378
11.5891
16.7518
6.7598
0.4211
0.7241
0.6827
0.6620
0.2765
0.2414
0.1931
3.7426
3.0248
3.0012
3.0805
3.9562
1.7890
0.6688
0.9163
6.5883
4.1476
10.9091
4.8830
8.3792
10.1790
5.2567
7.6123
1.8582
1.7589
0.9093
2.0988
0.7477
3.0056
19.1376
24.3616
6.3346
19.3408
2.5532
2.6229
15.8503
4.8605
77.4190
‐
1.0706
0.6328
2.9509
11.0466
8.6668
10.8447
15.2937
2.9001
13.3194
9.3724
4.0722
9.2806
168.4364
0.5467
5.9643
7.4378
11.5891
16.7518
6.7598
0.4211
0.7241
0.6827
0.6620
0.2765
0.2414
0.1931
3.7426
3.0248
3.0012
3.0805
3.9562
1.7890
0.6688
0.9163
6.5883
4.1476
10.9091
4.8830
8.3792
10.1790
5.2567
7.6123
1.8582
1.7589
0.9093
2.0988
0.7477
3.0056
19.1376
24.3616
6.3346
19.3408
2.5532
2.6229
15.8503
4.8605
77.4190
‐
1.0706
0.6328
2.9509
11.0466
8.6668
10.8447
15.2937
2.9001
13.3194
9.3724
4.0722
9.2806
168.4364
0.5467
5.9643
7.4378
11.5891
16.7518
6.7598
0.4211
0.7241
0.6827
0.6620
0.2765
0.2414
0.1931
3.7426
3.0248
3.0012
3.0805
3.9562
1.7890
0.6688
0.9163
7.0004
4.1476
10.9091
5.5356
10.3847
12.7947
6.3004
8.9296
1.9113
1.7589
0.9714
2.0988
0.7477
2.5273
21.3064
29.0512
7.2416
19.3408
2.6151
3.0358
19.4163
4.6789
77.4190
‐
1.0706
0.6328
2.9509
11.1217
8.9310
11.9679
17.2468
3.1707
15.1553
9.4862
4.1766
10.4110
168.4364
0.7380
6.7963
9.1426
12.9583
18.6564
7.8715
0.4211
0.7241
0.6827
0.6620
0.2765
0.2414
0.1931
5.0525
3.3282
3.0499
3.4539
3.2525
2.1453
0.6688
1.0565
7.0004
4.1476
10.9091
5.5356
10.3847
12.7947
6.3004
8.9296
1.9113
1.7589
0.9714
2.0988
0.7477
2.5273
21.3064
29.0512
7.2416
19.3408
2.6151
3.0358
19.4163
4.6789
77.4190
‐
1.0706
0.6328
2.9509
11.1217
8.9310
11.9679
17.2468
3.1707
15.1553
9.4862
4.1766
10.4110
168.4364
0.7380
6.7963
9.1426
12.9583
18.6564
7.8715
0.4211
0.7241
0.6827
0.6620
0.2765
0.2414
0.1931
5.0525
3.3282
3.0499
3.4539
3.2525
2.1453
0.6688
1.0565
Page 3 of 29
APG
288
289
290
291
292
293
294
295
296
297
298
299
300
301
302
303
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
327
328
329
330
331
332
340
341
342
343
344
345
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
APG Description
DIAGNOSTIC ULTRASOUND EXCEPT OBSTETRICAL AND VASCULAR OF LOWER
VASCULAR DIAGNOSTIC ULTRASOUND OF LOWER EXTREMITIES
PET SCANS
BONE DENSITOMETRY
MRI‐ ABDOMEN
MRI‐ JOINTS
MRI‐ BACK
MRI‐ CHEST
MRI‐ OTHER
MRI‐ BRAIN
CAT SCAN BACK
CAT SCAN ‐ BRAIN
CAT SCAN ‐ ABDOMEN
CAT SCAN ‐ OTHER
ANGIOGRAPHY, OTHER
ANGIOGRAPHY, CEREBRAL
DEVELOPMENTAL & NEUROPSYCHOLOGICAL TESTING
FULL DAY PARTIAL HOSPITALIZATION FOR SUBSTANCE ABUSE
FULL DAY PARTIAL HOSPITALIZATION FOR MENTAL ILLNESS
HALF DAY PARTIAL HOSPITALIZATION FOR SUBSTANCE ABUSE
HALF DAY PARTIAL HOSPITALIZATION FOR MENTAL ILLNESS
COUNSELLING OR INDIVIDUAL BRIEF PSYCHOTHERAPY
INDIVIDUAL COMPREHENSIVE PSYCHOTHERAPY
FAMILY PSYCHOTHERAPY
GROUP PSYCHOTHERAPY
ACTIVITY THERAPY
CASE MANAGEMENT & TREATMENT PLAN DEVELOPMENT ‐ MENTAL HEALTH
CRISIS INTERVENTION
MEDICATION ADMINISTRATION & OBSERVATION
MENTAL HYGIENE ASSESSMENT
MENTAL HEALTH SCREENING & BRIEF ASSESSMENT
INTENSIVE OUTPATIENT PSYCHIATRIC TREATMENT
DAY REHABILITATION, HALF DAY
DAY REHABILITATION, FULL DAY
LEVEL I DIAGNOSTIC NUCLEAR MEDICINE
LEVEL II DIAGNOSTIC NUCLEAR MEDICINE
LEVEL III DIAGNOSTIC NUCLEAR MEDICINE
THERAPEUTIC NUCLEAR MEDICINE
RADIATION THERAPY AND HYPERTHERMIA
AFTERLOADING BRACHYTHERAPY
RADIATION TREATMENT DELIVERY
INSTILLATION OF RADIOELEMENT SOLUTIONS
HYPERTHERMIC THERAPIES
RADIOSURGERY
HIGH ENERGY NEUTRON RADIATION TREATMENT DELIVERY
PROTON TREATMENT DELIVERY
LEVEL II AFTERLOADING BRACHYTHERAPY
LEVEL I ADJUNCTIVE GENERAL DENTAL SERVICES
LEVEL II ADJUNCTIVE GENERAL DENTAL SERVICES
PERIODONTICS
LEVEL I PROSTHODONTICS, FIXED
LEVEL II PROSTHODONTICS, FIXED
LEVEL III PROSTHODONTICS, FIXED
LEVEL I PROSTHODONTICS, REMOVABLE
LEVEL II PROSTHODONTICS, REMOVABLE
LEVEL III PROSTHODONTICS, REMOVABLE
LEVEL I MAXILLOFACIAL PROSTHETICS
LEVEL II MAXILLOFACIAL PROSTHETICS
Dec 1
2008
Jan 1
2010
Apr 1
2010
Jul 1
2010
Oct 1
2010
Jan 1
2011
Apr 1
2011
July 1 2011
Oct 1 2011
Jan 1 2012
Apr 1 2012
July 1 2012
Oct 1 2012
1.7234
10.7832
6.6637
0.2435
2.2816
2.1786
2.2816
2.2349
2.1853
2.2816
1.3814
1.3814
1.3814
1.2983
1.6509
1.6509
0.8706
‐
‐
‐
‐
0.3521
0.7905
0.4979
0.2828
‐
‐
‐
‐
‐
‐
‐
‐
‐
2.0592
2.8311
5.2893
1.4501
13.8980
9.1805
2.1725
5.2725
1.2275
60.9920
1.0337
5.9633
‐
0.3754
0.5753
0.4817
0.3097
1.5945
1.8493
0.4194
1.4189
1.8009
0.3188
0.3623
0.7609
3.8860
7.4321
0.8629
3.1044
2.7686
2.6167
3.0422
3.3155
3.0822
1.3976
1.1525
1.3393
1.4662
1.6385
1.9762
0.8275
‐
‐
‐
‐
0.6206
0.8275
0.6206
0.3207
‐
‐
0.8275
0.1483
1.0344
0.2803
‐
‐
‐
1.6002
1.9801
3.0866
1.1710
1.2696
6.2542
1.9298
2.4223
0.9459
63.9723
0.7966
4.5955
‐
0.4639
1.3073
0.8133
0.4550
1.7021
2.1055
0.9221
1.7644
1.3580
0.2562
1.3379
0.7609
3.8860
7.4321
0.8629
3.1044
2.7686
2.6167
3.0422
3.3155
3.0822
1.3976
1.1525
1.3393
1.4662
1.6385
1.9762
0.8275
‐
‐
‐
‐
0.6206
0.8275
0.6206
0.3207
‐
‐
0.8275
0.1483
1.0344
0.2803
‐
‐
‐
1.6002
1.9801
3.0866
1.1710
1.2696
6.2542
1.9298
2.4223
0.9459
63.9723
0.7966
4.5955
‐
0.4639
1.3073
0.8133
0.4550
1.7021
2.1055
0.9221
1.7644
1.3580
0.2562
1.3379
0.8050
3.1350
7.8631
0.9129
3.2844
2.9292
2.7685
3.2186
3.5078
3.2610
1.4786
1.2194
1.4170
1.5512
1.7335
2.0908
0.8275
‐
‐
‐
‐
0.6206
0.8275
0.6206
0.3207
‐
‐
0.8275
0.1483
1.0344
0.2803
‐
‐
‐
1.6930
2.0949
3.2657
1.2389
0.5646
4.8902
1.8318
2.5628
0.9459
29.0289
0.7966
4.5955
‐
0.4639
1.3073
0.8133
0.4550
1.7021
2.1055
0.9221
1.7644
1.3580
0.2562
1.3379
0.8050
3.1350
7.8631
0.9129
3.2844
2.9292
2.7685
3.2186
3.5078
3.2610
1.4786
1.2194
1.4170
1.5512
1.7335
2.0908
0.8275
‐
‐
‐
‐
0.6206
0.8275
0.6206
0.3207
‐
‐
0.8275
0.1483
1.0344
0.2803
‐
‐
‐
1.6930
2.0949
3.2657
1.2389
0.5646
4.8902
1.8318
2.5628
0.9459
29.0289
0.7966
4.5955
‐
0.4639
1.3073
0.8133
0.4550
1.7021
2.1055
0.9221
1.7644
1.3580
0.2562
1.3379
0.8050
3.1350
7.3108
0.8488
3.0537
2.7235
2.5740
2.9925
3.2614
3.0319
1.3748
1.1337
1.3175
1.4422
1.6118
1.9440
0.8275
‐
‐
‐
‐
0.6206
0.8275
0.6206
0.3207
‐
‐
0.8275
0.1483
1.0344
0.2803
0.6093
0.5948
0.7931
1.6930
2.0949
3.2657
1.2389
0.5646
4.8902
1.8318
2.5628
0.9459
29.0289
0.7966
4.5955
63.3117
0.4639
1.3073
0.8133
0.4550
1.7021
2.1055
0.9221
1.7644
1.3580
0.2562
1.3379
0.8050
3.1350
7.3108
0.8488
3.0537
2.7235
2.5740
2.9925
3.2614
3.0319
1.3748
1.1337
1.3175
1.4422
1.6118
1.9440
0.8275
‐
‐
‐
‐
0.6206
0.8275
0.6206
0.3207
‐
‐
0.8275
0.1483
1.0344
0.2803
0.6093
0.5948
0.7931
1.6930
2.0949
3.2657
1.2389
0.5646
4.8902
1.8318
2.5628
0.9459
29.0289
0.7966
4.5955
63.3117
0.4639
1.3073
0.8133
0.4550
1.7021
2.1055
0.9221
1.7644
1.3580
0.2562
1.3379
0.8050
2.9050
7.3108
0.9103
2.6688
2.5063
2.4533
3.4891
3.1608
3.1297
1.3748
1.1337
1.3175
1.4422
1.6118
1.9440
0.8275
‐
‐
‐
‐
0.6206
0.8275
0.6206
0.3207
‐
‐
0.8275
0.1483
1.0344
0.2803
0.6093
0.5948
0.7931
1.6439
2.0412
3.3983
1.6694
0.6869
4.8902
1.9028
2.5628
0.8666
22.6902
0.7298
4.2101
70.9328
0.4639
1.3073
0.8133
0.4550
1.7021
2.1055
0.9221
1.7644
1.3580
0.2562
1.3379
0.8050
2.9050
7.3108
0.9103
2.6688
2.5063
2.4533
3.4891
3.1608
3.1297
1.3748
1.1337
1.3175
1.4422
1.6118
1.9440
0.8275
‐
‐
‐
‐
0.6206
0.8275
0.6206
0.3207
‐
‐
0.8275
0.2669
1.0344
0.2803
0.6093
0.5948
0.7931
1.6439
2.0412
3.3983
1.6694
0.6869
4.8902
1.9028
2.5628
0.8666
22.6902
0.7298
4.2101
70.9328
0.4639
1.3073
0.8133
0.4550
1.7021
2.1055
0.9221
1.7644
1.3580
0.2562
1.3379
0.8050
2.9050
7.3108
0.9103
2.6688
2.5063
2.4533
3.4891
3.1608
3.1297
1.3748
1.1337
1.3175
1.4422
1.6118
1.9440
0.8275
‐
‐
‐
‐
0.6206
0.8275
0.6206
0.3207
‐
‐
0.8275
0.2669
1.0344
0.2803
0.6093
0.5948
0.7931
1.6439
2.0412
3.3983
1.6694
0.6869
4.8902
1.9028
2.5628
0.8666
22.6902
0.7298
4.2101
70.9328
0.4639
1.3073
0.8133
0.4550
1.7021
2.1055
0.9221
1.7644
1.3580
0.2562
1.3379
0.8050
2.9050
7.3108
0.9103
2.6688
2.5063
2.4533
3.4891
3.1608
3.1297
1.3748
1.1337
1.3175
1.4422
1.6118
1.9440
0.8275
‐
‐
‐
‐
0.6206
0.8275
0.6206
0.3207
‐
‐
0.8275
0.2669
1.0344
0.2803
0.6093
0.4937
0.6583
1.6439
2.0412
3.3983
1.6694
0.6869
4.8902
1.9028
2.5628
0.8666
22.6902
0.7298
4.2101
70.9328
0.4639
1.3073
0.8133
0.4550
1.7021
2.1055
0.9221
1.7644
1.3580
0.2562
1.3379
0.8050
3.4918
8.2971
0.8986
2.8988
2.3817
2.5346
3.5921
2.9048
3.2318
1.6652
1.6274
1.9449
1.4622
2.0636
1.9690
0.8275
‐
‐
‐
‐
0.6206
0.8275
0.6206
0.3207
‐
‐
0.8275
0.1335
1.0344
0.2803
0.6093
0.4937
0.6583
1.6686
1.8648
4.0697
2.1229
0.7446
5.3792
1.9028
2.5628
0.8666
26.0937
0.8758
4.2101
78.4972
0.4639
1.3073
0.8133
0.4550
1.7021
2.1055
0.9221
1.7644
1.3580
0.2562
1.3379
0.8050
3.4918
8.2971
0.8986
2.8988
2.3817
2.5346
3.5921
2.9048
3.2318
1.6652
1.6274
1.9449
1.4622
2.0636
1.9690
0.8275
‐
‐
‐
‐
0.6206
0.8275
0.6206
0.3207
‐
‐
0.8275
0.1335
1.0344
0.2803
0.6093
0.4937
0.6583
1.6686
1.8648
4.0697
2.1229
0.7446
5.3792
1.9028
2.5628
0.8666
26.0937
0.8758
4.2101
78.4972
0.4639
1.3073
0.8133
0.4550
1.7021
2.1055
0.9221
1.7644
1.3580
0.2562
1.3379
Page 4 of 29
APG
361
362
363
364
365
366
367
368
369
370
371
372
373
374
375
376
377
378
379
380
381
382
385
386
387
390
391
392
393
394
395
396
397
398
399
400
401
402
403
404
405
406
407
408
409
410
411
412
413
414
415
416
417
418
419
420
421
422
APG Description
LEVEL I DENTAL RESTORATIONS
LEVEL II DENTAL RESTORATIONS
LEVEL III DENTAL RESTORATION
LEVEL I ENDODONTICS
LEVEL II ENDODONTICS
LEVEL III ENDODONTICS
LEVEL I ORAL AND MAXILLOFACIAL SURGERY
LEVEL II ORAL AND MAXILLOFACIAL SURGERY
LEVEL III ORAL AND MAXILLOFACIAL SURGERY
LEVEL IV ORAL AND MAXILLOFACIAL SURGERY
LEVEL I ORTHODONTICS
SEALANT
LEVEL I DENTAL FILM
LEVEL II DENTAL FILM
DENTAL ANESTHESIA
DIAGNOSTIC DENTAL PROCEDURES
PREVENTIVE DENTAL PROCEDURES
LEVEL II PERIODONTICS
LEVEL II ORTHODONTICS
ANESTHESIA
LEVEL I DENTAL IMPLANTS
LEVEL II DENTAL IMPLANTS
LEVEL I MOLECULAR PATHOLOGY AND GENETIC TESTS
LEVEL II MOLECULAR PATHOLOGY AND GENETIC TESTS
LEVEL III MOLECULAR PATHOLOGY AND GENETIC TESTS
LEVEL I PATHOLOGY
LEVEL II PATHOLOGY
PAP SMEARS
BLOOD AND TISSUE TYPING
LEVEL I IMMUNOLOGY TESTS
LEVEL II IMMUNOLOGY TESTS
LEVEL I MICROBIOLOGY TESTS
LEVEL II MICROBIOLOGY TESTS
LEVEL I ENDOCRINOLOGY TESTS
LEVEL II ENDOCRINOLOGY TESTS
LEVEL I CHEMISTRY TESTS
LEVEL II CHEMISTRY TESTS
BASIC CHEMISTRY TESTS
ORGAN OR DISEASE ORIENTED PANELS
TOXICOLOGY TESTS
THERAPEUTIC DRUG MONITORING
LEVEL I CLOTTING TESTS
LEVEL II CLOTTING TESTS
LEVEL I HEMATOLOGY TESTS
LEVEL II HEMATOLOGY TESTS
URINALYSIS
BLOOD AND URINE DIPSTICK TESTS
SIMPLE PULMONARY FUNCTION TESTS
CARDIOGRAM
LEVEL I IMMUNIZATION AND ALLERGY IMMUNOTHERAPY
LEVEL II IMMUNIZATION
LEVEL III IMMUNIZATION
MINOR REPRODUCTIVE PROCEDURES
MINOR CARDIAC AND VASCULAR TESTS
MINOR OPHTHALMOLOGICAL INJECTION, SCRAPING AND TESTS
PACEMAKER AND OTHER ELECTRONIC ANALYSIS
TUBE CHANGE
PROVISION OF VISION AIDS
Dec 1
2008
Jan 1
2010
Apr 1
2010
Jul 1
2010
Oct 1
2010
Jan 1
2011
Apr 1
2011
July 1 2011
Oct 1 2011
Jan 1 2012
Apr 1 2012
July 1 2012
Oct 1 2012
0.3385
0.4993
1.6216
0.4874
0.9627
1.2303
0.7622
3.0174
3.0174
3.0174
‐
0.3287
0.2624
0.3182
1.2646
0.2334
0.2009
‐
‐
0.4324
‐
‐
‐
‐
‐
0.3762
0.6149
0.1464
0.1548
0.1688
0.3007
0.1687
0.2270
0.1787
0.2470
0.1102
0.2411
0.0838
0.3618
0.3917
0.2152
0.0895
0.1904
0.0857
0.2557
0.1139
0.1899
0.2771
0.1870
0.1155
0.2358
0.4323
1.3550
1.5511
0.6102
0.6782
3.5313
0.4068
0.6561
0.9844
2.3474
0.6251
1.1241
1.1324
0.7491
2.0751
2.0751
2.0751
‐
0.2676
0.1338
0.4631
1.7348
0.2264
0.3168
‐
‐
1.3350
‐
‐
‐
‐
‐
0.3956
0.8844
0.1782
0.3199
0.1492
0.1626
0.1137
0.2141
0.1526
0.2258
0.1150
0.2952
0.0857
0.1367
0.3084
0.1463
0.0593
0.2111
0.0831
0.1427
0.0669
0.0535
0.4482
0.2274
0.2475
0.3478
0.8428
0.8869
1.0853
0.5399
0.3735
2.4389
0.4387
0.6561
0.9844
2.3474
0.6251
1.1241
1.1324
0.7491
2.0751
2.0751
2.0751
‐
0.2676
0.1338
0.4631
1.7348
0.2264
0.3168
‐
‐
1.3350
‐
‐
‐
‐
‐
0.3956
0.8844
0.1782
0.3199
0.1492
0.1626
0.1137
0.2141
0.1526
0.2258
0.1150
0.2952
0.0857
0.1367
0.3084
0.1463
0.0593
0.2111
0.0831
0.1427
0.0669
0.0535
0.4482
0.2274
0.2475
0.3478
0.8428
0.8869
1.0853
0.5399
0.3735
2.4389
0.4387
0.6561
0.9844
2.3474
0.6251
1.1241
1.1324
0.7491
2.0751
2.0751
2.0751
‐
0.2676
0.1338
0.4631
1.7348
0.2264
0.3168
‐
‐
0.7937
‐
‐
‐
‐
‐
0.3395
0.4652
0.1885
0.2074
0.1243
0.1560
0.1016
0.2340
0.1598
0.2388
0.0952
0.2615
0.0473
0.1447
0.3263
0.1548
0.0825
0.2233
0.0743
0.1510
0.0590
0.0427
0.4341
0.2289
0.1929
0.4863
0.8135
0.6601
1.1402
0.5190
0.3952
1.8640
0.4642
0.6561
0.9844
2.3474
0.6251
1.1241
1.1324
0.7491
2.0751
2.0751
2.0751
‐
0.2676
0.1338
0.4631
1.7348
0.2264
0.3168
‐
‐
0.7937
‐
‐
‐
‐
‐
0.3395
0.4652
0.1885
0.2074
0.1243
0.1560
0.1016
0.2340
0.1598
0.2388
0.0952
0.2615
0.0473
0.1447
0.3263
0.1548
0.0825
0.2233
0.0743
0.1510
0.0590
0.0427
0.4341
0.2289
0.1929
0.4863
0.8135
0.6601
1.1402
0.5190
0.3952
1.8640
0.4642
0.6561
0.9844
2.3474
0.6251
1.1241
1.1324
0.7491
2.0751
2.0751
2.0751
‐
0.2676
0.1338
0.4631
3.0457
0.2264
0.3168
‐
‐
‐
‐
‐
‐
‐
‐
0.3156
0.4325
0.1753
0.1928
0.1156
0.1451
0.0945
0.2175
0.1486
0.2221
0.0885
0.2432
0.0440
0.1345
0.0909
0.1439
0.0767
0.2076
0.0691
0.1404
0.0549
0.0397
0.4341
0.2289
0.1793
0.4521
0.7563
0.6601
1.1402
0.5190
0.3952
1.8640
0.4642
0.6561
0.9844
2.3474
0.6251
1.1241
1.1324
0.7491
2.0751
2.0751
2.0751
‐
0.2676
0.1338
0.4631
5.1369
0.2264
0.3168
‐
‐
‐
‐
‐
‐
‐
‐
0.3156
0.4325
0.1753
0.1928
0.1156
0.1451
0.0945
0.2175
0.1486
0.2221
0.0885
0.2432
0.0440
0.1345
0.0909
0.1439
0.0767
0.2076
0.0691
0.1404
0.0549
0.0397
0.4341
0.2289
0.1793
0.4521
0.7563
0.6601
1.1402
0.5190
0.3952
1.8640
0.4642
0.6561
0.9844
2.3474
0.6251
1.1241
1.1324
0.7491
2.0751
2.0751
2.0751
‐
0.2051
0.1338
0.4631
5.1369
0.2264
0.3168
‐
‐
‐
‐
‐
‐
‐
‐
0.2464
0.4325
0.2279
0.1928
0.0982
0.1798
0.0945
0.2175
0.1653
0.2221
0.0772
0.1748
0.0406
0.1345
0.0909
0.1060
0.0688
0.2076
0.0691
0.1404
0.0549
0.0397
0.4239
0.2289
0.1793
0.3719
0.7563
0.6601
1.1402
0.5190
0.3952
1.9170
0.4642
0.6561
0.9844
2.3474
0.6251
1.1241
1.1324
0.7491
2.0751
2.0751
2.0751
‐
0.2051
0.1338
0.4631
5.1369
0.2264
0.3168
‐
‐
‐
‐
‐
‐
‐
‐
0.2464
0.4325
0.2279
0.1928
0.0982
0.1798
0.0945
0.2175
0.1653
0.2221
0.0772
0.1748
0.0406
0.1345
0.0909
0.1060
0.0688
0.2076
0.0691
0.1404
0.0549
0.0397
0.4239
0.2289
0.1793
0.3719
0.7563
0.6601
1.1402
0.5190
0.3952
1.9170
0.4642
0.6561
0.9844
2.3474
0.6251
1.1241
1.1324
0.7491
2.0751
2.0751
2.0751
‐
0.2051
0.1338
0.4631
5.1369
0.2264
0.3168
‐
‐
‐
‐
‐
‐
‐
‐
0.2464
0.4325
0.2279
0.1928
0.0982
0.1798
0.0945
0.2175
0.1653
0.2221
0.0772
0.1748
0.0406
0.1345
0.0909
0.1060
0.0688
0.2076
0.0691
0.1404
0.0549
0.0397
0.4239
0.2289
0.1793
0.3719
0.7563
0.6601
1.1402
0.5190
0.3952
1.9170
0.4642
0.6561
0.9844
2.3474
0.6251
1.1241
1.1324
0.7491
2.0751
2.0751
2.0751
‐
0.2051
0.1338
0.4631
5.1369
0.2264
0.3168
‐
‐
‐
‐
‐
‐
‐
‐
0.2464
0.4325
0.2279
0.1928
0.0982
0.1798
0.0945
0.2175
0.1653
0.2221
0.0772
0.1748
0.0406
0.1345
0.0909
0.1060
0.0688
0.2076
0.0691
0.1404
0.0549
0.0397
0.4239
0.2289
0.1793
0.3719
0.7563
0.6601
1.1402
0.5190
0.3952
1.9170
0.4642
0.6561
0.9844
2.3474
0.6251
1.1241
1.1324
0.7491
2.0751
2.0751
2.0751
‐
0.2051
0.1338
0.4631
5.6506
0.2332
0.3263
‐
‐
‐
‐
‐
‐
‐
‐
0.2324
0.4325
0.1808
0.2567
0.0654
0.2338
0.0604
0.2393
0.1577
0.2221
0.0672
0.2097
0.0417
0.1614
0.1182
0.1060
0.0831
0.2492
0.0691
0.1685
0.0659
0.0437
0.4035
0.2289
0.1793
0.3719
0.7563
0.8041
1.0129
0.4952
0.4544
1.9580
0.4642
0.6561
0.9844
2.3474
0.6251
1.1241
1.1324
0.7491
2.0751
2.0751
2.0751
‐
0.2051
0.1338
0.4631
5.6506
0.2332
0.3263
‐
‐
‐
‐
‐
‐
‐
‐
0.2324
0.4325
0.1808
0.2567
0.0654
0.2338
0.0604
0.2393
0.1577
0.2221
0.0672
0.2097
0.0417
0.1614
0.1182
0.1060
0.0831
0.2492
0.0691
0.1685
0.0659
0.0437
0.4035
0.2289
0.1793
0.3719
0.7563
0.8041
1.0129
0.4952
0.4544
1.9580
0.4642
Page 5 of 29
APG
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427
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451
452
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464
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APG Description
INTRODUCTION OF NEEDLE AND CATHETER
DRESSINGS AND OTHER MINOR PROCEDURES
LEVEL I OTHER MISCELLANEOUS ANCILLARY PROCEDURES
PSYCHOTROPIC MEDICATION MANAGEMENT
BIOFEEDBACK AND OTHER TRAINING
PATIENT EDUCATION, INDIVIDUAL
PATIENT EDUCATION, GROUP
CLASS I CHEMOTHERAPY DRUGS
CLASS II CHEMOTHERAPY DRUGS
CLASS III CHEMOTHERAPY DRUGS
CLASS IV CHEMOTHERAPY DRUGS
CLASS V CHEMOTHERAPY DRUGS
CLASS I PHARMACOTHERAPY
CLASS II PHARMACOTHERAPY
CLASS III PHARMACOTHERAPY
CLASS IV PHARMACOTHERAPY
CLASS V PHARMACOTHERAPY
CLASS VI PHARMACOTHERAPY
CLASS VI CHEMOTHERAPY DRUGS
CLASS VII COMBINED CHEMOTHERAPY & PHARMACOTHERAPY
CLASS VII CHEMOTHERAPY DRUGS
CLASS VII PHARMACOTHERAPY
EXPANDED HOURS ACCESS
Additional undifferentiated medical visit/services
OBSERVATION
SMOKING CESSATION TREATMENT
DIABETES SUPPLIES
MOTORIZED WHEELCHAIR
TPN FORMULAE
IMPLANTED TISSUE OF ANY TYPE
MOTORIZED WHEELCHAIR ACCESSORIES
VENIPUNCTURE
ALLERGY THERAPY
VACCINE ADMINISTRATION
CLASS VIII COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY
CLASS IX COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY
CLASS X COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY
CLASS XI COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY
CLASS XII COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY
CLASS XIII COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY
OBSTETRICAL ULTRASOUND
PLAIN FILM
ULTRASOUND GUIDANCE
CT GUIDANCE
RADIOLOGICAL GUIDANCE FOR THERAPEUTIC OR DIAGNOSTIC PROCEDURES
MRI GUIDANCE
LEVEL I THERAPEUTIC RADIATION TREATMENT PREPARATION
LEVEL II THERAPEUTIC RADIATION TREATMENT PREPARATION
MEDICAL RADIATION PHYSICS
TREATMENT DEVICE DESIGN AND CONSTRUCTION
TELETHERAPY/BRACHYTHERAPY CALCULATION
THERAPEUTIC RADIOLOGY SIMULATION FIELD SETTING
RADIOELEMENT APPLICATION
RADIATION THERAPY MANAGEMENT
THERAPEUTIC RADIOLOGY TREATMENT PLANNING
CORNEAL TISSUE PROCESSING
BASIC BLOOD TYPING
MINOR CARDIAC MONITORING
Dec 1
2008
Jan 1
2010
Apr 1
2010
Jul 1
2010
Oct 1
2010
Jan 1
2011
Apr 1
2011
July 1 2011
Oct 1 2011
Jan 1 2012
Apr 1 2012
July 1 2012
Oct 1 2012
0.9391
1.2969
1.0663
0.3535
‐
0.1202
0.0668
‐
‐
‐
‐
‐
0.1068
0.9989
2.1521
6.3796
13.6454
‐
‐
‐
‐
‐
0.0356
‐
‐
0.1090
‐
‐
‐
4.8634
‐
0.0675
‐
‐
‐
‐
‐
‐
‐
‐
0.9504
0.6885
1.3612
0.8405
2.9696
1.5646
1.0796
1.8461
1.5197
4.4205
2.4697
6.0354
1.8353
2.4471
2.9833
‐
‐
‐
2.1414
0.6994
0.4347
0.3448
‐
‐
‐
‐
‐
‐
‐
‐
0.1061
1.2529
2.7208
4.7852
12.2876
20.0367
‐
‐
‐
‐
0.0759
‐
‐
0.1100
‐
‐
‐
7.2736
‐
0.0602
‐
‐
‐
‐
‐
‐
‐
‐
0.9405
0.4758
1.2632
1.2002
2.3045
2.3306
2.3082
2.3097
0.7463
1.7071
1.7080
4.1129
3.1301
2.5251
1.7963
‐
‐
‐
2.1414
0.6994
0.4347
0.3448
‐
‐
‐
‐
‐
‐
‐
‐
0.1061
1.2529
2.7208
4.7852
12.2876
20.0367
‐
‐
‐
‐
0.0759
‐
‐
0.1100
‐
‐
‐
7.2736
‐
0.0602
‐
‐
‐
‐
‐
‐
‐
‐
0.9405
0.4758
1.2632
1.2002
2.3045
2.3306
2.3082
2.3097
0.7463
1.7071
1.7080
4.1129
3.1301
2.5251
1.7963
‐
‐
‐
1.0383
0.3869
0.5356
0.3448
‐
‐
‐
‐
‐
‐
‐
‐
0.1061
1.2529
2.7208
4.7852
12.2876
20.0367
‐
‐
‐
‐
0.0759
‐
‐
0.1100
‐
‐
‐
7.6954
‐
0.0637
‐
‐
‐
‐
‐
‐
‐
‐
0.9951
0.3223
0.8764
1.0718
2.4382
1.4302
2.4421
2.4436
0.7896
2.2975
1.8071
4.1946
3.3116
2.1130
1.9005
‐
‐
‐
1.0383
0.3869
0.5356
0.3448
‐
‐
‐
‐
‐
‐
‐
‐
0.1061
1.2529
2.7208
4.7852
12.2876
20.0367
‐
‐
‐
‐
0.0759
‐
‐
0.1100
‐
‐
‐
7.6954
‐
0.0637
‐
‐
‐
‐
‐
‐
‐
‐
0.9951
0.3223
0.8764
1.0718
2.4382
1.4302
2.4421
2.4436
0.7896
2.2975
1.8071
4.1946
3.3116
2.1130
1.9005
‐
‐
‐
1.0383
0.3869
0.5356
0.3448
‐
‐
‐
‐
‐
‐
‐
‐
0.1879
0.5636
1.0121
1.6970
2.7455
4.2788
‐
‐
‐
6.4061
0.0759
‐
1.6063
0.1100
‐
‐
‐
7.1549
‐
0.0637
‐
‐
9.2182
12.7152
20.2000
32.5818
50.0061
‐
0.9951
0.2997
0.8764
1.0718
2.4382
1.4302
2.4421
2.4436
0.7896
2.2975
1.8071
4.1946
3.3116
2.1130
1.9005
‐
‐
‐
1.0383
0.3869
0.5356
0.3448
‐
‐
‐
‐
‐
‐
‐
‐
0.1879
0.5636
1.0121
1.6970
2.7455
4.2788
‐
‐
‐
6.4061
0.0759
‐
1.6063
0.1100
‐
‐
‐
7.1549
‐
0.0637
‐
‐
9.2182
12.7152
20.2000
32.5818
50.0061
‐
0.9951
0.2997
0.8764
1.0718
2.4382
1.4302
2.4421
2.4436
0.7896
2.2975
1.8071
4.1946
3.3116
2.1130
1.9005
‐
‐
‐
1.0383
0.3869
0.5356
0.3448
‐
‐
‐
‐
‐
‐
‐
‐
0.1879
0.5636
1.0121
1.6970
2.7455
4.2788
‐
‐
‐
6.4061
0.0759
‐
2.1949
0.1267
‐
‐
‐
6.4572
‐
0.0427
‐
‐
9.2182
12.7152
20.2000
32.5818
50.0061
‐
0.8426
0.1724
1.0371
0.9856
1.9346
1.4302
2.5501
2.4084
0.8346
2.8379
2.0718
4.9793
4.3517
1.9669
1.7711
‐
‐
‐
1.0383
0.3869
0.5356
0.3448
‐
‐
‐
‐
‐
‐
‐
‐
0.1879
0.5636
1.0121
1.6970
2.7455
4.2788
‐
‐
‐
6.4061
0.0759
‐
2.1949
0.1267
‐
‐
‐
6.4572
‐
0.0427
‐
‐
9.2182
12.7152
20.2000
32.5818
50.0061
‐
0.8426
0.1724
1.0371
0.9856
1.9346
1.4302
2.5501
2.4084
0.8346
2.8379
2.0718
4.9793
4.3517
1.9669
1.7711
‐
‐
‐
1.0383
0.3869
0.5356
0.3448
‐
‐
‐
‐
‐
‐
‐
‐
0.1879
0.5636
1.0121
1.6970
2.7455
4.2788
‐
‐
‐
6.4061
0.0759
‐
2.1949
0.1267
‐
‐
‐
6.4572
‐
0.0427
‐
‐
9.2182
12.7152
20.2000
32.5818
50.0061
‐
0.8426
0.1724
1.0371
0.9856
1.9346
1.4302
2.5501
2.4084
0.8346
2.8379
2.0718
4.9793
4.3517
1.9669
1.7711
‐
‐
‐
1.0383
0.3869
0.5356
0.3448
‐
‐
‐
‐
‐
‐
‐
‐
0.1879
0.5636
1.0121
1.6970
2.7455
4.2788
‐
‐
‐
6.4061
0.0759
‐
2.1949
0.1267
‐
‐
‐
6.4572
‐
0.0427
‐
‐
9.2182
12.7152
20.2000
32.5818
50.0061
‐
0.8426
0.1724
1.0371
0.9856
1.9346
1.4302
2.5501
2.4084
0.8346
2.8379
2.0718
4.9793
4.3517
1.9669
1.7711
‐
‐
‐
1.0383
0.3869
0.5356
0.3448
‐
‐
‐
‐
‐
‐
‐
‐
0.1879
0.5636
1.0121
1.6970
2.7455
4.2788
‐
‐
‐
6.4061
0.0759
‐
2.1949
0.1267
‐
‐
‐
6.4572
‐
0.0440
‐
‐
9.2182
12.7152
20.2000
32.5818
50.0061
‐
0.6956
0.1896
1.1555
1.0641
1.9346
1.4302
2.5501
2.4084
0.9180
2.3515
2.0249
3.8645
4.9484
1.7169
2.0358
‐
‐
‐
1.0383
0.3869
0.5356
0.3448
‐
‐
‐
‐
‐
‐
‐
‐
0.1879
0.5636
1.0121
1.6970
2.7455
4.2788
‐
‐
‐
6.4061
0.0759
‐
2.1949
0.1267
‐
‐
‐
6.4572
‐
0.0440
‐
‐
9.2182
12.7152
20.2000
32.5818
50.0061
‐
0.6956
0.1896
1.1555
1.0641
1.9346
1.4302
2.5501
2.4084
0.9180
2.3515
2.0249
3.8645
4.9484
1.7169
2.0358
‐
‐
‐
Page 6 of 29
APG
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489
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491
492
495
497
498
496
500
501
502
510
520
521
522
523
524
525
526
527
528
529
530
531
532
533
534
535
536
550
551
552
553
554
555
560
561
562
563
564
565
570
571
572
573
574
575
576
577
578
579
591
592
593
594
595
596
APG Description
MINOR DEVICE EVALUATION & ELECTRONIC ANALYSIS
LEVEL II OTHER MISCELLANEOUS ANCILLARY PROCEDURES
INCIDENTAL TO MEDICAL VISIT OR SIGNIFICANT PROCEDURE
MEDICAL VISIT INDICATOR
ADMISSION FOR OBSERVATION INDICATOR
MINOR CHEMOTHERAPY DRUGS
TELEHEALTH FACILITATION
PEN FORMULAE
MINOR PHARMACOTHERAPY
DIRECT ADMISSION FOR OBSERVATION ‐ OBSTETRICAL
DIRECT ADMISSION FOR OBSERVATION ‐ OTHER DIAGNOSES
DIRECT REFERRAL FOR OBSERVATION ‐ BEHAVIORAL HEALTH
MAJOR SIGNS, SYMPTOMS AND FINDINGS
SPINAL DIAGNOSES & INJURIES
NERVOUS SYSTEM MALIGNANCY
DEGENERATIVE NERVOUS SYSTEM DIAGNOSES EXC MULT SCLEROSIS
MULTIPLE SCLEROSIS & OTHER DEMYELINATING DISEASES
LEVEL I CNS DIAGNOSES
LEVEL II CNS DIAGNOSES
TRANSIENT ISCHEMIA
PERIPHERAL NERVE DIAGNOSES
NONTRAUMATIC STUPOR & COMA
SEIZURE
HEADACHES OTHER THAN MIGRAINE
MIGRAINE
HEAD TRAUMA
AFTEREFFECTS OF CEREBROVASCULAR ACCIDENT
NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARC
CVA & PRECEREBRAL OCCLUSION W INFARCT
CEREBRAL PALSY
ACUTE MAJOR EYE INFECTIONS
CATARACTS
GLAUCOMA
LEVEL I OPHTHALMIC DIAGNOSES
LEVEL II OPHTHALMIC DIAGNOSES
CONJUNCTIVITIS
EAR, NOSE, MOUTH, THROAT, CRANIAL/FACIAL MALIGNANCIES
VERTIGINOUS DIAGNOSES EXCEPT FOR BENIGN VERTIGO
INFECTIONS OF UPPER RESPIRATORY TRACT
DENTAL & ORAL DIAGNOSES & INJURIES
LEVEL I OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES
LEVEL II OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES
CYSTIC FIBROSIS ‐ PULMONARY DISEASE
RESPIRATORY MALIGNANCY
BRONCHIOLITIS & RSV PNEUMONIA
COMMUNITY ACQUIRED PNUEMONIA
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
ASTHMA
LEVEL I OTHER RESPIRATORY DIAGNOSES
LEVEL II OTHER RESPIRATORY DIAGNOSES
PNEUMONIA EXCEPT FOR COMMUNITY ACQUIRED PNEUMONIA
STATUS ASTHMATICUS
ACUTE MYOCARDIAL INFARCTION
LEVEL I CARDIOVASCULAR DIAGNOSES
LEVEL II CARDIOVASCULAR DIAGNOSES
HEART FAILURE
CARDIAC ARREST OR OTHER CAUSES OF MORTALITY
PERIPHERAL & OTHER VASCULAR DIAGNOSES
Dec 1
2008
Jan 1
2010
Apr 1
2010
Jul 1
2010
Oct 1
2010
Jan 1
2011
Apr 1
2011
July 1 2011
Oct 1 2011
Jan 1 2012
Apr 1 2012
July 1 2012
Oct 1 2012
‐
‐
‐
1.1276
‐
‐
‐
‐
‐
‐
‐
‐
0.9701
0.6416
1.4170
0.6992
0.6393
0.6783
0.8319
1.4601
0.7120
1.0393
0.9756
0.9609
0.8847
1.7436
0.7435
0.9273
0.7053
‐
0.6763
0.6273
0.6453
0.6725
0.8497
0.7007
1.7033
1.1915
0.6893
0.4805
0.7397
1.4495
0.9766
1.8361
0.8498
1.3077
0.6739
0.9150
1.0672
0.7956
0.8720
0.5124
5.7122
0.8157
0.8157
0.7967
3.6827
0.7664
‐
‐
‐
0.7995
‐
‐
‐
‐
‐
‐
‐
‐
0.8466
0.8689
0.7216
0.8448
0.7490
0.9420
0.8167
0.8838
0.7377
0.8956
0.9218
0.8208
0.7556
0.7274
0.8360
0.9246
0.8058
‐
0.6374
0.8106
0.7766
0.7034
0.7757
0.6301
0.8000
0.8235
0.6284
0.5307
0.7677
0.8622
0.7880
0.7905
0.5136
0.6791
0.6893
0.7979
0.7013
0.8384
0.6586
0.9027
2.2552
0.7853
0.8735
0.8490
1.1669
0.8313
‐
‐
‐
0.7995
‐
‐
‐
‐
‐
‐
‐
‐
0.8466
0.8689
0.7216
0.8448
0.7490
0.9420
0.8167
0.8838
0.7377
0.8956
0.9218
0.8208
0.7556
0.7274
0.8360
0.9246
0.8058
‐
0.6374
0.8106
0.7766
0.7034
0.7757
0.6301
0.8000
0.8235
0.6284
0.5307
0.7677
0.8622
0.7880
0.7905
0.5136
0.6791
0.6893
0.7979
0.7013
0.8384
0.6586
0.9027
2.2552
0.7853
0.8735
0.8490
1.1669
0.8313
‐
‐
0.0971
0.8459
‐
‐
‐
‐
‐
‐
‐
‐
0.8661
0.8153
0.7832
0.7869
0.6685
0.7727
0.8504
0.7649
0.7677
0.8223
0.9236
0.8465
0.9208
0.7963
0.7337
0.8129
0.7915
‐
0.7669
0.8243
0.7978
0.8241
0.8241
0.7021
0.8167
0.9032
0.7152
0.6064
0.7957
0.9614
1.0257
0.7860
0.6372
0.9560
0.6792
0.8845
0.9150
0.9150
0.5165
0.7330
1.5488
0.8038
0.8918
0.8584
1.8677
0.7492
‐
‐
0.0971
0.8459
‐
‐
‐
‐
‐
‐
‐
‐
0.8661
0.8153
0.7832
0.7869
0.6685
0.7727
0.8504
0.7649
0.7677
0.8223
0.9236
0.8465
0.9208
0.7963
0.7337
0.8129
0.7915
‐
0.7669
0.8243
0.7978
0.8241
0.8241
0.7021
0.8167
0.9032
0.7152
0.6064
0.7957
0.9614
1.0257
0.7860
0.6372
0.9560
0.6792
0.8845
0.9150
0.9150
0.5165
0.7330
1.5488
0.8038
0.8918
0.8584
1.8677
0.7492
‐
‐
‐
0.8459
‐
‐
‐
‐
‐
‐
‐
‐
0.8661
0.8153
0.7832
0.7869
0.6685
0.7727
0.8504
0.7649
0.7677
0.8223
0.9236
0.8465
0.9208
0.7963
0.7337
0.8129
0.7915
0.7727
0.7669
0.8243
0.7978
0.8241
0.8241
0.7021
0.8167
0.9032
0.7152
0.6064
0.7957
0.9614
1.0257
0.7860
0.6372
0.9560
0.6792
0.8845
0.9150
0.9150
0.5165
0.7330
1.5488
0.8038
0.8918
0.8584
1.8677
0.7492
‐
‐
‐
0.8459
‐
‐
‐
‐
‐
‐
‐
‐
0.8661
0.8153
0.7832
0.7869
0.6685
0.7727
0.8504
0.7649
0.7677
0.8223
0.9236
0.8465
0.9208
0.7963
0.7337
0.8129
0.7915
0.7727
0.7669
0.8243
0.7978
0.8241
0.8241
0.7021
0.8167
0.9032
0.7152
0.6064
0.7957
0.9614
1.0257
0.7860
0.6372
0.9560
0.6792
0.8845
0.9150
0.9150
0.5165
0.7330
1.5488
0.8038
0.8918
0.8584
1.8677
0.7492
‐
‐
‐
0.8301
‐
‐
‐
‐
‐
‐
‐
‐
0.8979
0.8304
0.8179
0.8154
0.6667
0.7840
0.8505
0.7456
0.7703
0.8819
0.9473
0.7994
0.7855
0.7158
0.7821
0.7987
0.7651
0.8222
0.7346
0.8028
0.7605
0.7697
0.8454
0.6348
0.8409
0.8547
0.6792
0.6407
0.7932
0.8745
1.0289
0.7561
0.6407
0.9145
0.7438
1.0361
0.8926
1.1682
0.7681
0.8191
1.4044
0.8393
0.8673
0.8907
1.6341
0.7802
‐
‐
‐
0.8301
‐
‐
‐
‐
‐
‐
‐
‐
0.8979
0.8304
0.8179
0.8154
0.6667
0.7840
0.8505
0.7456
0.7703
0.8819
0.9473
0.7994
0.7855
0.7158
0.7821
0.7987
0.7651
0.8222
0.7346
0.8028
0.7605
0.7697
0.8454
0.6348
0.8409
0.8547
0.6792
0.6407
0.7932
0.8745
1.0289
0.7561
0.6407
0.9145
0.7438
1.0361
0.8926
1.1682
0.7681
0.8191
1.4044
0.8393
0.8673
0.8907
1.6341
0.7802
‐
‐
‐
0.8301
‐
‐
‐
‐
‐
‐
‐
‐
0.8979
0.8304
0.8179
0.8154
0.6667
0.7840
0.8505
0.7456
0.7703
0.8819
0.9473
0.7994
0.7855
0.7158
0.7821
0.7987
0.7651
0.8222
0.7346
0.8028
0.7605
0.7697
0.8454
0.6348
0.8409
0.8547
0.6792
0.6407
0.7932
0.8745
1.0289
0.7561
0.6407
0.9145
0.7438
1.0361
0.8926
1.1682
0.7681
0.8191
1.4044
0.8393
0.8673
0.8907
1.6341
0.7802
‐
‐
‐
0.8301
‐
‐
‐
‐
‐
‐
‐
‐
0.8979
0.8304
0.8179
0.8154
0.6667
0.7840
0.8505
0.7456
0.7703
0.8819
0.9473
0.7994
0.7855
0.7158
0.7821
0.7987
0.7651
0.8222
0.7346
0.8028
0.7605
0.7697
0.8454
0.6348
0.8409
0.8547
0.6792
0.6407
0.7932
0.8745
1.0289
0.7561
0.6407
0.9145
0.7438
1.0361
0.8926
1.1682
0.7681
0.8191
1.4044
0.8393
0.8673
0.8907
1.6341
0.7802
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
0.8103
0.7778
0.7228
0.7227
0.6667
0.6804
0.7751
0.6656
0.6914
0.8376
0.7801
0.7764
0.8010
0.7425
0.6855
0.6827
0.6813
0.8222
0.6522
0.6833
0.6761
0.7522
0.7533
0.6348
0.7514
0.7555
0.6427
0.6215
0.7018
0.8018
0.9653
0.6859
0.6199
0.8336
0.6631
0.8962
0.7727
0.9412
0.7648
0.7286
1.4738
0.7111
0.7396
0.7543
1.6299
0.7562
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
0.8103
0.7778
0.7228
0.7227
0.6667
0.6804
0.7751
0.6656
0.6914
0.8376
0.7801
0.7764
0.8010
0.7425
0.6855
0.6827
0.6813
0.8222
0.6522
0.6833
0.6761
0.7522
0.7533
0.6348
0.7514
0.7555
0.6427
0.6215
0.7018
0.8018
0.9653
0.6859
0.6199
0.8336
0.6631
0.8962
0.7727
0.9412
0.7648
0.7286
1.4738
0.7111
0.7396
0.7543
1.6299
0.7562
Page 7 of 29
APG
597
598
599
600
601
602
603
604
605
620
621
623
624
625
626
627
628
629
630
631
632
633
634
635
636
637
638
639
640
650
651
652
653
654
655
656
657
658
659
660
661
662
663
670
671
672
673
674
675
676
690
691
692
693
694
695
710
711
APG Description
Dec 1
2008
PHLEBITIS
0.7434
ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS
0.8736
HYPERTENSION
0.6952
CARDIAC STRUCTURAL & VALVULAR DIAGNOSES
1.0466
LEVEL I CARDIAC ARRHYTHMIA & CONDUCTION DIAGNOSES
1.1985
ATRIAL FIBRILLATION
0.9954
LEVEL II CARDIAC ARRHYTHMIA & CONDUCTION DIAGNOSES
0.9165
CHEST PAIN
2.0030
SYNCOPE & COLLAPSE
1.8564
DIGESTIVE MALIGNANCY
2.1345
PEPTIC ULCER & GASTRITIS
1.2964
ESOPHAGITIS
0.6373
LEVEL I GASTROINTESTINAL DIAGNOSES
0.8882
LEVEL II GASTROINTESTINAL DIAGNOSES
0.8004
INFLAMMATORY BOWEL DISEASE
0.6867
NON‐BACTERIAL GASTROENTERITIS, NAUSEA & VOMITING
1.0670
ABDOMINAL PAIN
1.4513
MALFUNCTION, REACTION & COMPLICATION OF GI DEVICE OR PROCEDURE 1.4552
CONSTIPATION
0.9378
HERNIA
0.7912
IRRITABLE BOWEL SYNDROME
0.6018
ALCOHOLIC LIVER DISEASE
0.7923
MALIGNANCY OF HEPATOBILIARY SYSTEM & PANCREAS
1.4269
PANCREAS DIAGNOSES EXCEPT MALIGNANCY
1.5278
HEPATITIS WITHOUT COMA
0.7291
GALLBLADDER & BILIARY TRACT DIAGNOSES
0.8423
CHOLECYSTITIS
1.1519
LEVEL I HEPATOBILIARY DIAGNOSES
0.9891
LEVEL II HEPATOBILIARY DIAGNOSES
0.6674
FRACTURE OF FEMUR
0.9813
FRACTURE OF PELVIS OR DISLOCATION OF HIP
0.9780
FRACTURES & DISLOCATIONS EXCEPT FEMUR, PELVIS & BACK
1.1211
MUSCULOSKELETAL MALIGNANCY & PATHOL FRACTURE D/T MUSCSKEL MAL 1.4795
OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTION 0.6728
CONNECTIVE TISSUE DIAGNOSES
0.6743
BACK & NECK DIAGNOSES EXCEPT LUMBAR DISC DIAGNOSES
0.9519
LUMBAR DISC DIAGNOSES
0.8104
LUMBAR DISC DIAGNOSES WITH SCIATICA
1.0996
MALFUNCTION, REACTION, COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDUR 1.5171
LEVEL I OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOS 0.8196
LEVEL II OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOS 0.9314
OSTEOPOROSIS
0.4961
PAIN
0.8372
SKIN ULCERS
0.7420
MAJOR SKIN DIAGNOSES
0.6644
MALIGNANT BREAST DIAGNOSES
1.7630
CELLULITIS & OTHER BACTERIAL SKIN INFECTIONS
0.9183
CONTUSION, OPEN WOUND & OTHER TRAUMA TO SKIN & SUBCUTANEOUS T 1.3805
OTHER SKIN, SUBCUTANEOUS TISSUE & BREAST DIAGNOSES
0.6997
DECUBITUS ULCER
0.7085
MALNUTRITION, FAILURE TO THRIVE & OTHER NUTRITIONAL DISORDERS
0.6268
INBORN ERRORS OF METABOLISM
0.5511
LEVEL I ENDOCRINE DIAGNOSES
0.6921
LEVEL II ENDOCRINE DIAGNOSES
0.6921
ELECTROLYTE DISORDERS
1.6055
OBESITY
0.4691
DIABETES WITH OPHTHALMIC MANIFESTATIONS
0.7201
DIABETES WITH CIRCULATORY DIAGNOSES
0.8197
Jan 1
2010
Apr 1
2010
Jul 1
2010
Oct 1
2010
Jan 1
2011
Apr 1
2011
July 1 2011
Oct 1 2011
Jan 1 2012
Apr 1 2012
July 1 2012
Oct 1 2012
0.5608
0.7776
0.7924
0.8305
0.8097
0.8178
1.0425
0.8151
0.7943
0.7214
1.0541
0.7081
0.7720
0.7720
0.8255
0.7240
0.8099
1.0179
0.7712
0.8163
0.6753
0.8245
0.8924
0.7530
0.8736
0.7058
0.7463
0.8765
0.7030
0.7209
0.6540
0.7464
0.5615
0.7358
0.7816
0.7486
0.7188
0.7287
0.6927
0.6864
0.7158
0.7418
0.6247
0.7083
0.7542
0.7032
0.7130
0.7721
0.7569
0.8081
0.7912
0.7457
0.7671
0.7757
0.7607
0.6351
0.7645
0.8886
0.5608
0.7776
0.7924
0.8305
0.8097
0.8178
1.0425
0.8151
0.7943
0.7214
1.0541
0.7081
0.7720
0.7720
0.8255
0.7240
0.8099
1.0179
0.7712
0.8163
0.6753
0.8245
0.8924
0.7530
0.8736
0.7058
0.7463
0.8765
0.7030
0.7209
0.6540
0.7464
0.5615
0.7358
0.7816
0.7486
0.7188
0.7287
0.6927
0.6864
0.7158
0.7418
0.6247
0.7083
0.7542
0.7032
0.7130
0.7721
0.7569
0.8081
0.7912
0.7457
0.7671
0.7757
0.7607
0.6351
0.7645
0.8886
0.7287
0.7434
0.7406
0.9975
0.9291
0.8270
0.9476
1.1736
0.9988
0.7036
1.0396
0.6757
0.8018
0.8018
0.7505
0.8297
0.8572
1.2239
0.8929
0.7936
0.6564
0.7192
0.8294
0.7756
0.7931
0.6097
0.6880
0.8023
0.6771
1.2104
1.1561
1.0804
0.7423
0.7790
0.7526
0.8953
0.8468
1.0187
0.9303
0.8636
0.9128
0.6327
0.8481
0.7204
0.7380
0.6827
0.7865
1.0307
0.7585
0.7264
0.7364
0.6455
0.7066
0.7385
0.7508
0.6988
0.7917
0.7440
0.7287
0.7434
0.7406
0.9975
0.9291
0.8270
0.9476
1.1736
0.9988
0.7036
1.0396
0.6757
0.8018
0.8018
0.7505
0.8297
0.8572
1.2239
0.8929
0.7936
0.6564
0.7192
0.8294
0.7756
0.7931
0.6097
0.6880
0.8023
0.6771
1.2104
1.1561
1.0804
0.7423
0.7790
0.7526
0.8953
0.8468
1.0187
0.9303
0.8636
0.9128
0.6327
0.8481
0.7204
0.7380
0.6827
0.7865
1.0307
0.7585
0.7264
0.7364
0.6455
0.7066
0.7385
0.7508
0.6988
0.7917
0.7440
0.7287
0.7434
0.7406
0.9975
0.9291
0.8270
0.9476
1.1736
0.9988
0.7036
1.0396
0.6757
0.8018
0.8018
0.7505
0.8297
0.8572
1.2239
0.8929
0.7936
0.6564
0.7192
0.8294
0.7756
0.7931
0.6097
0.6880
0.8023
0.6771
1.2104
1.1561
1.0804
0.7423
0.7790
0.7526
0.8953
0.8468
1.0187
0.9303
0.8636
0.9128
0.6327
0.8481
0.7204
0.7380
0.6827
0.7865
1.0307
0.7585
0.7264
0.7364
0.6455
0.7066
0.7385
0.7508
0.6988
0.7917
0.7440
0.7287
0.7434
0.7406
0.9975
0.9291
0.8270
0.9476
1.1736
0.9988
0.7036
1.0396
0.6757
0.8018
0.8018
0.7505
0.8297
0.8572
1.2239
0.8929
0.7936
0.6564
0.7192
0.8294
0.7756
0.7931
0.6097
0.6880
0.8023
0.6771
1.2104
1.1561
1.0804
0.7423
0.7790
0.7526
0.8953
0.8468
1.0187
0.9303
0.8636
0.9128
0.6327
0.8481
0.7204
0.7380
0.6827
0.7865
1.0307
0.7585
0.7264
0.7364
0.6455
0.7066
0.7385
0.7508
0.6988
0.7917
0.7440
0.7678
0.8171
0.7209
1.0593
0.9740
0.8060
1.0276
1.1033
0.9381
0.6808
0.9383
0.6757
0.8485
0.8569
0.6994
0.7744
0.8096
1.0342
0.9052
0.7361
0.6227
0.7917
0.8835
0.7295
1.0382
0.7469
0.6815
0.7575
0.7133
1.0538
0.9599
1.0484
0.9205
0.8841
0.7574
0.8506
0.8530
0.8826
0.8526
0.8178
0.9185
0.6395
0.7440
0.8057
0.7288
0.6588
0.6702
0.9485
0.7274
0.6915
0.7276
0.6103
0.7070
0.7796
0.7962
0.7292
0.7666
0.7038
0.7678
0.8171
0.7209
1.0593
0.9740
0.8060
1.0276
1.1033
0.9381
0.6808
0.9383
0.6757
0.8485
0.8569
0.6994
0.7744
0.8096
1.0342
0.9052
0.7361
0.6227
0.7917
0.8835
0.7295
1.0382
0.7469
0.6815
0.7575
0.7133
1.0538
0.9599
1.0484
0.9205
0.8841
0.7574
0.8506
0.8530
0.8826
0.8526
0.8178
0.9185
0.6395
0.7440
0.8057
0.7288
0.6588
0.6702
0.9485
0.7274
0.6915
0.7276
0.6103
0.7070
0.7796
0.7962
0.7292
0.7666
0.7038
0.7678
0.8171
0.7209
1.0593
0.9740
0.8060
1.0276
1.1033
0.9381
0.6808
0.9383
0.6757
0.8485
0.8569
0.6994
0.7744
0.8096
1.0342
0.9052
0.7361
0.6227
0.7917
0.8835
0.7295
1.0382
0.7469
0.6815
0.7575
0.7133
1.0538
0.9599
1.0484
0.9205
0.8841
0.7574
0.8506
0.8530
0.8826
0.8526
0.8178
0.9185
0.6395
0.7440
0.8057
0.7288
0.6588
0.6702
0.9485
0.7274
0.6915
0.7276
0.6103
0.7070
0.7796
0.7962
0.7292
0.7666
0.7038
0.7678
0.8171
0.7209
1.0593
0.9740
0.8060
1.0276
1.1033
0.9381
0.6808
0.9383
0.6757
0.8485
0.8569
0.6994
0.7744
0.8096
1.0342
0.9052
0.7361
0.6227
0.7917
0.8835
0.7295
1.0382
0.7469
0.6815
0.7575
0.7133
1.0538
0.9599
1.0484
0.9205
0.8841
0.7574
0.8506
0.8530
0.8826
0.8526
0.8178
0.9185
0.6395
0.7440
0.8057
0.7288
0.6588
0.6702
0.9485
0.7274
0.6915
0.7276
0.6103
0.7070
0.7796
0.7962
0.7292
0.7666
0.7038
0.6564
0.6914
0.6488
0.8643
0.7759
0.6975
0.8501
0.9139
0.8221
0.6278
0.8511
0.6757
0.7344
0.7469
0.6164
0.7498
0.7730
0.8849
0.8488
0.6622
0.5706
0.6997
0.7451
0.6838
0.7899
0.6404
0.6275
0.7214
0.6923
1.1385
1.0449
1.0470
0.8529
0.8245
0.6885
0.8082
0.7947
0.8401
0.8668
0.7618
0.8415
0.5743
0.7593
0.8593
0.6569
0.6478
0.6663
0.9660
0.6546
0.7964
0.7172
0.6103
0.6883
0.6754
0.7342
0.6715
0.7507
0.6793
0.6564
0.6914
0.6488
0.8643
0.7759
0.6975
0.8501
0.9139
0.8221
0.6278
0.8511
0.6757
0.7344
0.7469
0.6164
0.7498
0.7730
0.8849
0.8488
0.6622
0.5706
0.6997
0.7451
0.6838
0.7899
0.6404
0.6275
0.7214
0.6923
1.1385
1.0449
1.0470
0.8529
0.8245
0.6885
0.8082
0.7947
0.8401
0.8668
0.7618
0.8415
0.5743
0.7593
0.8593
0.6569
0.6478
0.6663
0.9660
0.6546
0.7964
0.7172
0.6103
0.6883
0.6754
0.7342
0.6715
0.7507
0.6793
Page 8 of 29
APG
712
713
714
720
721
722
723
724
725
726
727
740
741
742
743
744
750
751
752
753
760
761
762
763
764
765
766
770
771
772
780
781
782
783
784
785
786
800
801
802
803
804
805
806
807
808
809
810
820
821
822
823
824
825
826
827
828
829
APG Description
DIABETES WITH NEUROLOGIC MANIFESTATIONS
DIABETES WITHOUT COMPLICATIONS
DIABETES WITH RENAL MANIFESTATIONS
RENAL FAILURE
KIDNEY & URINARY TRACT MALIGNANCY
NEPHRITIS & NEPHROSIS
KIDNEY AND CHRONIC URINARY TRACT INFECTIONS
URINARY STONES & ACQUIRED UPPER URINARY TRACT OBSTRUCTION
MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PROC
OTHER KIDNEY & URINARY TRACT DIAGNOSES, SIGNS & SYMPTOMS
ACUTE LOWER URINARY TRACT INFECTIONS
MALIGNANCY, MALE REPRODUCTIVE SYSTEM
MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY
NEOPLASMS OF THE MALE REPRODUCTIVE SYSTEM
PROSTATITIS
MALE REPRODUCTIVE INFECTIONS
FEMALE REPRODUCTIVE SYSTEM MALIGNANCY
FEMALE REPRODUCTIVE SYSTEM INFECTIONS
LEVEL I MENSTRUAL AND OTHER FEMALE DIAGNOSES
LEVEL II MENSTRUAL AND OTHER FEMALE DIAGNOSES
VAGINAL DELIVERY
POSTPARTUM & POST ABORTION DIAGNOSES W/O PROCEDURE
THREATENED ABORTION
ABORTION W/O D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
FALSE LABOR
OTHER ANTEPARTUM DIAGNOSES
ROUTINE PRENATAL CARE
NORMAL NEONATE
LEVEL I NEONATAL DIAGNOSES
LEVEL II NEONATAL DIAGNOSES
OTHER HEMATOLOGICAL DIAGNOSES
COAGULATION & PLATELET DIAGNOSES
CONGENITAL FACTOR DEFICIENCIES
SICKLE CELL ANEMIA CRISIS
SICKLE CELL ANEMIA
ANEMIA EXCEPT FOR IRON DEFICIENCY ANEMIA AND SICKLE CELL ANEMIA
IRON DEFICIENCY ANEMIA
ACUTE LEUKEMIA
LYMPHOMA, MYELOMA & NON‐ACUTE LEUKEMIA
RADIOTHERAPY
CHEMOTHERAPY
LYMPHATIC & OTHER MALIGNANCIES & NEOPLASMS OF UNCERTAIN BEHAVI
SEPTICEMIA & DISSEMINATED INFECTIONS
POST‐OPERATIVE, POST‐TRAUMATIC, OTHER DEVICE INFECTIONS
FEVER
VIRAL ILLNESS
OTHER INFECTIOUS & PARASITIC DISEASES
H. PYLORI INFECTION
SCHIZOPHRENIA
MAJOR DEPRESSIVE DIAGNOSES & OTHER/UNSPECIFIED PSYCHOSES
PERSONALITY & IMPULSE CONTROL DIAGNOSES
BIPOLAR DISORDERS
DEPRESSION EXCEPT MAJOR DEPRESSIVE DIAGNOSES
ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES
ACUTE ANXIETY & DELIRIUM STATES
ORGANIC MENTAL HEALTH DISTURBANCES
MENTAL RETARDATION
CHILDHOOD BEHAVIORAL DIAGNOSES
Dec 1
2008
Jan 1
2010
Apr 1
2010
Jul 1
2010
Oct 1
2010
Jan 1
2011
Apr 1
2011
July 1 2011
Oct 1 2011
Jan 1 2012
Apr 1 2012
July 1 2012
Oct 1 2012
0.6362
0.6435
0.7749
0.8922
1.4204
0.6984
1.4546
1.8679
1.7307
0.7469
1.0652
0.8480
0.8631
0.5886
0.7853
0.9622
1.9785
0.8237
0.7687
1.0479
0.6670
0.8171
2.4096
1.6166
1.8375
1.0761
0.7566
0.4284
1.0195
0.6602
0.6816
0.6657
0.7194
1.7354
0.6323
0.7141
0.6396
1.7166
2.0890
0.7403
0.7997
0.9222
1.0837
1.0900
1.3409
0.9073
0.7158
0.6080
1.2655
1.0514
0.9219
1.0948
0.7663
1.0154
0.9012
0.7644
0.5493
0.5568
0.8010
0.7405
0.7779
0.7758
0.7536
1.0495
0.6344
0.8226
0.9526
0.8033
0.8930
0.7722
0.8213
0.7359
0.8646
0.8231
0.7049
0.8056
0.7361
0.8135
0.7511
0.8639
0.9263
0.9720
1.1301
0.8176
0.7961
0.4722
1.3476
0.9587
0.9255
0.7856
0.9455
0.9420
0.8978
0.7984
0.7968
0.7835
0.8165
0.6563
2.0576
0.8889
0.8668
0.7795
0.4439
0.8734
0.7634
0.7593
0.8969
0.9476
0.8945
0.8574
0.6982
0.8061
0.6352
0.7817
0.7149
0.5939
0.8010
0.7405
0.7779
0.7758
0.7536
1.0495
0.6344
0.8226
0.9526
0.8033
0.8930
0.7722
0.8213
0.7359
0.8646
0.8231
0.7049
0.8056
0.7361
0.8135
0.7511
0.8639
0.9263
0.9720
1.1301
0.8176
0.7961
0.4722
1.3476
0.9587
0.9255
0.7856
0.9455
0.9420
0.8978
0.7984
0.7968
0.7835
0.8165
0.6563
2.0576
0.8889
0.8668
0.7795
0.4439
0.8734
0.7634
0.7593
0.8969
0.9476
0.8945
0.8574
0.6982
0.8061
0.6352
0.7817
0.7149
0.6982
0.8535
0.7171
0.7947
0.7625
0.8698
1.0549
0.8384
0.8528
1.2410
0.7815
0.8885
0.7405
0.7916
0.7748
0.7649
0.8954
0.6528
0.8569
0.7464
0.8679
0.7587
0.8410
1.0438
0.8924
1.2006
0.8433
0.8058
0.4447
1.2575
0.8896
0.9252
0.7657
0.9246
1.7087
0.9882
0.7752
0.7413
0.9599
0.7460
0.4464
1.3465
0.7861
0.9895
0.8719
0.8929
0.8755
0.7794
0.7787
0.8969
0.9476
0.8945
0.8574
0.6982
0.8061
0.6352
0.7817
0.7149
0.6982
0.8535
0.7171
0.7947
0.7625
0.8698
1.0549
0.8384
0.8528
1.2410
0.7815
0.8885
0.7405
0.7916
0.7748
0.7649
0.8954
0.6528
0.8569
0.7464
0.8679
0.7587
0.8410
1.0438
0.8924
1.2006
0.8433
0.8058
0.4447
1.2575
0.8896
0.9252
0.7657
0.9246
1.7087
0.9882
0.7752
0.7413
0.9599
0.7460
0.4464
1.3465
0.7861
0.9895
0.8719
0.8929
0.8755
0.7794
0.7787
0.8969
0.9476
0.8945
0.8574
0.6982
0.8061
0.6352
0.7817
0.7149
0.6982
0.8535
0.7171
0.7947
0.7625
0.8698
1.0549
0.8384
0.8528
1.2410
0.7815
0.8885
0.7405
0.7916
0.7748
0.7649
0.8954
0.6528
0.8569
0.7464
0.8679
0.7587
0.8410
1.0438
0.8924
1.2006
0.8433
0.8058
0.4447
1.2575
0.8896
0.9252
0.7657
0.9246
1.7087
0.9882
0.7752
0.7413
0.9599
0.7460
0.4464
1.3465
0.7861
0.9895
0.8719
0.8929
0.8755
0.7794
0.7787
0.8969
0.9476
0.8945
0.8574
0.6982
0.8061
0.6352
0.7817
0.7149
0.6982
0.8535
0.7171
0.7947
0.7625
0.8698
1.0549
0.8384
0.8528
1.2410
0.7815
0.8885
0.7405
0.7916
0.7748
0.7649
0.8954
0.6528
0.8569
0.7464
0.8679
0.7587
0.8410
1.0438
0.8924
1.2006
0.8433
0.8058
0.4447
1.2575
0.8896
0.9252
0.7657
0.9246
1.7087
0.9882
0.7752
0.7413
0.9599
0.7460
0.4464
1.3465
0.7861
0.9895
0.8719
0.8929
0.8755
0.7794
0.7787
0.8969
0.9476
0.8945
0.8574
0.6982
0.8061
0.6352
0.7817
0.7149
0.6982
0.8731
0.7065
0.7285
0.8186
0.8526
0.9641
0.8255
0.8045
1.2793
0.8136
0.7961
0.7430
0.7991
0.9072
0.7141
0.8617
0.6578
0.8393
0.7258
0.8109
0.7102
0.7917
1.0663
0.8654
1.0558
0.8064
0.7636
0.3554
0.9792
0.7987
1.0309
0.7837
0.9252
1.9446
1.0994
0.7878
0.7407
1.0846
0.7764
0.6098
0.8692
0.7857
0.7810
0.7744
0.6658
0.7769
0.7683
0.5885
0.8969
0.9476
0.8945
0.8574
0.6982
0.8061
0.6352
0.7817
0.7149
0.6982
0.8731
0.7065
0.7285
0.8186
0.8526
0.9641
0.8255
0.8045
1.2793
0.8136
0.7961
0.7430
0.7991
0.9072
0.7141
0.8617
0.6578
0.8393
0.7258
0.8109
0.7102
0.7917
1.0663
0.8654
1.0558
0.8064
0.7636
0.3554
0.9792
0.7987
1.0309
0.7837
0.9252
1.9446
1.0994
0.7878
0.7407
1.0846
0.7764
0.6098
0.8692
0.7857
0.7810
0.7744
0.6658
0.7769
0.7683
0.5885
0.8969
0.9476
0.8945
0.8574
0.6982
0.8061
0.6352
0.7817
0.7149
0.6982
0.8731
0.7065
0.7285
0.8186
0.8526
0.9641
0.8255
0.8045
1.2793
0.8136
0.7961
0.7430
0.7991
0.9072
0.7141
0.8617
0.6578
0.8393
0.7258
0.8109
0.7102
0.7917
1.0663
0.8654
1.0558
0.8064
0.7636
0.3554
0.9792
0.7987
1.0309
0.7837
0.9252
1.9446
1.0994
0.7878
0.7407
1.0846
0.7764
0.6098
0.8692
0.7857
0.7810
0.7744
0.6658
0.7769
0.7683
0.5885
0.8969
0.9476
0.8945
0.8574
0.6982
0.8061
0.6352
0.7817
0.7149
0.6982
0.8731
0.7065
0.7285
0.8186
0.8526
0.9641
0.8255
0.8045
1.2793
0.8136
0.7961
0.7430
0.7991
0.9072
0.7141
0.8617
0.6578
0.8393
0.7258
0.8109
0.7102
0.7917
1.0663
0.8654
1.0558
0.8064
0.7636
0.3554
0.9792
0.7987
1.0309
0.7837
0.9252
1.9446
1.0994
0.7878
0.7407
1.0846
0.7764
0.6098
0.8692
0.7857
0.7810
0.7744
0.6658
0.7769
0.7683
0.5885
0.8969
0.9476
0.8945
0.8574
0.6982
0.8061
0.6352
0.7817
0.7149
0.6982
0.7412
0.6448
0.6017
0.6680
0.7496
0.7411
0.7990
0.7640
1.1487
0.7309
0.7761
0.6926
0.7162
0.7660
0.6519
0.7586
0.6578
0.7227
0.6479
0.7828
0.6328
0.7208
0.9262
0.7388
1.0955
0.7669
0.7359
0.6194
0.7731
0.7153
0.7940
0.6776
0.9252
1.7409
0.8986
0.6573
0.6527
1.0222
0.7678
0.6042
0.8735
0.7705
0.9227
0.7790
0.7154
0.7086
0.6714
0.5403
0.7953
0.7160
0.7720
0.6784
0.6083
0.7243
0.6110
0.8078
0.6849
0.6846
0.7412
0.6448
0.6017
0.6680
0.7496
0.7411
0.7990
0.7640
1.1487
0.7309
0.7761
0.6926
0.7162
0.7660
0.6519
0.7586
0.6578
0.7227
0.6479
0.7828
0.6328
0.7208
0.9262
0.7388
1.0955
0.7669
0.7359
0.6194
0.7731
0.7153
0.7940
0.6776
0.9252
1.7409
0.8986
0.6573
0.6527
1.0222
0.7678
0.6042
0.8735
0.7705
0.9227
0.7790
0.7154
0.7086
0.6714
0.5403
0.7953
0.7160
0.7720
0.6784
0.6083
0.7243
0.6110
0.8078
0.6849
0.6846
Page 9 of 29
APG
830
831
840
841
842
843
850
851
852
853
854
860
861
870
871
872
873
874
875
876
APG Description
EATING DISORDERS
OTHER MENTAL HEALTH DIAGNOSES
OPIOID ABUSE & DEPENDENCE
COCAINE ABUSE & DEPENDENCE
ALCOHOL ABUSE & DEPENDENCE
OTHER DRUG ABUSE & DEPENDENCE
ALLERGIC REACTIONS
POISONING OF MEDICINAL AGENTS
OTHER COMPLICATIONS OF TREATMENT
OTHER INJURY, POISONING & TOXIC EFFECT DIAGNOSES
TOXIC EFFECTS OF NON‐MEDICINAL SUBSTANCES
EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS W/O SKIN GRAFT
PARTIAL THICKNESS BURNS W OR W/O SKIN GRAFT
REHABILITATION
SIGNS, SYMPTOMS & OTHER FACTORS INFLUENCING HEALTH STATUS
OTHER AFTERCARE & CONVALESCENCE
NEONATAL AFTERCARE
JOINT REPLACEMENT
CONTRACEPTIVE MANAGEMENT
ADULT PREVENTIVE MEDICINE
Dec 1
2008
Jan 1
2010
Apr 1
2010
Jul 1
2010
Oct 1
2010
Jan 1
2011
Apr 1
2011
July 1 2011
Oct 1 2011
Jan 1 2012
Apr 1 2012
July 1 2012
Oct 1 2012
0.4825
0.6736
1.3467
1.7477
2.0693
1.7857
0.9385
1.9830
1.2746
1.3262
1.1333
0.7269
0.8125
0.4118
0.6547
0.8845
0.9984
0.5778
‐
‐
0.9135
0.7248
0.7268
0.7268
1.0469
0.9946
0.9126
0.9544
0.9691
0.9800
0.7857
0.5979
0.7094
0.4136
0.7656
0.8477
0.8308
0.8105
‐
‐
0.9135
0.7248
0.7268
0.7268
1.0469
0.9946
0.9126
0.9544
0.9691
0.9800
0.7857
0.5979
0.7094
0.4136
0.7656
0.8477
0.8308
0.8105
‐
‐
0.9135
0.7248
0.7268
0.7268
1.0469
0.9946
0.9557
1.2335
0.8866
1.1020
0.8665
0.7916
0.8556
0.4136
0.7343
0.8116
0.8242
0.7972
‐
‐
0.9135
0.7248
0.7268
0.7268
1.0469
0.9946
0.9557
1.2335
0.8866
1.1020
0.8665
0.7916
0.8556
0.4136
0.7343
0.8116
0.8242
0.7972
‐
‐
0.9135
0.7248
0.7268
0.7268
1.0469
0.9946
0.9557
1.2335
0.8866
1.1020
0.8665
0.7916
0.8556
0.4136
0.7343
0.8116
0.8242
0.7972
‐
‐
0.9135
0.7248
0.7268
0.7268
1.0469
0.9946
0.9557
1.2335
0.8866
1.1020
0.8665
0.7916
0.8556
0.4136
0.7343
0.8116
0.8242
0.7972
‐
‐
0.9135
0.7248
0.7268
0.7268
1.0469
0.9946
0.8669
1.0037
0.8281
0.9504
0.8010
0.7979
0.7974
0.5165
0.7459
0.8149
0.7569
0.6740
1.1189
‐
0.9135
0.7248
0.7268
0.7268
1.0469
0.9946
0.8669
1.0037
0.8281
0.9504
0.8010
0.7979
0.7974
0.5165
0.7459
0.8149
0.7569
0.6740
1.1189
‐
0.9135
0.7248
0.7268
0.7268
1.0469
0.9946
0.8669
1.0037
0.8281
0.9504
0.8010
0.7979
0.7974
0.5165
0.7459
0.8149
0.7569
0.6740
1.1189
‐
0.9135
0.7248
0.7268
0.7268
1.0469
0.9946
0.8669
1.0037
0.8281
0.9504
0.8010
0.7979
0.7974
0.5165
0.7459
0.8149
0.7569
0.6740
1.1189
‐
0.6835
0.6434
0.6946
0.7977
0.8279
0.7517
0.8716
1.0037
0.8616
0.9005
0.7827
0.9008
0.8632
0.6198
0.6968
0.6825
0.7426
0.6549
1.1189
‐
0.6835
0.6434
0.6946
0.7977
0.8279
0.7517
0.8716
1.0037
0.8616
0.9005
0.7827
0.9008
0.8632
0.6198
0.6968
0.6825
0.7426
0.6549
1.1189
‐
Page 10 of 29
NYS DOH APG‐Based Weights History File (yello
Revised for January 1, 2016 Updates:
APG
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
20
21
22
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
60
61
62
63
64
65
66
67
80
81
82
83
84
85
86
87
88
APG Description
PHOTOCHEMOTHERAPY
SUPERFICIAL NEEDLE BIOPSY AND ASPIRATION
LEVEL I SKIN INCISION AND DRAINAGE
LEVEL II SKIN INCISION AND DRAINAGE
NAIL PROCEDURES
LEVEL I SKIN DEBRIDEMENT AND DESTRUCTION
LEVEL II SKIN DEBRIDEMENT AND DESTRUCTION
LEVEL III SKIN DEBRIDEMENT AND DESTRUCTION
LEVEL I EXCISION AND BIOPSY OF SKIN AND SOFT TISSUE
LEVEL II EXCISION AND BIOPSY OF SKIN AND SOFT TISSUE
LEVEL III EXCISION AND BIOPSY OF SKIN AND SOFT TISSUE
LEVEL I SKIN REPAIR
LEVEL II SKIN REPAIR
LEVEL III SKIN REPAIR
LEVEL IV SKIN REPAIR
LEVEL I BREAST PROCEDURES
LEVEL II BREAST PROCEDURES
LEVEL III BREAST PROCEDURES
LEVEL I MUSCULOSKELETAL PROCEDURES EXCLUDING HAND AND FOOT
LEVEL II MUSCULOSKELETAL PROCEDURES EXCLUDING HAND AND FOOT
LEVEL III MUSCULOSKELETAL PROCEDURES EXCLUDING HAND AND FOOT
LEVEL I HAND PROCEDURES
LEVEL II HAND PROCEDURES
LEVEL I FOOT PROCEDURES
LEVEL II FOOT PROCEDURES
LEVEL I ARTHROSCOPY
LEVEL II ARTHROSCOPY
REPLACEMENT OF CAST
SPLINT, STRAPPING AND CAST REMOVAL
CLOSED TREATMENT FX & DISLOCATION OF FINGER, TOE & TRUNK
CLOSED TREATMENT FX & DISLOCATION EXC FINGER, TOE & TRUNK
OPEN OR PERCUTANEOUS TREATMENT OF FRACTURES
BONE OR JOINT MANIPULATION UNDER ANESTHESIA
BUNION PROCEDURES
LEVEL I ARTHROPLASTY
LEVEL II ARTHROPLASTY
HAND AND FOOT TENOTOMY
ARTHROCENTESIS AND LIGAMENT OR TENDON INJECTION
PULMONARY TESTS
NEEDLE AND CATHETER BIOPSY, ASPIRATION, LAVAGE AND INTUBATION
LEVEL I ENDOSCOPY OF THE UPPER AIRWAY
LEVEL II ENDOSCOPY OF THE UPPER AIRWAY
ENDOSCOPY OF THE LOWER AIRWAY
RESPIRATORY THERAPY
PULMONARY REHABILITATION
VENTILATION ASSISTANCE AND MANAGEMENT
EXERCISE TOLERANCE TESTS
ECHOCARDIOGRAPHY
CARDIAC ELECTROPHYSIOLOGIC TESTS
PLACEMENT OF TRANSVENOUS CATHETERS
DIAGNOSTIC CARDIAC CATHETERIZATION
ANGIOPLASTY AND TRANSCATHETER PROCEDURES
PACEMAKER INSERTION AND REPLACEMENT
REMOVAL AND REVISION OF PACEMAKER AND VASCULAR DEVICE
LEVEL I CARDIOTHORACIC PROCEDURES
Page 11 of 29
Jan 1 2013
April 1 2013
0.5526
2.7636
1.7565
3.3245
0.5009
1.2998
4.3784
5.7434
3.4361
6.7476
11.3125
1.6991
4.1388
7.0338
8.6250
8.5721
12.1046
17.3364
9.4188
10.2397
15.0668
6.9057
11.4221
8.8955
11.3823
9.9509
18.9106
1.5815
1.1572
2.7434
2.8302
16.1779
5.0556
12.2733
16.5949
19.0650
3.7618
1.5996
1.4912
3.2899
2.0823
9.1971
6.3946
‐
‐
1.0267
0.9085
1.7687
5.0296
7.5690
9.8204
14.5669
34.6743
12.3879
11.5643
0.5526
2.7636
1.7565
3.3245
0.5009
1.2998
4.3784
5.7434
3.4361
6.7476
11.3125
1.6991
4.1388
7.0338
8.6250
8.5721
12.1046
17.3364
9.4188
10.2397
15.0668
6.9057
11.4221
8.8955
11.3823
9.9509
18.9106
1.5815
1.1572
2.7434
2.8302
16.1779
5.0556
12.2733
16.5949
19.0650
3.7618
1.5996
1.4912
3.2899
2.0823
9.1971
6.3946
‐
‐
1.0267
0.9085
1.7687
5.0296
7.5690
9.8204
14.5669
34.6743
12.3879
11.5643
APG
89
90
91
92
93
94
95
96
97
99
110
111
112
113
114
115
116
117
118
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
160
161
162
163
164
165
166
167
168
169
180
181
182
183
184
185
190
191
192
APG Description
LEVEL II CARDIOTHORACIC PROCEDURES
SECONDARY VARICOSE VEINS AND VASCULAR INJECTION
VASCULAR LIGATION AND RECONSTRUCTION
RESUSCITATION
CARDIOVERSION
CARDIAC REHABILITATION
THROMBOLYSIS
ATRIAL AND VENTRICULAR RECORDING AND PACING
AICD IMPLANT
CORONARY ANGIOPLASTY
PHARMACOTHERAPY BY EXTENDED INFUSION
PHARMACOTHERAPY EXCEPT BY EXTENDED INFUSION
PHLEBOTOMY
LEVEL I BLOOD AND BLOOD PRODUCT EXCHANGE
LEVEL II BLOOD AND BLOOD PRODUCT EXCHANGE
DEEP LYMPH STRUCTURE AND THYROID PROCEDURES
ALLERGY TESTS
HOME INFUSION
NUTRITION THERAPY
ALIMENTARY TESTS AND SIMPLE TUBE PLACEMENT
ESOPHAGEAL DILATION WITHOUT ENDOSCOPY
ANOSCOPY WITH BIOPSY AND DIAGNOSTIC PROCTOSIGMOIDOSCOPY
PROCTOSIGMOIDOSCOPY WITH EXCISION OR BIOPSY
DIAGNOSTIC UPPER GI ENDOSCOPY OR INTUBATION
THERAPEUTIC UPPER GI ENDOSCOPY OR INTUBATION
DIAGNOSTIC LOWER GASTROINTESTINAL ENDOSCOPY
THERAPEUTIC COLONOSCOPY
ERCP AND MISCELLANEOUS GI ENDOSCOPY PROCEDURES
LEVEL I HERNIA REPAIR
LEVEL II HERNIA REPAIR
LEVEL I ANAL AND RECTAL PROCEDURES
LEVEL II ANAL AND RECTAL PROCEDURES
LEVEL I GASTROINTESTINAL PROCEDURES
LEVEL II GASTROINTESTINAL PROCEDURES
LEVEL I LAPAROSCOPY
LEVEL II LAPAROSCOPY
LEVEL III LAPAROSCOPY
LEVEL IV LAPAROSCOPY
SCREENING COLORECTAL SERVICES
EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY
URINARY STUDIES AND PROCEDURES
URINARY CATHETERIZATION AND DILATATION
LEVEL I BLADDER AND KIDNEY PROCEDURES
LEVEL II BLADDER AND KIDNEY PROCEDURES
LEVEL III BLADDER AND KIDNEY PROCEDURES
LEVEL I URETHRA AND PROSTATE PROCEDURES
LEVEL II URETHRA AND PROSTATE PROCEDURES
HEMODIALYSIS
PERITONEAL DIALYSIS
TESTICULAR AND EPIDIDYMAL PROCEDURES
CIRCUMCISION
INSERTION OF PENILE PROSTHESIS
LEVEL I PENILE AND PROSTATE PROCEDURES
LEVEL II PENILE AND PROSTATE PROCEDURES
PROSTATE NEEDLE AND PUNCH BIOPSY
ARTIFICIAL FERTILIZATION
LEVEL I FETAL PROCEDURES
LEVEL II FETAL PROCEDURES
Page 12 of 29
Jan 1 2013
April 1 2013
15.7299
5.7167
13.9477
3.1285
2.9021
0.2075
1.1450
2.9256
82.3742
15.7299
5.7167
13.9477
3.1285
2.9021
0.2075
1.1450
2.9256
82.3742
3.9048
1.4624
0.5657
2.9598
11.1540
7.8415
1.3799
‐
‐
2.7399
3.3375
3.0084
4.2463
4.3955
5.0274
4.2224
4.7839
7.1026
11.1445
13.6513
5.9480
8.3716
6.5720
13.1905
10.1423
13.7456
14.3530
17.6039
4.2224
14.0419
2.3199
1.7376
4.9167
10.7891
11.3343
5.4761
13.8140
1.3651
0.5851
7.0959
6.4683
28.8569
5.1617
14.6991
5.6782
‐
1.2969
3.8856
3.9048
1.4624
0.5657
2.9598
11.1540
7.8415
1.3799
‐
‐
2.7399
3.3375
3.0084
4.2463
4.3955
5.0274
4.2224
4.7839
7.1026
11.1445
13.6513
5.9480
8.3716
6.5720
13.1905
10.1423
13.7456
14.3530
17.6039
4.2224
14.0419
2.3199
1.7376
4.9167
10.7891
11.3343
5.4761
13.8140
1.3651
0.5851
7.0959
6.4683
28.8569
5.1617
14.6991
5.6782
‐
1.2969
3.8856
APG
193
194
195
196
197
198
199
200
201
210
211
212
213
214
215
216
217
218
219
220
221
222
223
224
230
231
232
233
234
235
236
237
238
239
240
241
250
251
252
253
254
255
256
257
270
271
272
273
274
275
280
281
282
283
284
285
286
287
APG Description
TREATMENT OF INCOMPLETE ABORTION
THERAPEUTIC ABORTION
VAGINAL DELIVERY
LEVEL I FEMALE REPRODUCTIVE PROCEDURES
LEVEL II FEMALE REPRODUCTIVE PROCEDURES
LEVEL III FEMALE REPRODUCTIVE PROCEDURES
DILATION AND CURETTAGE
HYSTEROSCOPY
COLPOSCOPY
EXTENDED EEG STUDIES
ELECTROENCEPHALOGRAM
ELECTROCONVULSIVE THERAPY
NERVE AND MUSCLE TESTS
LEVEL I NERVOUS SYSTEM INJECTIONS, STIMULATIONS OR CRANIAL TAP
LEVEL I REVISION OR REMOVAL OF NEUROLOGICAL DEVICE
LEVEL II REVISION OR REMOVAL OF NEUROLOGICAL DEVICE
LEVEL I NERVE PROCEDURES
LEVEL II NERVE PROCEDURES
SPINAL TAP
LEVEL II NERVOUS SYSTEM INJECTIONS, STIMULATIONS OR CRANIAL TAP
LAMINOTOMY AND LAMINECTOMY
SLEEP STUDIES
LEVEL III NERVE PROCEDURES
LEVEL IV NERVE PROCEDURES
MINOR OPHTHALMOLOGICAL TESTS AND PROCEDURES
FITTING OF CONTACT LENSES
LASER EYE PROCEDURES
CATARACT PROCEDURES
LEVEL I ANTERIOR SEGMENT EYE PROCEDURES
LEVEL II ANTERIOR SEGMENT EYE PROCEDURES
LEVEL III ANTERIOR SEGMENT EYE PROCEDURES
LEVEL I POSTERIOR SEGMENT EYE PROCEDURES
LEVEL II POSTERIOR SEGMENT EYE PROCEDURES
STRABISMUS AND MUSCLE EYE PROCEDURES
LEVEL I REPAIR AND PLASTIC PROCEDURES OF EYE
LEVEL II REPAIR AND PLASTIC PROCEDURES OF EYE
COCHLEAR DEVICE IMPLANTATION
OTORHINOLARYNGOLOGIC FUNCTION TESTS
LEVEL I FACIAL AND ENT PROCEDURES
LEVEL II FACIAL AND ENT PROCEDURES
LEVEL III FACIAL AND ENT PROCEDURES
LEVEL IV FACIAL AND ENT PROCEDURES
TONSIL AND ADENOID PROCEDURES
AUDIOMETRY
OCCUPATIONAL THERAPY
PHYSICAL THERAPY
SPEECH THERAPY AND EVALUATION
MANIPULATION THERAPY
PHYSICAL THERAPY, GROUP
SPEECH THERAPY & EVALUATION, GROUP
VASCULAR RADIOLOGY EXCEPT VENOGRAPHY OF EXTREMITY
MAGNETIC RESONANCE ANGIOGRAPHY ‐ HEAD AND/OR NECK
MAGNETIC RESONANCE ANGIOGRAPHY ‐ CHEST
MAGNETIC RESONANCE ANGIOGRAPHY ‐ OTHER SITES
MYELOGRAPHY
MISCELLANEOUS RADIOLOGICAL PROCEDURES WITH CONTRAST
MAMMOGRAPHY & OTHER RELATED PROCEDURES
DIGESTIVE RADIOLOGY
Page 13 of 29
Jan 1 2013
April 1 2013
7.0004
4.1476
10.9091
5.5356
10.3847
12.7947
6.3004
8.9296
1.9113
1.7589
0.9714
2.0988
0.7477
2.5273
21.3064
29.0512
7.2416
19.3408
2.6151
3.0358
19.4163
4.6789
77.4190
77.4190
1.0706
0.6328
2.9509
11.1217
8.9310
11.9679
17.2468
3.1707
15.1553
9.4862
4.1766
10.4110
168.4364
0.7380
6.7963
9.1426
12.9583
18.6564
7.8715
0.4211
0.7241
0.6827
0.6620
0.2765
0.2414
0.1931
5.0525
3.3282
3.0499
3.4539
3.2525
2.1453
0.6688
1.0565
7.0004
4.1476
10.9091
5.5356
10.3847
12.7947
6.3004
8.9296
1.9113
1.7589
0.9714
2.0988
0.7477
2.5273
21.3064
29.0512
7.2416
19.3408
2.6151
3.0358
19.4163
4.6789
77.4190
77.4190
1.0706
0.6328
2.9509
11.1217
8.9310
11.9679
17.2468
3.1707
15.1553
9.4862
4.1766
10.4110
168.4364
0.7380
6.7963
9.1426
12.9583
18.6564
7.8715
0.4211
0.7241
0.6827
0.6620
0.2765
0.2414
0.1931
5.0525
3.3282
3.0499
3.4539
3.2525
2.1453
0.6688
1.0565
APG
288
289
290
291
292
293
294
295
296
297
298
299
300
301
302
303
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
327
328
329
330
331
332
340
341
342
343
344
345
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
APG Description
DIAGNOSTIC ULTRASOUND EXCEPT OBSTETRICAL AND VASCULAR OF LOWER
VASCULAR DIAGNOSTIC ULTRASOUND OF LOWER EXTREMITIES
PET SCANS
BONE DENSITOMETRY
MRI‐ ABDOMEN
MRI‐ JOINTS
MRI‐ BACK
MRI‐ CHEST
MRI‐ OTHER
MRI‐ BRAIN
CAT SCAN BACK
CAT SCAN ‐ BRAIN
CAT SCAN ‐ ABDOMEN
CAT SCAN ‐ OTHER
ANGIOGRAPHY, OTHER
ANGIOGRAPHY, CEREBRAL
DEVELOPMENTAL & NEUROPSYCHOLOGICAL TESTING
FULL DAY PARTIAL HOSPITALIZATION FOR SUBSTANCE ABUSE
FULL DAY PARTIAL HOSPITALIZATION FOR MENTAL ILLNESS
HALF DAY PARTIAL HOSPITALIZATION FOR SUBSTANCE ABUSE
HALF DAY PARTIAL HOSPITALIZATION FOR MENTAL ILLNESS
COUNSELLING OR INDIVIDUAL BRIEF PSYCHOTHERAPY
INDIVIDUAL COMPREHENSIVE PSYCHOTHERAPY
FAMILY PSYCHOTHERAPY
GROUP PSYCHOTHERAPY
ACTIVITY THERAPY
CASE MANAGEMENT & TREATMENT PLAN DEVELOPMENT ‐ MENTAL HEALTH
CRISIS INTERVENTION
MEDICATION ADMINISTRATION & OBSERVATION
MENTAL HYGIENE ASSESSMENT
MENTAL HEALTH SCREENING & BRIEF ASSESSMENT
INTENSIVE OUTPATIENT PSYCHIATRIC TREATMENT
DAY REHABILITATION, HALF DAY
DAY REHABILITATION, FULL DAY
LEVEL I DIAGNOSTIC NUCLEAR MEDICINE
LEVEL II DIAGNOSTIC NUCLEAR MEDICINE
LEVEL III DIAGNOSTIC NUCLEAR MEDICINE
THERAPEUTIC NUCLEAR MEDICINE
RADIATION THERAPY AND HYPERTHERMIA
AFTERLOADING BRACHYTHERAPY
RADIATION TREATMENT DELIVERY
INSTILLATION OF RADIOELEMENT SOLUTIONS
HYPERTHERMIC THERAPIES
RADIOSURGERY
HIGH ENERGY NEUTRON RADIATION TREATMENT DELIVERY
PROTON TREATMENT DELIVERY
LEVEL II AFTERLOADING BRACHYTHERAPY
LEVEL I ADJUNCTIVE GENERAL DENTAL SERVICES
LEVEL II ADJUNCTIVE GENERAL DENTAL SERVICES
PERIODONTICS
LEVEL I PROSTHODONTICS, FIXED
LEVEL II PROSTHODONTICS, FIXED
LEVEL III PROSTHODONTICS, FIXED
LEVEL I PROSTHODONTICS, REMOVABLE
LEVEL II PROSTHODONTICS, REMOVABLE
LEVEL III PROSTHODONTICS, REMOVABLE
LEVEL I MAXILLOFACIAL PROSTHETICS
LEVEL II MAXILLOFACIAL PROSTHETICS
Page 14 of 29
Jan 1 2013
April 1 2013
0.8050
3.4918
8.2971
0.8986
2.8988
2.3817
2.5346
3.5921
2.9048
3.2318
1.6652
1.6274
1.9449
1.4622
2.0636
1.9690
0.8275
‐
‐
‐
‐
0.6206
0.8275
0.6206
0.3207
‐
‐
0.8275
0.1335
1.0344
0.2803
0.6093
0.4937
0.6583
1.6686
1.8648
4.0697
2.1229
0.7446
5.3792
1.9028
2.5628
0.8666
26.0937
0.8758
4.2101
78.4972
0.4639
1.3073
0.8133
0.4550
1.7021
2.1055
0.9221
1.7644
1.3580
0.2562
1.3379
0.8050
3.4918
8.2971
0.8986
2.8988
2.3817
2.5346
3.5921
2.9048
3.2318
1.6652
1.6274
1.9449
1.4622
2.0636
1.9690
0.8275
‐
‐
‐
‐
0.6206
0.8275
0.6206
0.3207
‐
‐
0.8275
0.1335
1.0344
0.2803
0.6093
0.4937
0.6583
1.6686
1.8648
4.0697
2.1229
0.7446
5.3792
1.9028
2.5628
0.8666
26.0937
0.8758
4.2101
78.4972
0.4639
1.3073
0.8133
0.4550
1.7021
2.1055
0.9221
1.7644
1.3580
0.2562
1.3379
APG
361
362
363
364
365
366
367
368
369
370
371
372
373
374
375
376
377
378
379
380
381
382
385
386
387
390
391
392
393
394
395
396
397
398
399
400
401
402
403
404
405
406
407
408
409
410
411
412
413
414
415
416
417
418
419
420
421
422
APG Description
LEVEL I DENTAL RESTORATIONS
LEVEL II DENTAL RESTORATIONS
LEVEL III DENTAL RESTORATION
LEVEL I ENDODONTICS
LEVEL II ENDODONTICS
LEVEL III ENDODONTICS
LEVEL I ORAL AND MAXILLOFACIAL SURGERY
LEVEL II ORAL AND MAXILLOFACIAL SURGERY
LEVEL III ORAL AND MAXILLOFACIAL SURGERY
LEVEL IV ORAL AND MAXILLOFACIAL SURGERY
LEVEL I ORTHODONTICS
SEALANT
LEVEL I DENTAL FILM
LEVEL II DENTAL FILM
DENTAL ANESTHESIA
DIAGNOSTIC DENTAL PROCEDURES
PREVENTIVE DENTAL PROCEDURES
LEVEL II PERIODONTICS
LEVEL II ORTHODONTICS
ANESTHESIA
LEVEL I DENTAL IMPLANTS
LEVEL II DENTAL IMPLANTS
LEVEL I MOLECULAR PATHOLOGY AND GENETIC TESTS
LEVEL II MOLECULAR PATHOLOGY AND GENETIC TESTS
LEVEL III MOLECULAR PATHOLOGY AND GENETIC TESTS
LEVEL I PATHOLOGY
LEVEL II PATHOLOGY
PAP SMEARS
BLOOD AND TISSUE TYPING
LEVEL I IMMUNOLOGY TESTS
LEVEL II IMMUNOLOGY TESTS
LEVEL I MICROBIOLOGY TESTS
LEVEL II MICROBIOLOGY TESTS
LEVEL I ENDOCRINOLOGY TESTS
LEVEL II ENDOCRINOLOGY TESTS
LEVEL I CHEMISTRY TESTS
LEVEL II CHEMISTRY TESTS
BASIC CHEMISTRY TESTS
ORGAN OR DISEASE ORIENTED PANELS
TOXICOLOGY TESTS
THERAPEUTIC DRUG MONITORING
LEVEL I CLOTTING TESTS
LEVEL II CLOTTING TESTS
LEVEL I HEMATOLOGY TESTS
LEVEL II HEMATOLOGY TESTS
URINALYSIS
BLOOD AND URINE DIPSTICK TESTS
SIMPLE PULMONARY FUNCTION TESTS
CARDIOGRAM
LEVEL I IMMUNIZATION AND ALLERGY IMMUNOTHERAPY
LEVEL II IMMUNIZATION
LEVEL III IMMUNIZATION
MINOR REPRODUCTIVE PROCEDURES
MINOR CARDIAC AND VASCULAR TESTS
MINOR OPHTHALMOLOGICAL INJECTION, SCRAPING AND TESTS
PACEMAKER AND OTHER ELECTRONIC ANALYSIS
TUBE CHANGE
PROVISION OF VISION AIDS
Page 15 of 29
Jan 1 2013
April 1 2013
0.6561
0.9844
2.3474
0.6251
1.1241
1.1324
0.7491
2.0751
2.0751
2.0751
‐
0.2051
0.1338
0.4631
5.6506
0.2332
0.3263
‐
‐
‐
‐
‐
‐
‐
‐
0.2324
0.4325
0.1808
0.2567
0.0654
0.2338
0.0604
0.2393
0.1577
0.2221
0.0672
0.2097
0.0417
0.1614
0.1182
0.1060
0.0831
0.2492
0.0691
0.1685
0.0659
0.0437
0.4035
0.2289
0.1793
0.3719
0.7563
0.8041
1.0129
0.4952
0.4544
1.9580
0.4642
0.6561
0.9844
2.3474
0.6251
1.1241
1.1324
0.7491
2.0751
2.0751
2.0751
‐
0.2051
0.1338
0.4631
5.6506
0.2332
0.3263
‐
‐
‐
‐
‐
‐
‐
‐
0.2324
0.4325
0.1808
0.2567
0.0654
0.2338
0.0604
0.2393
0.1577
0.2221
0.0672
0.2097
0.0417
0.1614
0.1182
0.1060
0.0831
0.2492
0.0691
0.1685
0.0659
0.0437
0.4035
0.2289
0.1793
0.3719
0.7563
0.8041
1.0129
0.4952
0.4544
1.9580
0.4642
APG
423
424
425
426
427
428
429
430
431
432
433
434
435
436
437
438
439
440
441
442
443
444
448
449
450
451
452
453
454
455
456
457
458
459
460
461
462
463
464
465
470
471
472
473
474
475
476
477
478
479
480
481
482
483
484
485
486
487
APG Description
INTRODUCTION OF NEEDLE AND CATHETER
DRESSINGS AND OTHER MINOR PROCEDURES
LEVEL I OTHER MISCELLANEOUS ANCILLARY PROCEDURES
PSYCHOTROPIC MEDICATION MANAGEMENT
BIOFEEDBACK AND OTHER TRAINING
PATIENT EDUCATION, INDIVIDUAL
PATIENT EDUCATION, GROUP
CLASS I CHEMOTHERAPY DRUGS
CLASS II CHEMOTHERAPY DRUGS
CLASS III CHEMOTHERAPY DRUGS
CLASS IV CHEMOTHERAPY DRUGS
CLASS V CHEMOTHERAPY DRUGS
CLASS I PHARMACOTHERAPY
CLASS II PHARMACOTHERAPY
CLASS III PHARMACOTHERAPY
CLASS IV PHARMACOTHERAPY
CLASS V PHARMACOTHERAPY
CLASS VI PHARMACOTHERAPY
CLASS VI CHEMOTHERAPY DRUGS
CLASS VII COMBINED CHEMOTHERAPY & PHARMACOTHERAPY
CLASS VII CHEMOTHERAPY DRUGS
CLASS VII PHARMACOTHERAPY
EXPANDED HOURS ACCESS
Additional undifferentiated medical visit/services
OBSERVATION
SMOKING CESSATION TREATMENT
DIABETES SUPPLIES
MOTORIZED WHEELCHAIR
TPN FORMULAE
IMPLANTED TISSUE OF ANY TYPE
MOTORIZED WHEELCHAIR ACCESSORIES
VENIPUNCTURE
ALLERGY THERAPY
VACCINE ADMINISTRATION
CLASS VIII COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY
CLASS IX COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY
CLASS X COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY
CLASS XI COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY
CLASS XII COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY
CLASS XIII COMBINED CHEMOTHERAPY AND PHARMACOTHERAPY
OBSTETRICAL ULTRASOUND
PLAIN FILM
ULTRASOUND GUIDANCE
CT GUIDANCE
RADIOLOGICAL GUIDANCE FOR THERAPEUTIC OR DIAGNOSTIC PROCEDURES
MRI GUIDANCE
LEVEL I THERAPEUTIC RADIATION TREATMENT PREPARATION
LEVEL II THERAPEUTIC RADIATION TREATMENT PREPARATION
MEDICAL RADIATION PHYSICS
TREATMENT DEVICE DESIGN AND CONSTRUCTION
TELETHERAPY/BRACHYTHERAPY CALCULATION
THERAPEUTIC RADIOLOGY SIMULATION FIELD SETTING
RADIOELEMENT APPLICATION
RADIATION THERAPY MANAGEMENT
THERAPEUTIC RADIOLOGY TREATMENT PLANNING
CORNEAL TISSUE PROCESSING
BASIC BLOOD TYPING
MINOR CARDIAC MONITORING
Page 16 of 29
Jan 1 2013
April 1 2013
1.0383
0.3869
0.5356
0.3448
‐
‐
‐
‐
‐
‐
‐
‐
0.1879
0.5636
1.0121
1.6970
2.7455
4.2788
‐
‐
‐
6.4061
0.0759
‐
2.1949
0.1267
‐
‐
‐
6.4572
‐
0.0440
0.1793
0.0827
9.2182
12.7152
20.2000
32.5818
50.0061
‐
0.6956
0.1896
1.1555
1.0641
1.9346
1.4302
2.5501
2.4084
0.9180
2.3515
2.0249
3.8645
4.9484
1.7169
2.0358
1.0383
0.3869
0.5356
0.3448
‐
‐
‐
‐
‐
‐
‐
‐
0.1879
0.5636
1.0121
1.6970
2.7455
4.2788
‐
‐
‐
6.4061
0.0759
‐
0.1563
0.1267
‐
‐
‐
6.4572
‐
0.0440
0.1793
0.0827
9.2182
12.7152
20.2000
32.5818
50.0061
‐
0.6956
0.1896
1.1555
1.0641
1.9346
1.4302
2.5501
2.4084
0.9180
2.3515
2.0249
3.8645
4.9484
1.7169
2.0358
4.2224
4.2224
‐
‐
‐
‐
APG
488
489
490
491
492
495
497
498
496
500
501
502
510
520
521
522
523
524
525
526
527
528
529
530
531
532
533
534
535
536
550
551
552
553
554
555
560
561
562
563
564
565
570
571
572
573
574
575
576
577
578
579
591
592
593
594
595
596
APG Description
MINOR DEVICE EVALUATION & ELECTRONIC ANALYSIS
LEVEL II OTHER MISCELLANEOUS ANCILLARY PROCEDURES
INCIDENTAL TO MEDICAL VISIT OR SIGNIFICANT PROCEDURE
MEDICAL VISIT INDICATOR
ADMISSION FOR OBSERVATION INDICATOR
MINOR CHEMOTHERAPY DRUGS
TELEHEALTH FACILITATION
PEN FORMULAE
MINOR PHARMACOTHERAPY
DIRECT ADMISSION FOR OBSERVATION ‐ OBSTETRICAL
DIRECT ADMISSION FOR OBSERVATION ‐ OTHER DIAGNOSES
DIRECT REFERRAL FOR OBSERVATION ‐ BEHAVIORAL HEALTH
MAJOR SIGNS, SYMPTOMS AND FINDINGS
SPINAL DIAGNOSES & INJURIES
NERVOUS SYSTEM MALIGNANCY
DEGENERATIVE NERVOUS SYSTEM DIAGNOSES EXC MULT SCLEROSIS
MULTIPLE SCLEROSIS & OTHER DEMYELINATING DISEASES
LEVEL I CNS DIAGNOSES
LEVEL II CNS DIAGNOSES
TRANSIENT ISCHEMIA
PERIPHERAL NERVE DIAGNOSES
NONTRAUMATIC STUPOR & COMA
SEIZURE
HEADACHES OTHER THAN MIGRAINE
MIGRAINE
HEAD TRAUMA
AFTEREFFECTS OF CEREBROVASCULAR ACCIDENT
NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARC
CVA & PRECEREBRAL OCCLUSION W INFARCT
CEREBRAL PALSY
ACUTE MAJOR EYE INFECTIONS
CATARACTS
GLAUCOMA
LEVEL I OPHTHALMIC DIAGNOSES
LEVEL II OPHTHALMIC DIAGNOSES
CONJUNCTIVITIS
EAR, NOSE, MOUTH, THROAT, CRANIAL/FACIAL MALIGNANCIES
VERTIGINOUS DIAGNOSES EXCEPT FOR BENIGN VERTIGO
INFECTIONS OF UPPER RESPIRATORY TRACT
DENTAL & ORAL DIAGNOSES & INJURIES
LEVEL I OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES
LEVEL II OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES
CYSTIC FIBROSIS ‐ PULMONARY DISEASE
RESPIRATORY MALIGNANCY
BRONCHIOLITIS & RSV PNEUMONIA
COMMUNITY ACQUIRED PNUEMONIA
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
ASTHMA
LEVEL I OTHER RESPIRATORY DIAGNOSES
LEVEL II OTHER RESPIRATORY DIAGNOSES
PNEUMONIA EXCEPT FOR COMMUNITY ACQUIRED PNEUMONIA
STATUS ASTHMATICUS
ACUTE MYOCARDIAL INFARCTION
LEVEL I CARDIOVASCULAR DIAGNOSES
LEVEL II CARDIOVASCULAR DIAGNOSES
HEART FAILURE
CARDIAC ARREST OR OTHER CAUSES OF MORTALITY
PERIPHERAL & OTHER VASCULAR DIAGNOSES
Page 17 of 29
Jan 1 2013
April 1 2013
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
0.8103
0.7778
0.7228
0.7227
0.6667
0.6804
0.7751
0.6656
0.6914
0.8376
0.7801
0.7764
0.8010
0.7425
0.6855
0.6827
0.6813
0.8222
0.6522
0.6833
0.6761
0.7522
0.7533
0.6348
0.7514
0.7555
0.6427
0.6215
0.7018
0.8018
0.9653
0.6859
0.6199
0.8336
0.6631
0.8962
0.7727
0.9412
0.7648
0.7286
1.4738
0.7111
0.7396
0.7543
1.6299
0.7562
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
0.8103
0.7778
0.7228
0.7227
0.6667
0.6804
0.7751
0.6656
0.6914
0.8376
0.7801
0.7764
0.8010
0.7425
0.6855
0.6827
0.6813
0.8222
0.6522
0.6833
0.6761
0.7522
0.7533
0.6348
0.7514
0.7555
0.6427
0.6215
0.7018
0.8018
0.9653
0.6859
0.6199
0.8336
0.6631
0.8962
0.7727
0.9412
0.7648
0.7286
1.4738
0.7111
0.7396
0.7543
1.6299
0.7562
APG
597
598
599
600
601
602
603
604
605
620
621
623
624
625
626
627
628
629
630
631
632
633
634
635
636
637
638
639
640
650
651
652
653
654
655
656
657
658
659
660
661
662
663
670
671
672
673
674
675
676
690
691
692
693
694
695
710
711
Jan 1 2013
APG Description
PHLEBITIS
0.6564
ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS
0.6914
HYPERTENSION
0.6488
CARDIAC STRUCTURAL & VALVULAR DIAGNOSES
0.8643
LEVEL I CARDIAC ARRHYTHMIA & CONDUCTION DIAGNOSES
0.7759
ATRIAL FIBRILLATION
0.6975
LEVEL II CARDIAC ARRHYTHMIA & CONDUCTION DIAGNOSES
0.8501
CHEST PAIN
0.9139
SYNCOPE & COLLAPSE
0.8221
DIGESTIVE MALIGNANCY
0.6278
PEPTIC ULCER & GASTRITIS
0.8511
ESOPHAGITIS
0.6757
LEVEL I GASTROINTESTINAL DIAGNOSES
0.7344
LEVEL II GASTROINTESTINAL DIAGNOSES
0.7469
INFLAMMATORY BOWEL DISEASE
0.6164
NON‐BACTERIAL GASTROENTERITIS, NAUSEA & VOMITING
0.7498
ABDOMINAL PAIN
0.7730
MALFUNCTION, REACTION & COMPLICATION OF GI DEVICE OR PROCEDURE 0.8849
CONSTIPATION
0.8488
HERNIA
0.6622
IRRITABLE BOWEL SYNDROME
0.5706
ALCOHOLIC LIVER DISEASE
0.6997
MALIGNANCY OF HEPATOBILIARY SYSTEM & PANCREAS
0.7451
PANCREAS DIAGNOSES EXCEPT MALIGNANCY
0.6838
HEPATITIS WITHOUT COMA
0.7899
GALLBLADDER & BILIARY TRACT DIAGNOSES
0.6404
CHOLECYSTITIS
0.6275
LEVEL I HEPATOBILIARY DIAGNOSES
0.7214
LEVEL II HEPATOBILIARY DIAGNOSES
0.6923
FRACTURE OF FEMUR
1.1385
FRACTURE OF PELVIS OR DISLOCATION OF HIP
1.0449
FRACTURES & DISLOCATIONS EXCEPT FEMUR, PELVIS & BACK
1.0470
MUSCULOSKELETAL MALIGNANCY & PATHOL FRACTURE D/T MUSCSKEL MAL 0.8529
OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTION 0.8245
0.6885
CONNECTIVE TISSUE DIAGNOSES
0.8082
BACK & NECK DIAGNOSES EXCEPT LUMBAR DISC DIAGNOSES
0.7947
LUMBAR DISC DIAGNOSES
0.8401
LUMBAR DISC DIAGNOSES WITH SCIATICA
MALFUNCTION, REACTION, COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDUR 0.8668
LEVEL I OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOS 0.7618
LEVEL II OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOS 0.8415
OSTEOPOROSIS
0.5743
PAIN
0.7593
SKIN ULCERS
0.8593
MAJOR SKIN DIAGNOSES
0.6569
MALIGNANT BREAST DIAGNOSES
0.6478
CELLULITIS & OTHER BACTERIAL SKIN INFECTIONS
0.6663
CONTUSION, OPEN WOUND & OTHER TRAUMA TO SKIN & SUBCUTANEOUS T 0.9660
OTHER SKIN, SUBCUTANEOUS TISSUE & BREAST DIAGNOSES
0.6546
DECUBITUS ULCER
0.7964
MALNUTRITION, FAILURE TO THRIVE & OTHER NUTRITIONAL DISORDERS
0.7172
0.6103
INBORN ERRORS OF METABOLISM
0.6883
LEVEL I ENDOCRINE DIAGNOSES
0.6754
LEVEL II ENDOCRINE DIAGNOSES
0.7342
ELECTROLYTE DISORDERS
0.6715
OBESITY
0.7507
DIABETES WITH OPHTHALMIC MANIFESTATIONS
0.6793
DIABETES WITH CIRCULATORY DIAGNOSES
Page 18 of 29
April 1 2013
0.6564
0.6914
0.6488
0.8643
0.7759
0.6975
0.8501
0.9139
0.8221
0.6278
0.8511
0.6757
0.7344
0.7469
0.6164
0.7498
0.7730
0.8849
0.8488
0.6622
0.5706
0.6997
0.7451
0.6838
0.7899
0.6404
0.6275
0.7214
0.6923
1.1385
1.0449
1.0470
0.8529
0.8245
0.6885
0.8082
0.7947
0.8401
0.8668
0.7618
0.8415
0.5743
0.7593
0.8593
0.6569
0.6478
0.6663
0.9660
0.6546
0.7964
0.7172
0.6103
0.6883
0.6754
0.7342
0.6715
0.7507
0.6793
APG
712
713
714
720
721
722
723
724
725
726
727
740
741
742
743
744
750
751
752
753
760
761
762
763
764
765
766
770
771
772
780
781
782
783
784
785
786
800
801
802
803
804
805
806
807
808
809
810
820
821
822
823
824
825
826
827
828
829
APG Description
DIABETES WITH NEUROLOGIC MANIFESTATIONS
DIABETES WITHOUT COMPLICATIONS
DIABETES WITH RENAL MANIFESTATIONS
RENAL FAILURE
KIDNEY & URINARY TRACT MALIGNANCY
NEPHRITIS & NEPHROSIS
KIDNEY AND CHRONIC URINARY TRACT INFECTIONS
URINARY STONES & ACQUIRED UPPER URINARY TRACT OBSTRUCTION
MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PROC
OTHER KIDNEY & URINARY TRACT DIAGNOSES, SIGNS & SYMPTOMS
ACUTE LOWER URINARY TRACT INFECTIONS
MALIGNANCY, MALE REPRODUCTIVE SYSTEM
MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY
NEOPLASMS OF THE MALE REPRODUCTIVE SYSTEM
PROSTATITIS
MALE REPRODUCTIVE INFECTIONS
FEMALE REPRODUCTIVE SYSTEM MALIGNANCY
FEMALE REPRODUCTIVE SYSTEM INFECTIONS
LEVEL I MENSTRUAL AND OTHER FEMALE DIAGNOSES
LEVEL II MENSTRUAL AND OTHER FEMALE DIAGNOSES
VAGINAL DELIVERY
POSTPARTUM & POST ABORTION DIAGNOSES W/O PROCEDURE
THREATENED ABORTION
ABORTION W/O D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
FALSE LABOR
OTHER ANTEPARTUM DIAGNOSES
ROUTINE PRENATAL CARE
NORMAL NEONATE
LEVEL I NEONATAL DIAGNOSES
LEVEL II NEONATAL DIAGNOSES
OTHER HEMATOLOGICAL DIAGNOSES
COAGULATION & PLATELET DIAGNOSES
CONGENITAL FACTOR DEFICIENCIES
SICKLE CELL ANEMIA CRISIS
SICKLE CELL ANEMIA
ANEMIA EXCEPT FOR IRON DEFICIENCY ANEMIA AND SICKLE CELL ANEMIA
IRON DEFICIENCY ANEMIA
ACUTE LEUKEMIA
LYMPHOMA, MYELOMA & NON‐ACUTE LEUKEMIA
RADIOTHERAPY
CHEMOTHERAPY
LYMPHATIC & OTHER MALIGNANCIES & NEOPLASMS OF UNCERTAIN BEHAVI
SEPTICEMIA & DISSEMINATED INFECTIONS
POST‐OPERATIVE, POST‐TRAUMATIC, OTHER DEVICE INFECTIONS
FEVER
VIRAL ILLNESS
OTHER INFECTIOUS & PARASITIC DISEASES
H. PYLORI INFECTION
SCHIZOPHRENIA
MAJOR DEPRESSIVE DIAGNOSES & OTHER/UNSPECIFIED PSYCHOSES
PERSONALITY & IMPULSE CONTROL DIAGNOSES
BIPOLAR DISORDERS
DEPRESSION EXCEPT MAJOR DEPRESSIVE DIAGNOSES
ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES
ACUTE ANXIETY & DELIRIUM STATES
ORGANIC MENTAL HEALTH DISTURBANCES
MENTAL RETARDATION
CHILDHOOD BEHAVIORAL DIAGNOSES
Page 19 of 29
Jan 1 2013
April 1 2013
0.7412
0.6448
0.6017
0.6680
0.7496
0.7411
0.7990
0.7640
1.1487
0.7309
0.7761
0.6926
0.7162
0.7660
0.6519
0.7586
0.6578
0.7227
0.6479
0.7828
0.6328
0.7208
0.9262
0.7388
1.0955
0.7669
0.7359
0.6194
0.7731
0.7153
0.7940
0.6776
0.9252
1.7409
0.8986
0.6573
0.6527
1.0222
0.7678
0.6042
0.8735
0.7705
0.9227
0.7790
0.7154
0.7086
0.6714
0.5403
0.7953
0.7160
0.7720
0.6784
0.6083
0.7243
0.6110
0.8078
0.6849
0.6846
0.7412
0.6448
0.6017
0.6680
0.7496
0.7411
0.7990
0.7640
1.1487
0.7309
0.7761
0.6926
0.7162
0.7660
0.6519
0.7586
0.6578
0.7227
0.6479
0.7828
0.6328
0.7208
0.9262
0.7388
1.0955
0.7669
0.7359
0.6194
0.7731
0.7153
0.7940
0.6776
0.9252
1.7409
0.8986
0.6573
0.6527
1.0222
0.7678
0.6042
0.8735
0.7705
0.9227
0.7790
0.7154
0.7086
0.6714
0.5403
0.7953
0.7160
0.7720
0.6784
0.6083
0.7243
0.6110
0.8078
0.6849
0.6846
APG
830
831
840
841
842
843
850
851
852
853
854
860
861
870
871
872
873
874
875
876
APG Description
EATING DISORDERS
OTHER MENTAL HEALTH DIAGNOSES
OPIOID ABUSE & DEPENDENCE
COCAINE ABUSE & DEPENDENCE
ALCOHOL ABUSE & DEPENDENCE
OTHER DRUG ABUSE & DEPENDENCE
ALLERGIC REACTIONS
POISONING OF MEDICINAL AGENTS
OTHER COMPLICATIONS OF TREATMENT
OTHER INJURY, POISONING & TOXIC EFFECT DIAGNOSES
TOXIC EFFECTS OF NON‐MEDICINAL SUBSTANCES
EXTENSIVE 3RD DEGREE OR FULL THICKNESS BURNS W/O SKIN GRAFT
PARTIAL THICKNESS BURNS W OR W/O SKIN GRAFT
REHABILITATION
SIGNS, SYMPTOMS & OTHER FACTORS INFLUENCING HEALTH STATUS
OTHER AFTERCARE & CONVALESCENCE
NEONATAL AFTERCARE
JOINT REPLACEMENT
CONTRACEPTIVE MANAGEMENT
ADULT PREVENTIVE MEDICINE
Page 20 of 29
Jan 1 2013
April 1 2013
0.6835
0.6434
0.6946
0.7977
0.8279
0.7517
0.8716
1.0037
0.8616
0.9005
0.7827
0.9008
0.8632
0.6198
0.6968
0.6825
0.7426
0.6549
1.2543
0.6835
0.6434
0.6946
0.7977
0.8279
0.7517
0.8716
1.0037
0.8616
0.9005
0.7827
0.9008
0.8632
0.6198
0.6968
0.6825
0.7426
0.6549
1.2543
0.6968
0.6968
7/8/2016
NYS DOH APG Procedure Based Weights History File
Revised for July 1, 2016 Updates:
Effective Date > HCPCS Code
55450
58300
58301
58615
90805
90807
90809
90811
90813
90815
90819
90833
90836
90838
90847
90862
90863
90882
90993
92065
92340
92341
92342
92506
92521
92522
92523
92524
92597
92605
92607
92608
92618
92626
92627
92640
94250
95943
95951
96040
96101
96102
96111
96116
96118
96119
96125
96150
96151
96152
96153
96154
96155
97001
97002
97003
97004
97010
97012
97014
97016
97018
97022
97024
97026
HCPCS Code Description
Ligation of sperm duct
Insert intrauterine device
Remove intrauterine device
Occlude fallopian tube(s)
Psytx, off, 20‐30 min w/e&m
Psytx, off, 45‐50 min w/e&m
Psytx, off, 75‐80, w/e&m
Intact psytx, 20‐30, w/e&m
Intact psytx, 45‐50 min w/e&m
Intact psytx, 75‐80 w/e&m
Psytx, hosp, 45‐50 min w/e&m
Psychotherapy, 30 minutes with e&m (code e&m separately)
Psychotherapy, 45 minutes with e&m (code e&m separately)
Psychotherapy, 60 minutes with e&m (code e&m separately)
Family psytx w/patient
Medication management
Pharmacologic management, when performed with psychotherapy.
Environmental manipulation
Dialysis training incompl
Orthoptic/pleoptic training
Fitting of spectacles
Fitting of spectacles
Fitting of spectacles
Speech/hearing evaluation
Evaluation of speech fluency
Evaluate speech production
Speech sound lang comprehen
Behavral qualit analys voice
Oral speech device eval
Eval for nonspeech device rx
Ex for speech device rx, 1hr
Ex for speech device rx addl
Ex for nonspeech dev rx add
Eval aud rehab status
Eval aud status rehab add‐on
Aud brainstem implt programg
Expired gas collection
Parasymp&symp hrt rate test
EEG monitoring/videorecord
Genetic counseling, 30 min
Psycho testing by psych/phys
Psycho testing by technician
Developmental test, extend
Neurobehavioral status exam
Neuropsych tst by psych/phys
Neuropsych testing by tec
Cognitive test by hc pro
Assess hlth/behave, init
Assess hlth/behave, subseq
Intervene hlth/behave, indiv
Intervene hlth/behave, group
Interv hlth/behav, fam w/pt
Interv hlth/behav, fam w/o pt
Pt evaluation
Pt re‐evaluation
Ot evaluation
Ot re‐evaluation
Hot or cold packs therapy
Mechanical traction therapy
Electric stimulation therapy
Vasopneumatic device therapy
Paraffin bath therapy
Whirlpool therapy
Diathermy eg, microwave
Infrared therapy
Final Px Based Weights
APG (ref only)
180
417
417
197
315
316
316
315
316
316
316
Jan 1, 2010
Px‐Based Weight
‐
‐
‐
‐
1.0344
1.2413
1.2413
1.0344
1.2413
1.2413
1.2413
Units Limit
0
0
0
0
1
1
1
1
1
1
1
Apr 1, 2010
Px‐Based Weight
‐
‐
‐
‐
1.0344
1.2413
1.2413
1.0344
1.2413
1.2413
1.2413
Units Limit
0
0
0
0
1
1
1
1
1
1
1
Jul 1, 2010
Px‐Based Weight
‐
‐
‐
‐
1.0344
1.2413
1.2413
1.0344
1.2413
1.2413
1.2413
Units Limit
0
0
0
0
1
1
1
1
1
1
1
Oct 1, 2010
Px‐Based Weight
‐
‐
‐
‐
1.0344
1.2413
1.2413
1.0344
1.2413
1.2413
1.2413
Units Limit
0
0
0
0
1
1
1
1
1
1
1
Jan 1, 2011
Px‐Based Weight
‐
‐
‐
‐
1.0344
1.2413
1.2413
1.0344
1.2413
1.2413
1.2413
Units Limit
0
0
0
0
1
1
1
1
1
1
1
Apr 1, 2011
Px‐Based Weight
‐
‐
‐
‐
1.0344
1.2413
1.2413
1.0344
1.2413
1.2413
1.2413
Units Limit
0
0
0
0
1
1
1
1
1
1
1
July 1, 2011
Px‐Based Weight
9.9081
‐
‐
10.8930
1.0344
1.2413
1.2413
1.0344
1.2413
1.2413
1.2413
Units Limit
1
0
0
1
1
1
1
1
1
1
1
Oct 1, 2011
Px‐Based Weight
9.9081
‐
‐
10.8930
1.0344
1.2413
1.2413
1.0344
1.2413
1.2413
1.2413
Units Limit
1
0
0
1
1
1
1
1
1
1
1
Jan 1, 2012
Px‐Based Weight
9.9081
0.9902
0.9902
10.8930
1.0344
1.2413
1.2413
1.0344
1.2413
1.2413
1.2413
Units Limit
1
1
1
1
1
1
1
1
1
1
1
Apr 1, 2012
Px‐Based Weight
9.9081
0.9902
0.9902
10.8930
1.0344
1.2413
1.2413
1.0344
1.2413
1.2413
1.2413
Units Limit
1
1
1
1
1
1
1
1
1
1
1
July 1, 2012
Px‐Based Weight
9.9081
0.9902
0.9902
10.8930
1.0344
1.2413
1.2413
1.0344
1.2413
1.2413
1.2413
Units Limit
1
1
1
1
1
1
1
1
1
1
1
Oct 1, 2012
Px‐Based Weight
9.9081
0.9902
0.9902
10.8930
1.0344
1.2413
1.2413
1.0344
1.2413
1.2413
1.2413
Units Limit
1
1
1
1
1
1
1
1
1
1
1
Jan 1, 2013
Px‐Based Weight Units Limit
9.9081
1
0.9902
1
0.9902
1
10.8930
1
‐
0
‐
0
‐
0
‐
0
‐
0
‐
0
‐
0
315
‐
0
‐
0
‐
0
‐
0
‐
0
‐
0
‐
0
‐
0
‐
0
‐
0
‐
0
‐
0
0.3322
316
‐
0
‐
0
‐
0
‐
0
‐
0
‐
0
‐
0
‐
0
‐
0
‐
0
‐
0
‐
0
0.5390
1
316
317
426
‐
1.2413
0.8275
0
1
1
‐
1.2413
0.8275
0
1
1
‐
1.2413
0.8275
0
1
1
‐
1.2413
0.6620
0
1
1
‐
1.2413
0.6620
0
1
1
‐
1.2413
0.6620
0
1
1
‐
1.2413
0.6620
0
1
1
‐
1.2413
0.6620
0
1
1
‐
1.2413
0.6620
0
1
1
‐
1.2413
0.6620
0
1
1
‐
1.2413
0.6620
0
1
1
‐
1.2413
0.6620
0
1
1
0.5390
1.2413
‐
1
1
0
322
490
428
‐
0.2896
‐
0.3820
0.2624
0.2624
0.2624
‐
0
1
0
1
1
1
1
0
‐
0.2896
‐
0.3820
0.2624
0.2624
0.2624
‐
0
1
0
1
1
1
1
0
‐
0.2896
‐
0.3820
0.2624
0.2624
0.2624
‐
0
1
0
1
1
1
1
0
‐
0.2896
‐
0.3820
0.2624
0.2624
0.2624
‐
0
1
0
1
1
1
1
0
‐
0.2896
‐
0.3820
0.2624
0.2624
0.2624
0.8996
0
1
0
1
1
1
1
1
‐
0.2896
‐
0.3820
0.2624
0.2624
0.2624
0.8996
0
1
0
1
1
1
1
1
‐
0.2896
‐
0.3820
0.2624
0.2624
0.2624
0.8996
0
1
0
1
1
1
1
1
‐
0.2896
‐
0.3820
0.2624
0.2624
0.2624
0.8996
0
1
0
1
1
1
1
1
‐
0.2896
‐
0.3820
0.2624
0.2624
0.2624
0.8996
0
1
0
1
1
1
1
1
‐
0.2896
‐
0.3820
0.2624
0.2624
0.2624
0.8996
0
1
0
1
1
1
1
1
‐
0.2896
‐
0.3820
0.2624
0.2624
0.2624
0.8996
0
1
0
1
1
1
1
1
‐
0.2896
‐
0.3820
0.2624
0.2624
0.2624
0.8996
0
1
0
1
1
1
1
1
0.6620
0.2896
0.1939
0.3820
0.2624
0.2624
0.2624
0.8996
1
1
1
1
1
1
1
1
‐
‐
0.8827
0.8827
0
0
1
1
‐
‐
0.8827
0.8827
0
0
1
1
‐
‐
0.8827
0.8827
0
0
1
1
‐
‐
0.8827
0.8827
0
0
1
1
0.8996
0.8996
0.8996
0.4498
1
1
1
2
0.8996
0.8996
0.8996
0.4498
1
1
1
2
0.8996
0.8996
0.8996
0.4498
1
1
1
2
0.8996
0.8996
0.8996
0.4498
1
1
1
2
0.8996
0.8996
0.8996
0.4498
1
1
1
2
0.8996
0.8996
0.8996
0.4498
1
1
1
2
0.8996
0.8996
0.8996
0.4498
1
1
1
2
0.8996
0.8996
0.8996
0.4498
1
1
1
2
0.8996
0.8996
0.8996
0.4498
1
1
1
2
‐
‐
‐
0
0
0
‐
‐
‐
0
0
0
‐
‐
‐
0
0
0
‐
‐
‐
0
0
0
0.8996
0.2249
0.8996
1
2
1
0.8996
0.2249
0.8996
1
2
1
0.8996
0.2249
0.8996
1
2
1
0.8996
0.2249
0.8996
1
2
1
0.8996
0.2249
0.8996
1
2
1
0.8996
0.2249
0.8996
1
2
1
0.8996
0.2249
0.8996
1
2
1
0.8996
0.2249
0.8996
1
2
1
0.8996
0.2249
0.8996
1
2
1
‐
‐
‐
1.6551
1.2413
1.2413
1.6551
1.6551
1.2413
1.2413
0.1517
0.1448
0.1379
0.0690
0.1379
0.1517
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
0
0
0
1
1
1
1
1
1
1
3
3
3
4
4
4
0
0
0
0
0
0
0
0
0
0
0
0
‐
‐
‐
1.6551
1.2413
1.2413
1.6551
1.6551
1.2413
1.2413
0.1517
0.1448
0.1379
0.0690
0.1379
0.1517
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
0
0
0
1
1
1
1
1
1
1
3
3
3
4
4
4
0
0
0
0
0
0
0
0
0
0
0
0
‐
‐
‐
1.6551
1.2413
1.2413
1.6551
1.6551
1.2413
1.2413
0.1517
0.1448
0.1379
0.0690
0.1379
0.1517
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
0
0
0
1
1
1
1
1
1
1
3
3
3
4
4
4
0
0
0
0
0
0
0
0
0
0
0
0
‐
‐
‐
1.6551
1.2413
1.2413
1.6551
1.6551
1.2413
1.2413
0.1517
0.1448
0.1379
0.0690
0.1379
0.1517
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
0
0
0
1
1
1
1
1
1
1
3
3
3
4
4
4
0
0
0
0
0
0
0
0
0
0
0
0
‐
‐
0.1939
1.6551
1.2413
1.2413
1.6551
1.6551
1.2413
1.2413
0.1517
0.1448
0.1379
0.0690
0.1379
0.1517
0.9045
0.9045
0.8141
0.8141
0.1379
0.1379
0.1379
0.1379
0.1379
0.1379
0.1379
0.1379
0
0
4
1
1
1
1
1
1
1
3
3
3
4
4
4
1
1
1
1
1
1
1
1
1
1
1
1
‐
‐
0.1939
1.6551
1.2413
1.2413
1.6551
1.6551
1.2413
1.2413
0.1517
0.1448
0.1379
0.0690
0.1379
0.1517
0.9045
0.9045
0.8141
0.8141
0.1379
0.1379
0.1379
0.1379
0.1379
0.1379
0.1379
0.1379
0
0
4
1
1
1
1
1
1
1
3
3
3
4
4
4
1
1
1
1
1
1
1
1
1
1
1
1
‐
‐
0.1939
1.6551
1.2413
1.2413
1.6551
1.6551
1.2413
1.2413
0.1517
0.1448
0.1379
0.0690
0.1379
0.1517
0.9045
0.9045
0.8141
0.8141
0.1379
0.1379
0.1379
0.1379
0.1379
0.1379
0.1379
0.1379
0
0
4
1
1
1
1
1
1
1
3
3
3
4
4
4
1
1
1
1
1
1
1
1
1
1
1
1
‐
‐
0.1939
1.6551
1.2413
1.2413
1.6551
1.6551
1.2413
1.2413
0.1517
0.1448
0.1379
0.0690
0.1379
0.1517
0.9045
0.9045
0.8141
0.8141
0.1379
0.1379
0.1379
0.1379
0.1379
0.1379
0.1379
0.1379
0
0
4
1
1
1
1
1
1
1
3
3
3
4
4
4
1
1
1
1
1
1
1
1
1
1
1
1
‐
3.9000
0.1939
1.6551
1.2413
1.2413
1.6551
1.6551
1.2413
1.2413
0.1517
0.1448
0.1379
0.0690
0.1379
0.1517
0.9045
0.9045
0.8141
0.8141
0.1379
0.1379
0.1379
0.1379
0.1379
0.1379
0.1379
0.1379
0
1
4
1
1
1
1
1
1
1
3
3
3
4
4
4
1
1
1
1
1
1
1
1
1
1
1
1
‐
3.9000
0.1939
1.6551
1.2413
1.2413
1.6551
1.6551
1.2413
1.2413
0.1517
0.1448
0.1379
0.0690
0.1379
0.1517
0.9045
0.9045
0.8141
0.8141
0.1379
0.1379
0.1379
0.1379
0.1379
0.1379
0.1379
0.1379
0
1
4
1
1
1
1
1
1
1
3
3
3
4
4
4
1
1
1
1
1
1
1
1
1
1
1
1
‐
3.9000
0.1939
1.6551
1.2413
1.2413
1.6551
1.6551
1.2413
1.2413
0.1517
0.1448
0.1379
0.0690
0.1379
0.1517
0.9045
0.9045
0.8141
0.8141
0.1379
0.1379
0.1379
0.1379
0.1379
0.1379
0.1379
0.1379
0
1
4
1
1
1
1
1
1
1
3
3
3
4
4
4
1
1
1
1
1
1
1
1
1
1
1
1
‐
3.9000
0.1939
1.6551
1.2413
1.2413
1.6551
1.6551
1.2413
1.2413
0.1517
0.1448
0.1379
0.0690
0.1379
0.1517
0.9045
0.9045
0.8141
0.8141
0.1379
0.1379
0.1379
0.1379
0.1379
0.1379
0.1379
0.1379
0
1
4
1
1
1
1
1
1
1
3
3
3
4
4
4
1
1
1
1
1
1
1
1
1
1
1
1
‐
3.9000
0.1939
1.6551
1.2413
1.2413
1.6551
1.6551
1.2413
1.2413
0.1517
0.1448
0.1379
0.0690
0.1379
0.1517
0.9045
0.9045
0.8141
0.8141
0.1379
0.1379
0.1379
0.1379
0.1379
0.1379
0.1379
0.1379
0
1
4
1
1
1
1
1
1
1
3
3
3
4
4
4
1
1
1
1
1
1
1
1
1
1
1
1
427
490
490
490
272
272
272
272
272
272
272
272
272
272
272
272
272
412
213
210
490
310
310
310
310
310
310
310
490
490
490
490
490
490
271
271
270
270
271
271
271
271
271
271
271
271
Page 21 of 29
1
7/8/2016
Effective Date > HCPCS Code
97028
97032
97033
97034
97035
97036
97039
97110
97112
97113
97116
97124
97139
97140
97530
97532
97533
97535
97537
97542
97545
97750
97755
97760
97761
97762
97799
97802
HCPCS Code Description
Ultraviolet therapy
Electrical stimulation, 15 min
Electric current therapy, 15 min
Contrast bath therapy, 15 min
Ultrasound therapy, 15 min
Hydrotherapy, 15 min
Physical therapy treatment
Therapeutic exercises, 15 min
Neuromuscular reeducation
Aquatic therapy/exercises
Gait training therapy
Massage therapy, 15 min
Physical medicine procedure
Manual therapy, 15 min
Therapeutic activities, 15 min
Cognitive skills development, 15 min
Sensory integration, 15 min
Self care mngment training, 15 min
Community/work reintegration, 15 min
Wheelchair mngment training, 15 min
Work hardening
Physical performance test, 15 min
Assistive technology assess, 15 min
Orthotic mgmt and training, 15 min
Prosthetic training, 15 min
C/o for orthotic/prosth use, 15 min
Physical medicine procedure
Medical nutrition, indiv, each 15 min
97803
97804
97810
98941
98960
98961
98962
99002
99050
99051
99401
99402
99403
99404
99411
99412
D0190
D0191
D0502
Jan 1, 2010
Apr 1, 2010
Jul 1, 2010
Oct 1, 2010
Jan 1, 2011
Apr 1, 2011
July 1, 2011
Oct 1, 2011
Jan 1, 2012
Apr 1, 2012
July 1, 2012
Oct 1, 2012
Jan 1, 2013
APG (ref only)
271
271
271
271
271
271
271
271
271
271
271
271
271
271
271
270
270
270
270
270
271
271
271
271
271
271
271
118
Px‐Based Weight
‐
0.2276
0.2276
0.2276
0.2276
0.2276
‐
0.2276
0.2276
0.2276
0.2276
0.2276
‐
0.2276
0.2276
0.2414
0.2414
0.2414
0.2414
0.2414
‐
0.2276
0.2276
0.2276
0.2276
0.2276
‐
0.1793
Units Limit
0
3
3
3
3
3
0
3
3
3
3
3
0
3
3
3
3
3
3
3
0
3
3
3
3
3
0
2
Px‐Based Weight
‐
0.2276
0.2276
0.2276
0.2276
0.2276
‐
0.2276
0.2276
0.2276
0.2276
0.2276
‐
0.2276
0.2276
0.2414
0.2414
0.2414
0.2414
0.2414
‐
0.2276
0.2276
0.2276
0.2276
0.2276
‐
0.1793
Units Limit
0
3
3
3
3
3
0
3
3
3
3
3
0
3
3
3
3
3
3
3
0
3
3
3
3
3
0
2
Px‐Based Weight
‐
0.2276
0.2276
0.2276
0.2276
0.2276
‐
0.2276
0.2276
0.2276
0.2276
0.2276
‐
0.2276
0.2276
0.2414
0.2414
0.2414
0.2414
0.2414
‐
0.2276
0.2276
0.2276
0.2276
0.2276
‐
0.1793
Units Limit
0
3
3
3
3
3
0
3
3
3
3
3
0
3
3
3
3
3
3
3
0
3
3
3
3
3
0
2
Px‐Based Weight
‐
0.2276
0.2276
0.2276
0.2276
0.2276
‐
0.2276
0.2276
0.2276
0.2276
0.2276
‐
0.2276
0.2276
0.2414
0.2414
0.2414
0.2414
0.2414
‐
0.2276
0.2276
0.2276
0.2276
0.2276
‐
0.1793
Units Limit
0
3
3
3
3
3
0
3
3
3
3
3
0
3
3
3
3
3
3
3
0
3
3
3
3
3
0
2
Px‐Based Weight
0.1379
0.1379
0.1379
0.1379
0.1379
0.1379
0.1379
0.2276
0.2276
0.2276
0.2276
0.2276
0.1379
0.2276
0.2276
0.2414
0.2414
0.2414
0.2414
0.2603
0.9045
0.2276
0.2276
0.2276
0.2276
0.2276
0.1379
0.1847
Units Limit
1
1
1
1
1
1
1
3
3
3
3
3
1
3
3
3
3
3
3
8
1
3
3
3
3
3
1
2
Px‐Based Weight
0.1379
0.1379
0.1379
0.1379
0.1379
0.1379
0.1379
0.2276
0.2276
0.2276
0.2276
0.2276
0.1379
0.2276
0.2276
0.2414
0.2414
0.2414
0.2414
0.2603
0.9045
0.2276
0.2276
0.1939
0.2276
0.2276
0.1379
0.1847
Units Limit
1
2
2
2
2
2
1
3
3
3
3
3
1
3
3
3
3
3
3
8
1
3
6
4
4
3
1
2
Px‐Based Weight
0.1379
0.1379
0.1379
0.1379
0.1379
0.1379
0.1379
0.2276
0.2276
0.2276
0.2276
0.2276
0.1379
0.2276
0.2276
0.2414
0.2414
0.2414
0.2414
0.2603
0.9045
0.2276
0.2276
0.2276
0.2276
0.2276
0.1379
0.1847
Units Limit
1
2
2
2
2
2
1
3
3
3
3
3
1
3
3
3
3
3
3
8
1
3
6
4
4
3
1
2
Px‐Based Weight
0.1379
0.1379
0.1379
0.1379
0.1379
0.1379
0.1379
0.2276
0.2276
0.2276
0.2276
0.2276
0.1379
0.2276
0.2276
0.2414
0.2414
0.2414
0.2414
0.2603
0.9045
0.2276
0.2276
0.2276
0.2276
0.2276
0.1379
0.1847
Units Limit
1
2
2
2
2
2
1
3
3
3
3
3
1
3
3
3
3
3
3
8
1
3
6
4
4
3
1
2
Px‐Based Weight
0.1379
0.1379
0.1379
0.1379
0.1379
0.1379
0.1379
0.2276
0.2276
0.2276
0.2276
0.2276
0.1379
0.2276
0.2276
0.2414
0.2414
0.2414
0.2414
0.2603
0.9045
0.2276
0.2276
0.2276
0.2276
0.2276
0.1379
0.1847
Units Limit
1
2
2
2
2
2
1
3
3
3
3
3
1
3
3
3
3
3
3
8
1
3
6
4
4
3
1
2
Px‐Based Weight
0.1379
0.1379
0.1379
0.1379
0.1379
0.1379
0.1379
0.2276
0.2276
0.2276
0.2276
0.2276
0.1379
0.2276
0.2276
0.2414
0.2414
0.2414
0.2414
0.2603
0.9045
0.2276
0.2276
0.2276
0.2276
0.2276
0.1379
0.1847
Units Limit
1
2
2
2
2
2
1
3
3
3
3
3
1
3
3
3
3
3
3
8
1
3
6
4
4
3
1
2
Px‐Based Weight
0.1379
0.1379
0.1379
0.1379
0.1379
0.1379
0.1379
0.2276
0.2276
0.2276
0.2276
0.2276
0.1379
0.2276
0.2276
0.2414
0.2414
0.2414
0.2414
0.2603
0.9045
0.2276
0.2276
0.2276
0.2276
0.2276
0.1379
0.1847
Units Limit
1
2
2
2
2
2
1
3
3
3
3
3
1
3
3
3
3
3
3
8
1
3
6
4
4
3
1
2
Px‐Based Weight
0.1379
0.1379
0.1379
0.1379
0.1379
0.1379
0.1379
0.2276
0.2276
0.2276
0.2276
0.2276
0.1379
0.2276
0.2276
0.2414
0.2414
0.2414
0.2414
0.2603
0.9045
0.2276
0.2276
0.2276
0.2276
0.2276
0.1379
0.1847
Units Limit
1
2
2
2
2
2
1
3
3
3
3
3
1
3
3
3
3
3
3
8
1
3
6
4
4
3
1
2
Med nutrition, indiv, subseq, each 15 min
Medical nutrition, group, each 30 min
Acupunct w/o stimul 15 min
Chiropractic manipulation
Self‐mgmt educ & train, 1 pt, 30 min
Self‐mgmt educ/train, 2‐4 pt
Self‐mgmt educ/train, 5‐8 pt
Device Handling
Medical services after hrs
Med serv eve/wkend/holiday
Preventive counseling, indiv
Preventive counseling, indiv
Preventive counseling, indiv
Preventive counseling, indiv
Preventive counseling, group
Preventive counseling, group
Screening of a patient
Assessment of a patient
Other oral pathology procedu
118
118
271
271
428
429
429
490
448
448
490
490
490
490
490
490
376
376
376
0.1793
0.3448
0.2276
‐
0.1379
0.0690
0.0690
0.7586
2
1
3
0
4
4
4
1
0.1793
0.3448
0.2276
‐
0.1379
0.0690
0.0690
0.7586
2
1
3
0
4
4
4
1
0.1793
0.3448
‐
‐
0.1379
0.0690
0.0690
0.7586
2
1
0
0
4
4
4
1
0.1793
0.3448
‐
‐
0.1379
0.0690
0.0690
0.7586
2
1
0
0
4
4
4
1
0.1847
0.1638
‐
‐
0.1939
0.0970
0.0970
‐
2
1
0
0
4
4
4
0
0.1847
0.1638
‐
‐
0.1939
0.0970
0.0970
‐
2
1
0
0
4
4
4
0
0.1847
0.1638
‐
‐
0.1939
0.0970
0.0970
‐
2
1
0
0
4
4
4
0
0.1847
0.1638
‐
‐
0.1939
0.0970
0.0970
‐
2
1
0
0
4
4
4
0
0.1847
0.1638
‐
‐
0.1939
0.0970
0.0970
‐
2
1
0
0
4
4
4
0
0.1847
0.1638
‐
‐
0.1939
0.0970
0.0970
‐
2
1
0
0
4
4
4
0
0.1847
0.1638
‐
‐
0.1939
0.0970
0.0970
‐
2
1
0
0
4
4
4
0
0.1847
0.1638
‐
‐
0.1939
0.0970
0.0970
‐
2
1
0
0
4
4
4
0
0.1847
0.1638
‐
‐
0.1939
0.0970
0.0970
‐
2
1
0
0
4
4
4
0
0.1724
0.3103
0.4482
0.5862
0.1379
0.2414
‐
‐
1
1
1
1
1
1
0
0
0.1724
0.3103
0.4482
0.5862
0.1379
0.2414
‐
‐
1
1
1
1
1
1
0
0
0.1724
0.3103
0.4482
0.5862
0.1379
0.2414
‐
‐
1
1
1
1
1
1
0
0
0.1724
0.3103
0.4482
0.5862
0.1379
0.2414
‐
‐
1
1
1
1
1
1
0
0
0.1724
0.3103
0.4482
0.5862
0.1379
0.2414
‐
‐
1
1
1
1
1
1
0
0
0.1724
0.3103
0.4482
0.5862
0.1379
0.2414
‐
‐
1
1
1
1
1
1
0
0
0.2500
0.3103
0.4482
0.5862
0.1379
0.2414
‐
‐
1
1
1
1
1
1
0
0
0.2500
0.3103
0.4482
0.5862
0.1379
0.2414
‐
‐
1
1
1
1
1
1
0
0
0.2500
0.3103
0.4482
0.5862
0.1379
0.2414
‐
‐
1
1
1
1
1
1
0
0
0.2500
0.3103
0.4482
0.5862
0.1379
0.2414
‐
‐
1
1
1
1
1
1
0
0
0.2500
0.3103
0.4482
0.5862
0.1379
0.2414
‐
‐
1
1
1
1
1
1
0
0
0.2500
0.3103
0.4482
0.5862
0.1379
0.2414
‐
‐
1
1
1
1
1
1
0
0
0.2500
0.3103
0.4482
0.5862
0.1379
0.2414
‐
‐
1
1
1
1
1
1
0
0
D1320
D5410
D5411
D5421
D5422
D9223
Tobacco counseling
Dentures adjust cmplt maxil
Dentures adjust cmplt mand
Dentures adjust part maxill
Dentures adjust part mandbl
General anesthesia each 15m
999
350
350
350
350
375
‐
0
‐
0
‐
0
‐
0
‐
0
‐
0
‐
0
‐
0
‐
0
0.1267
1
‐
0
‐
0
‐
0
D9230
D9243
D9248
D9310
D9920
G0108
G0109
G0270
G0271
G0283
H0001
H0004
H0006
H0014
H0023
H0031
H0038
Analgesia
Iv sedation each 15m
Sedation (non‐iv)
Dental consultation
Behavior management
Diab manage trn per indiv
Diab manage trn ind/group
MNT subs tx for change dx, each 15 min
Group MNT 2 or more 30 mins
Elec stim other than wound
Alcohol and/or drug assessment
Alcohol and/or drug services
490
375
490
350
350
428
429
118
118
271
323
315
320
426
490
323
490
‐
0
‐
0
‐
0
‐
0
0.1515
1
0.3030
1
0.3030
1
0.4688
1
0.4688
1
0.4688
1
0.4688
1
0.4688
1
0.4688
1
‐
‐
‐
0.1379
0.0690
0.1793
0.1517
‐
0.8965
‐
0.4138
‐
0.7034
0.8965
‐
0
0
0
4
4
2
1
0
1
0
1
0
1
1
0
0.4545
‐
‐
0.1379
0.0690
0.1793
0.1517
‐
0.8965
‐
0.4138
‐
0.7034
0.8965
‐
1
0
0
4
4
2
1
0
1
0
1
0
1
1
0
0.4545
‐
‐
0.1379
0.0690
0.1793
0.1517
‐
0.8965
‐
0.4138
‐
0.7034
0.8965
‐
1
0
0
4
4
2
1
0
1
0
1
0
1
1
0
0.4545
‐
‐
0.1379
0.0690
0.1793
0.1517
‐
0.8965
‐
0.4138
‐
‐
0.8965
‐
1
0
0
4
4
2
1
0
1
0
1
0
1
1
0
0.1515
0.2976
‐
0.1939
0.0970
0.1847
0.1517
0.1379
0.8965
‐
0.4138
0.8275
‐
0.8965
0.0172
1
1
0
4
4
2
1
1
1
0
1
1
1
1
4
0.3030
0.2976
‐
0.1939
0.0970
0.1847
0.1517
0.1379
0.8965
‐
0.4138
0.8275
‐
0.8965
0.0172
1
1
0
4
4
2
1
1
1
0
1
1
1
1
4
0.3030
0.1875
0.1563
0.1939
0.0970
0.1847
0.1517
0.1379
0.8965
‐
0.4138
0.8275
‐
0.8965
0.0172
1
1
1
4
4
2
1
1
1
0
1
1
1
1
4
0.4688
0.1875
0.3125
0.1939
0.0970
0.1847
0.1517
0.1379
0.8965
‐
0.4138
0.8275
‐
0.8965
0.0172
1
1
1
4
4
2
1
1
1
0
1
1
1
1
4
0.4688
0.1875
0.3125
0.1939
0.0970
0.1847
0.1517
0.1379
0.8965
‐
0.4138
0.8275
‐
0.8965
0.0172
1
1
1
4
4
2
1
1
1
0
1
1
1
1
4
0.4688
0.1875
0.3125
0.1939
0.0970
0.1847
0.1517
0.1379
0.8965
‐
0.4138
0.8275
‐
0.8965
0.0313
1
1
1
4
4
2
1
1
1
0
1
1
1
1
4
0.4688
0.1875
0.3125
0.1939
0.0970
0.1847
0.1517
0.1379
0.8965
‐
0.4138
0.8275
‐
0.8965
0.0313
1
1
1
4
4
2
1
1
1
0
1
1
0
1
4
0.4688
0.1875
0.3125
0.1939
0.0970
0.1847
0.1517
0.1379
0.8965
0.2803
0.4138
0.8275
‐
0.8965
0.0313
1
1
1
4
4
2
1
1
1
1
1
1
0
1
4
0.4688
0.1875
0.3125
0.1939
0.0970
0.1847
0.1517
0.1379
0.8965
0.2803
0.4138
0.8275
‐
0.8965
0.0313
1
1
1
4
4
2
1
1
1
1
1
1
0
1
4
Alcohol and/or drug services
Alcohol and/or drug services
Behavioral health outreach service
MH health assess by non‐md
Self‐help/peer services per 15 min
Final Px Based Weights
Page 22 of 29
Px‐Based Weight Units Limit
0.1379
1
0.1379
2
0.1379
2
0.1379
2
0.1379
2
0.1379
2
0.1379
1
0.2276
3
0.2276
3
0.2276
3
0.2276
3
0.2276
3
0.1379
1
0.2276
3
0.2276
3
0.2414
3
0.2414
3
0.2414
3
0.2414
3
0.2603
8
0.9045
1
0.2276
3
0.2276
6
0.2276
4
0.2276
4
0.2276
3
0.1379
1
0.1847
2
7/8/2016
Effective Date > HCPCS Code
H1000
H1005
H2010
H2011
Q3014
S9152
S9445
S9446
S9484
S9485
T1007
T1013
V2020
V2103
V2200
V2203
V2300
V2303
V5010
V5014
V5020
V5160
V5200
V5240
V5241
V5362
V5364
HCPCS Code Description
Prenatal care atrisk assessm
Prenatal care enhanced srv pk
Comprehensive med svc 15 min
Crisis interven svc, per 15 min
Telehealth facility fee
Speech therapy, re‐eval
Patient education noc individ
Patient education noc group
Crisis intervention per hour
Crisis intervention mental h
Treatment Plan Development
Sign Lang/Oral Interpreter
Vision svcs frames purchases
Spherocylindr 4.00d/12‐2.00d
Lens spher bifoc plano 4.00d
Lens sphcyl bifocal 4.00d/.1
Lens sphere trifocal 4.00d
Lens sphcy trifocal 4.0/.12‐
Assessment for hearing aid
Hearing aid repair/modifying
Conformity evaluation
Dispensing fee binaural
Cros hearing aid dispens fee
Dispensing fee bicros
Dispensing fee, monaural
Speech screening
Dysphagia screening
Final Px Based Weights
APG (ref only)
490
490
490
321
490
272
999
999
321
312
320
490
490
490
490
490
490
490
257
257
257
490
490
490
490
272
272
Jan 1, 2010
Px‐Based Weight
0.2069
0.0690
0.4138
0.2069
‐
‐
‐
‐
2.4136
5.7927
0.4138
‐
0.3567
0.3567
0.3567
0.3567
‐
‐
‐
‐
‐
1.3792
1.3792
1.3792
0.9310
‐
‐
Units Limit
1
1
1
8
0
0
0
0
1
1
1
0
1
1
1
1
0
0
0
0
0
1
1
1
1
0
0
Apr 1, 2010
Px‐Based Weight
0.2069
0.0690
0.4138
0.4000
‐
‐
‐
‐
2.4136
5.7927
0.4138
0.0295
0.3567
0.3567
0.3567
0.3567
‐
‐
0.0844
‐
0.0422
1.3792
1.3792
1.3792
0.9310
‐
‐
Units Limit
1
1
1
6
0
0
0
0
1
1
1
3
1
1
1
1
0
0
1
0
1
1
1
1
1
0
0
Jul 1, 2010
Px‐Based Weight
0.2069
0.0690
0.4138
0.4000
‐
‐
‐
‐
2.4136
5.7927
0.4138
0.0295
0.3567
0.3567
0.3567
0.3567
‐
‐
0.0844
‐
0.0422
1.3792
1.3792
1.3792
0.9310
‐
‐
Units Limit
1
1
1
6
0
0
0
0
1
1
1
3
1
1
1
1
0
0
1
0
1
1
1
1
1
0
0
Oct 1, 2010
Px‐Based Weight
0.2069
0.0690
0.4138
0.4000
‐
‐
‐
‐
2.4136
5.7927
0.4138
0.0295
0.3567
0.3567
0.3567
0.3567
‐
‐
0.0844
‐
0.0422
1.3792
1.3792
1.3792
0.9310
‐
‐
Units Limit
1
1
1
6
0
0
0
0
1
1
1
3
1
1
1
1
0
0
1
0
1
1
1
1
1
0
0
Jan 1, 2011
Px‐Based Weight
0.2069
0.0690
0.4138
0.4000
‐
‐
‐
‐
2.4136
5.7927
0.4138
0.0295
0.3567
0.3567
0.3567
0.3567
‐
‐
0.0844
‐
0.0422
1.3792
1.3792
1.3792
0.9310
‐
‐
Units Limit
1
1
1
6
0
0
0
0
1
1
1
3
1
1
1
1
0
0
1
0
1
1
1
1
1
0
0
Apr 1, 2011
Px‐Based Weight
0.2069
0.0690
0.4138
0.4000
‐
‐
‐
‐
2.4136
5.7927
0.4138
0.0295
0.3567
0.3567
0.3567
0.3567
‐
‐
0.0844
‐
0.0422
1.3792
1.3792
1.3792
0.9310
‐
‐
Page 23 of 29
Units Limit
1
1
1
6
0
0
0
0
1
1
1
3
1
1
1
1
0
0
1
0
1
1
1
1
1
0
0
July 1, 2011
Px‐Based Weight
0.2069
0.0690
0.4138
0.4000
‐
0.8996
‐
‐
2.4136
5.7927
0.4138
0.0295
0.3567
0.3567
0.3567
0.3567
‐
‐
0.1688
‐
0.0844
1.3792
1.3792
1.3792
0.9310
‐
‐
Units Limit
1
1
1
6
0
1
0
0
1
1
1
3
1
1
1
1
0
0
1
0
1
1
1
1
1
0
0
Oct 1, 2011
Px‐Based Weight
0.2069
0.0690
0.4138
0.4000
‐
0.8996
‐
‐
2.4136
5.7927
0.4138
0.0295
0.3567
0.3567
0.3567
0.3567
‐
‐
0.4211
‐
0.4211
1.3792
1.3792
1.3792
0.9310
‐
‐
Units Limit
1
1
1
6
0
1
0
0
1
1
1
3
1
1
1
1
0
0
1
0
1
1
1
1
1
0
0
Jan 1, 2012
Px‐Based Weight
0.2069
0.0690
0.4138
0.4000
0.2813
0.8996
‐
‐
2.4136
5.7927
0.4138
0.0295
0.3567
0.3567
0.3567
0.3567
0.3567
0.3567
‐
0.1563
‐
1.3792
1.3792
1.3792
0.9310
‐
‐
Units Limit
1
1
1
6
1
1
0
0
1
1
1
3
1
1
1
1
1
1
0
1
0
1
1
1
1
0
0
Apr 1, 2012
Px‐Based Weight
0.2069
0.0690
0.4138
0.4000
0.2813
0.8996
‐
‐
2.4136
5.7927
0.4138
0.0295
0.3567
0.3567
0.3567
0.3567
0.3567
0.3567
‐
0.1563
‐
1.3792
1.3792
1.3792
0.9310
‐
‐
Units Limit
1
1
1
6
1
1
0
0
1
1
1
3
1
1
1
1
1
1
0
1
0
1
1
1
1
0
0
July 1, 2012
Px‐Based Weight
0.2069
0.0690
0.4138
0.4000
0.2813
0.8996
0.2813
0.0938
2.4136
5.7927
0.4138
0.0688
0.3567
0.3567
0.3567
0.3567
0.3567
0.3567
‐
‐
‐
1.3792
1.3792
1.3792
0.9310
‐
‐
Units Limit
1
1
1
6
1
1
1
1
1
1
1
2
1
1
1
1
1
1
0
0
0
1
1
1
1
0
0
Oct 1, 2012
Px‐Based Weight
0.2069
0.0690
0.4138
0.4000
0.2813
0.8996
0.2813
0.0938
2.4136
5.7927
0.4138
0.0688
0.3567
0.3567
0.3567
0.3567
0.3567
0.3567
‐
‐
‐
1.3792
1.3792
1.3792
0.9310
‐
‐
Units Limit
1
1
1
6
1
1
1
1
1
1
1
2
1
1
1
1
1
1
0
0
0
1
1
1
1
0
0
Jan 1, 2013
Px‐Based Weight Units Limit
0.2069
1
0.0690
1
0.4138
1
0.4000
6
0.2813
1
0.8996
1
0.2813
1
0.0938
1
2.4136
1
5.7927
1
0.4138
1
0.0688
2
0.3567
1
0.3567
1
0.3567
1
0.3567
1
0.3567
1
0.3567
1
‐
0
‐
0
‐
0
1.3792
1
1.3792
1
1.3792
1
0.9310
1
‐
0
‐
0
7/8/2016
APG Fee Schedule Procedures (only periods with changes are shown)
Revised for Jan 1, 2016 Updates:
Effective Date > HCPCS Code
59412
61885
64568
81025
86480
86580
86701
86702
86703
87806
87390
87391
90473
90655
90656
90657
90658
90660
90669
90732
99211
G0008
G0009
G0432
G0433
G0435
H0038
J0129
J0178
J0475
J0490
J0583
J0592
J0638
J0882
J0885
J0886
Fee Schedule
HCPCS Code Description
Ante‐partum manipulation
Insrt/redo neurostim 1 array
Inc for vagus n elect impl
Urine pregnancy test
Tb test cell immun measure
TB intradermal test
HIV‐1
HIV‐2
Hiv‐1/hiv‐2 single assay
Hiv antigen w/hiv antibodies
Hiv‐1 ag eia
Hiv‐2 ag eia
Immune admin oral/nasal
Flu vaccine no preserv 6‐35m
Flu vaccine no preserv 3 & >
Flu vaccine 3 yrs im
Flu vaccine 3 yrs & > im
Flu vaccine nasal
Pneumococcal vacc 7 val im
Pneumococcal vaccine
Office/outpatient visit est
Admin influenza virus vac
Admin pneumococcal vaccine
EIA HIV‐1/HIV‐2 screen
ELISA HIV‐1/HIV‐2 screen
Oral HIV‐1/HIV‐2 screen
Self‐help/peer services per 15 min
Abatacept injection
Aflibercept injection
Baclofen 10 MG injection
Belimumab injection
Bivalirudin
Buprenorphine hydrochloride
Canakinumab injection
Darbepoetin alfa, esrd use
Epoetin alfa, non‐esrd
Epoetin alfa 1000 units ESRD
Jan 1, 2011
Apr 1, 2011
Jul 1, 2011
Jan 1, 2012
Jan 1, 20
Reimbursement Amount
(per unit)
Max units
Reimbursement Amount
(per unit)
Max units
Reimbursement Amount
(per unit)
Max units
Reimbursement Amount
(per unit)
Max units
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
$ 11,794.40
$ 19,630.40
‐
$ 69.78
$ 5.00
‐
‐
‐
1
1
‐
1
1
‐
‐
‐
$ 11,794.40
$ 19,630.40
$ 3.19
$ 69.78
$ 5.00
$ 10.00
$ 15.22
$ 15.44
1
1
1
1
1
1
1
1
$ 11,794.40
$ 19,630.40
$ 3.19
$ 69.78
$ 5.00
$ 10.00
$ 15.22
$ 15.44
1 $ 11,794.40
1 $ 19,630.40
1 $ 3.19
1 $ 69.78
1 $ 5.00
1 $ 10.00
1 $ 15.22
1 $ 15.44
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
$ 8.57
$ 15.45
$ 12.54
$ 5.68
$ 11.37
$ 22.32
$ 95.48
$ 43.25
‐
‐
1
1
1
1
1
1
1
1
$ 19.86
$ 19.86
$ 8.57
$ 15.45
$ 12.54
$ 5.68
$ 11.37
$ 22.32
$ 95.48
$ 43.25
1
1
1
1
1
1
1
1
1
1
$ 19.86
$ 19.86
$ 8.57
$ 15.45
$ 12.54
$ 5.68
$ 11.37
$ 22.32
$ 95.48
$ 43.25
1
1
1
1
1
1
1
1
1
1
$ 19.86
$ 19.86
$ 8.57
$ 15.45
$ 12.54
$ 5.68
$ 11.37
$ 22.32
$ 95.48
$ 43.25
‐
‐
‐
‐
‐
‐
‐
‐
‐
‐
$ 13.23
$ 13.23
‐
‐
‐
1
1
‐
‐
‐
$ 13.23
$ 13.23
$ 15.44
$ 15.44
$ 13.50
1
1
1
1
1
$ 13.23
$ 13.23
$ 15.44
$ 15.44
$ 13.50
1
1
1
1
1
$ 13.23
$ 13.23
$ 15.44
$ 15.44
$ 13.50
$ 176.50
‐
‐
‐
8 $ 176.50
‐
‐
‐
‐
‐
‐
Page 24 of 29
8 $ 176.50
‐
‐
‐
‐
‐
‐
8 $ 176.50
‐
‐
‐
$ 3.12
$ 9.82
$ 9.82
Reimbursement Amount
(per unit)
8 $ 176.50
80
80
60
$ 3.12
$ 9.82
$ 9.82
7/8/2016
Effective Date > HCPCS Code
J0894
J1050
J1453
J1459
J1561
J1568
J1569
J1572
J1745
J1756
J2310
J2315
J2323
J2353
J2916
J2997
J3357
J3489
J9000
J9041
J9047
J9179
J9201
J9306
J9315
Q2049
Q4081
S4993
V2100
V2215
V2600
V2610
V2615
V2784
Fee Schedule
HCPCS Code Description
Decitabine injection
Medroxyprogesterone acetate
Fosaprepitant injection
Inj IVIG privigen 500 mg
Gamunex‐C/Gammaked
Octagam injection
Gammagard liquid injection
Flebogamma injection
Infliximab injection
Iron sucrose injection
Inj naloxone hydrochloride
Inj, Naltrexone, Depot Form, 1mg
Natalizumab injection
Octreotide injection, depot
Na ferric gluconate complex
Alteplase recombinant
Ustekinumab injection
Injection, zoledronic acid
Doxorubicin HCL Injection
Bortezomib injection
Injection, carfilzomib
Eribulin mesylate injection
Gemcitabine hcl injection
Injection, pertuzumab
Romidepsin injection
Imported lipodox inj
Epoetin alfa, 100 units ESRD
Contraceptive pills for bc
Lens spher single plano 4.00
Lens lenticular bifocal
Hand held low vision aids
Single lens spectacle mount
Telescop/othr compound lens
Lens polycarb or equal
Jan 1, 2011
Apr 1, 2011
Jul 1, 2011
Jan 1, 2012
Jan 1, 20
Reimbursement Amount
(per unit)
Max units
Reimbursement Amount
(per unit)
Max units
Reimbursement Amount
(per unit)
Max units
Reimbursement Amount
(per unit)
Max units
Reimbursement Amount
(per unit)
‐
‐
$ 38.87
80
$ 38.87
80
$ 38.87
80
$ 38.87
‐
$ 0.98
‐
‐
2 $ 5.00
2 $ 26.50
1 $ 150.00
1 $ 545.00
1 $ 835.00
2 $ 10.00
600
‐
2
2
1
1
1
2
$ 0.98
$ 6.00
$ 5.00
$ 26.50
$ 150.00
$ 545.00
$ 835.00
$ 10.00
‐
‐
‐
‐
$ 150.00
$ 545.00
$ 835.00
‐
‐
‐
‐
‐
‐
‐
‐
‐
1 $ 150.00
1 $ 545.00
1 $ 835.00
‐
‐
Page 25 of 29
‐
‐
‐
‐
‐
$ 5.00
‐
$ 26.50
1 $ 150.00
1 $ 545.00
1 $ 835.00
‐
$ 10.00
7/8/2016
APG Fee Schedule Procedures (onl
Revised for Jan 1, 2016 Updates:
Effective Date >013
HCPCS Code
59412
61885
64568
81025
86480
86580
86701
86702
86703
87806
87390
87391
90473
90655
90656
90657
90658
90660
90669
90732
99211
G0008
G0009
G0432
G0433
G0435
H0038
J0129
J0178
J0475
J0490
J0583
J0592
J0638
J0882
J0885
J0886
Fee Schedule
HCPCS Code Description
Ante‐partum manipulation
Insrt/redo neurostim 1 array
Inc for vagus n elect impl
Urine pregnancy test
Tb test cell immun measure
TB intradermal test
HIV‐1
HIV‐2
Hiv‐1/hiv‐2 single assay
Hiv antigen w/hiv antibodies
Hiv‐1 ag eia
Hiv‐2 ag eia
Immune admin oral/nasal
Flu vaccine no preserv 6‐35m
Flu vaccine no preserv 3 & >
Flu vaccine 3 yrs im
Flu vaccine 3 yrs & > im
Flu vaccine nasal
Pneumococcal vacc 7 val im
Pneumococcal vaccine
Office/outpatient visit est
Admin influenza virus vac
Admin pneumococcal vaccine
EIA HIV‐1/HIV‐2 screen
ELISA HIV‐1/HIV‐2 screen
Oral HIV‐1/HIV‐2 screen
Self‐help/peer services per 15 min
Abatacept injection
Aflibercept injection
Baclofen 10 MG injection
Belimumab injection
Bivalirudin
Buprenorphine hydrochloride
Canakinumab injection
Darbepoetin alfa, esrd use
Epoetin alfa, non‐esrd
Epoetin alfa 1000 units ESRD
Oct 1, 2013
Jan 1, 2014
July 1, 2014
January 1, 2015
Reimbursement Reimbursement Reimbursement Reimbursement Amount
Amount
Amount
Amount
(per unit)
(per unit)
(per unit)
(per unit)
Max units
Max units
Max units
Max units
Max units
1 $ 11,794.40
1 $ 19,630.40
1 $ 3.19
1 $ 69.78
1 $ 5.00
1 $ 10.00
1 $ 15.22
1 $ 15.44
1 $ 11,794.40
1 $ 19,630.40
1 $ 3.19
1 $ 69.78
1 $ 5.00
1 $ 10.00
1 $ 15.22
1 $ 15.44
1
1
1
1
1
1
1
1
1
1
$ 19.86
$ 19.86
$ 8.57
$ 15.45
$ 12.54
$ 5.68
$ 11.37
$ 22.32
$ 95.48
$ 43.25
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
$ 13.23
$ 13.23
$ 15.44
$ 15.44
$ 13.50
1
1
1
1
1
8 $ 176.50
$ 19.86
$ 19.86
$ 8.57
$ 15.45
$ 12.54
$ 5.68
$ 11.37
$ 22.32
$ 95.48
$ 43.25
$ 20.00
$ 13.23
$ 13.23
$ 15.44
$ 15.44
$ 13.50
$ 35.00
1 $ 11,794.40
1 $ 19,630.40
1 $ 3.19
1 $ 69.78
1 $ 5.00
1 $ 10.00
1 $ 15.22
1 $ 15.44
1
1
1
1
1
1
1
1
1
$ 35.00
$ 11,794.40
$ 19,630.40
$ 3.19
$ 69.78
$ 5.00
$ 10.00
$ 15.22
$ 15.44
1
1
1
1
1
1
1
1
1
1 $ 19.86
1 $ 19.86
1 $ 8.57
1 $ 15.45
1 $ 12.54
1 $ 5.68
1 $ 11.37
1 $ 22.32
1 $ 95.48
1 $ 43.25
1 $ 20.00
1 $ 13.23
1 $ 13.23
1 $ 15.44
1 $ 15.44
1 $ 13.50
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
$ 19.86
$ 19.86
$ 8.57
$ 15.45
$ 12.54
$ 5.68
$ 11.37
$ 22.32
$ 95.48
$ 43.25
$ 20.00
$ 13.23
$ 13.23
$ 15.44
$ 15.44
$ 13.50
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
100 $ 22.84
2 $ 980.50
8 $ 176.50
8 $ 38.23
250 $ 3.21
28 $ 7.01
150 $ 90.94
80 $ 3.12
80 $ 9.82
$ ‐
‐
100
2
8
8
250
28
150
80
80
‐
8 $ 176.50
8
$ 7.04
28
$ 3.12
$ 9.82
$ ‐
80
80
‐
80 $ 3.12 80
80 $ 9.82 80
60 $ ‐
‐
Page 26 of 29
$ 22.84
$ 980.50
$ 176.50
$ 38.23
$ 3.21
$ 7.04
$ 90.94
$ 3.12
$ 9.82
$ ‐
7/8/2016
Effective Date >013
HCPCS Code
J0894
J1050
J1453
J1459
J1561
J1568
J1569
J1572
J1745
J1756
J2310
J2315
J2323
J2353
J2916
J2997
J3357
J3489
J9000
J9041
J9047
J9179
J9201
J9306
J9315
Q2049
Q4081
S4993
V2100
V2215
V2600
V2610
V2615
V2784
Fee Schedule
HCPCS Code Description
Decitabine injection
Medroxyprogesterone acetate
Fosaprepitant injection
Inj IVIG privigen 500 mg
Gamunex‐C/Gammaked
Octagam injection
Gammagard liquid injection
Flebogamma injection
Infliximab injection
Iron sucrose injection
Inj naloxone hydrochloride
Inj, Naltrexone, Depot Form, 1mg
Natalizumab injection
Octreotide injection, depot
Na ferric gluconate complex
Alteplase recombinant
Ustekinumab injection
Injection, zoledronic acid
Doxorubicin HCL Injection
Bortezomib injection
Injection, carfilzomib
Eribulin mesylate injection
Gemcitabine hcl injection
Injection, pertuzumab
Romidepsin injection
Imported lipodox inj
Epoetin alfa, 100 units ESRD
Contraceptive pills for bc
Lens spher single plano 4.00
Lens lenticular bifocal
Hand held low vision aids
Single lens spectacle mount
Telescop/othr compound lens
Lens polycarb or equal
Oct 1, 2013
Jan 1, 2014
July 1, 2014
January 1, 2015
Reimbursement Reimbursement Reimbursement Reimbursement Amount
Amount
Amount
Amount
(per unit)
(per unit)
(per unit)
(per unit)
Max units
Max units
Max units
Max units
Max units
$ 20.00
80
600
3
2
2
1
1
1
2
$ 38.87
$ 0.98
$ 6.00
$ 5.00
$ 26.50
$ 150.00
$ 545.00
$ 835.00
$ 10.00
80
600
3
2
2
1
1
1
2
$ 38.87
$ 0.98
$ 6.00
$ 5.00
$ 26.50
$ 150.00
$ 545.00
$ 835.00
$ 10.00
Page 27 of 29
$ 34.54
192
$ 1.72
$ 36.60
$ 38.97
$ 31.57
$ 39.17
$ 35.95
$ 67.96
$ 0.34
$ 20.00
115
1
1
1
1
1
70
200
1
$ 13.08
$ 134.64
80
600
3
2
2
1
1
1
2
1
300
30
$ 34.54
$ 0.27
$ 1.72
$ 36.60
$ 38.97
$ 31.57
$ 39.17
$ 35.95
$ 67.96
$ 0.34
$ 20.00
$ 2.74
$ 13.08
$ 134.64
192
150
115
1
1
1
1
1
70
200
1
380
300
30
$ 38.87
80
$ 38.87
80
$ 105.42
$ 3.67
$ 45.33
$ 29.29
$ 97.92
$ 5.67
$ 10.21
$ 253.47
$ 498.26
$ 0.98
$ 6.00
$ 5.00
$ 26.50
$ 150.00
$ 545.00
$ 835.00
$ 10.00
5
15
35
56
20
13
840
30
8
600
3
2
2
1
1
1
2
$ 105.42
$ 3.67
$ 45.33
$ 29.29
$ 97.92
$ 5.67
$ 10.21
$ 253.47
$ 498.26
$ 0.98
$ 6.00
$ 5.00
$ 26.50
$ 150.00
$ 545.00
$ 835.00
$ 10.00
5
15
35
56
20
13
840
30
8
600
3
2
2
1
1
1
2
7/8/2016
APG Fee Schedule Procedures (onl
Revised for Jan 1, 2016 Updates:
Effective Date > HCPCS Code
59412
61885
64568
81025
86480
86580
86701
86702
86703
87806
87390
87391
90473
90655
90656
90657
90658
90660
90669
90732
99211
G0008
G0009
G0432
G0433
G0435
H0038
J0129
J0178
J0475
J0490
J0583
J0592
J0638
J0882
J0885
J0886
Fee Schedule
HCPCS Code Description
Ante‐partum manipulation
Insrt/redo neurostim 1 array
Inc for vagus n elect impl
Urine pregnancy test
Tb test cell immun measure
TB intradermal test
HIV‐1
HIV‐2
Hiv‐1/hiv‐2 single assay
Hiv antigen w/hiv antibodies
Hiv‐1 ag eia
Hiv‐2 ag eia
Immune admin oral/nasal
Flu vaccine no preserv 6‐35m
Flu vaccine no preserv 3 & >
Flu vaccine 3 yrs im
Flu vaccine 3 yrs & > im
Flu vaccine nasal
Pneumococcal vacc 7 val im
Pneumococcal vaccine
Office/outpatient visit est
Admin influenza virus vac
Admin pneumococcal vaccine
EIA HIV‐1/HIV‐2 screen
ELISA HIV‐1/HIV‐2 screen
Oral HIV‐1/HIV‐2 screen
Self‐help/peer services per 15 min
Abatacept injection
Aflibercept injection
Baclofen 10 MG injection
Belimumab injection
Bivalirudin
Buprenorphine hydrochloride
Canakinumab injection
Darbepoetin alfa, esrd use
Epoetin alfa, non‐esrd
Epoetin alfa 1000 units ESRD
July 1, 2015
Jan 1, 2016
Reimbursement Reimbursement Amount
Amount
(per unit)
(per unit)
Max units
Max units
$ 35.00
$ 11,794.40
$ 19,630.40
$ 3.19
$ 69.78
$ 5.00
$ 10.00
$ 15.22
$ 15.44
1
1
1
1
1
1
1
1
1
$ 19.86
$ 19.86
$ 8.57
$ 15.45
$ 12.54
$ 5.68
$ 11.37
$ 22.32
$ 95.48
$ 43.25
$ 20.00
$ 13.23
$ 13.23
$ 15.44
$ 15.44
$ 13.50
$ 13.05
$ 22.84
$ 980.50
$ 176.50
$ 38.23
$ 3.21
$ 7.01
$ 90.94
$ 3.12
$ 9.82
$ ‐
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
4
100
2
8
8
250
28
150
80
80
‐
Page 28 of 29
$ 35.00
$ 11,794.40
$ 19,630.40
$ 3.19
$ 69.78
$ 5.00
$ 10.00
$ 15.22
$ 15.44
$ 18.49
$ 19.86
$ 19.86
$ 8.57
$ 15.45
$ 12.54
$ 5.68
$ 11.37
$ 22.32
$ 95.48
$ 43.25
$ 20.00
$ 13.23
$ 13.23
$ 15.44
$ 15.44
$ 13.50
$ 13.05
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
4
$ 35.81
$ 980.50
$ 164.08
$ 40.54
$ 3.21
$ 7.01
100
4
8
114
975
28
$ 91.49
$ 4.06
$ 12.14
$ ‐
300
86
69
‐
7/8/2016
Effective Date > HCPCS Code
J0894
J1050
J1453
J1459
J1561
J1568
J1569
J1572
J1745
J1756
J2310
J2315
J2323
J2353
J2916
J2997
J3357
J3489
J9000
J9041
J9047
J9179
J9201
J9306
J9315
Q2049
Q4081
S4993
V2100
V2215
V2600
V2610
V2615
V2784
Fee Schedule
HCPCS Code Description
Decitabine injection
Medroxyprogesterone acetate
Fosaprepitant injection
Inj IVIG privigen 500 mg
Gamunex‐C/Gammaked
Octagam injection
Gammagard liquid injection
Flebogamma injection
Infliximab injection
Iron sucrose injection
Inj naloxone hydrochloride
Inj, Naltrexone, Depot Form, 1mg
Natalizumab injection
Octreotide injection, depot
Na ferric gluconate complex
Alteplase recombinant
Ustekinumab injection
Injection, zoledronic acid
Doxorubicin HCL Injection
Bortezomib injection
Injection, carfilzomib
Eribulin mesylate injection
Gemcitabine hcl injection
Injection, pertuzumab
Romidepsin injection
Imported lipodox inj
Epoetin alfa, 100 units ESRD
Contraceptive pills for bc
Lens spher single plano 4.00
Lens lenticular bifocal
Hand held low vision aids
Single lens spectacle mount
Telescop/othr compound lens
Lens polycarb or equal
July 1, 2015
Jan 1, 2016
Reimbursement Reimbursement Amount
Amount
(per unit)
(per unit)
Max units
Max units
$ 34.54
$ 0.27
$ 1.72
$ 36.60
$ 38.97
$ 31.57
$ 39.17
$ 35.95
$ 67.96
$ 0.34
$ 20.00
$ 2.74
$ 13.08
$ 134.64
$ 2.56
$ 38.87
$ 163.47
$ 105.42
$ 3.67
$ 45.33
$ 29.29
$ 97.92
$ 5.67
$ 10.21
$ 253.47
$ 498.26
$ 0.98
$ 6.00
$ 5.00
$ 26.50
$ 150.00
$ 545.00
$ 835.00
$ 10.00
Page 29 of 29
192
150
115
1
1
600
600
1
70
200
1
380
300
30
10
80
90
5
15
35
56
20
13
840
30
8
600
3
2
2
1
1
1
2
$ 24.29
$ 0.32
$ 1.73
$ 38.28
$ 39.80
$ 38.66
$ 38.78
$ 34.75
$ 76.89
$ 0.27
$ 20.00
257
150
115
456
456
456
545
137
114
400
1
$ 3.18
380
$ 16.40
300
$ 156.48
40
$ 2.63
10
$ 73.05
100
$ 164.51
90
$ 32.24
4
$ ‐
‐
$ 46.75
25
‐
$ ‐
$ 101.93
27
$ 8.20
12
$ 10.22
840
$ 290.02
27
‐
$ ‐
$ 0.98 600
$ 6.00 3
$ 5.00 2
$ 26.50 2
$ 150.00 1
$ 545.00 1
$ 835.00 1
$ 10.00 2