18 CRR-NY 533.6NY-CRR
18 CRR-NY 533.6
18 CRR-NY 533.6
533.6 Radiology.
(a) Maximum payment for radiology services.
The department will pay providers of radiology services according to the radiology fees listed in the Radiology Fee Schedule in subdivision (f) of this section. Unless otherwise indicated, these fees are full payment for the radiology service provided.
(b) Radiology fee components.
The fees listed in the Radiology Fee Schedule include payment for the professional component and for the technical and administrative component of radiology services.
(1) Professional component.
(i) The professional component of radiology services refers to the various professional services performed by physicians, including:
(a) determining the patient's problem, including interviewing the patient, obtaining the patient's medical history, and physically examining the patient to decide how to perform radiology procedures;
(b) studying the results of diagnostic or therapeutic procedures, interpreting X-rays or radioisotope data and estimating treatment results;
(c) dictating examination or treatment reports; and
(d) Consulting with and furnishing written reports to referring physicians regarding the results of diagnostic or therapeutic procedures.
(ii) Physicians who render these services in hospitals are paid 40 percent of the appropriate fee listed in the Radiology Fee Schedule. The remaining 60 percent is applied to the technical and administrative component described in paragraph (2) of this subdivision.
(iii) Payments may be made only to physicians meeting the requirements of section 505.17 of this Title. Only physicians who are not paid by a hospital for patient care and who bill separately from a hospital may be paid under this section.
(2) Technical and administrative component of radiology services.
(i) The technical and administrative component of radiology services refers to the various services provided to the physician by the hospital, including the following:
(a) use of hospital personnel, such as technologists and clerical staff;
(b) use of hospital supplies such as film, opaques, radioactive substances, chemicals and drugs; and
(c) purchase, rental or maintenance of space, equipment, telephones or other facilities or supplies.
(ii) Sixty percent of the fee listed in the Radiology Fee Schedule is applicable to these technical and administrative services provided by the hospital.
(3) Procedures not separable into professional and technical and administrative components.
Injections of radiopaque media, fluoroscopy and consultations must be performed by the physician. Consequently, these procedures are not separated for billing into professional and technical and administrative components, and the total fee listed in the Radiology Fee Schedule for such services is paid to the physician.
(c) General rules.
These rules apply to all procedure codes found in the Radiology Fee Schedule.
(1) What is included in radiology fees. Fees listed in the Radiology Fee Schedule include the following:
(i) the usual contrast media, equipment and materials. When the physician supplies special surgical trays or materials, an additional charge may be claimed from the department;
(ii) consultation with and written reports provided to the referring physician; and
(iii) payment for injection procedures, such as local anesthesia, needle or catheter placement or injection of contrast media as provided in the Radiology Fee Schedule, except for injection procedures which are identified by an asterisk before the MMIS code in the Radiology Fee Schedule.
(2) Payment for multiple or repeat radiology procedures.
(i) When more than one radiology procedure is performed on different parts of the body during the same visit, the total payment is the sum of the fee for the more costly procedure plus 60 percent of the fee for the less costly procedure.
(ii) When a single radiology procedure is performed which shows more than one part of the body, payment will be made for only one procedure.
(iii) When repeat radiology procedures are performed on the same part of the body and for the same illness, payment for the repeat procedures will be made according to the fee listed in the Radiology Fee Schedule. However, no payment will be made for repeat procedures on the same part of the body and for the same illness when the reason for the repeat procedure is technical or professional error in the original procedure.
(d) Outpatient and clinic services.
No additional payment will be made for outpatient emergency and clinic services if the cost of providing radiology or radiotherapy services is included in the maximum reimbursement rate promulgated for the hospital by the Director of the Budget pursuant to section 2807 of the Public Health Law. When physicians refer patients for outpatient radiology or radiotherapy services, payment will be made according to the Radiology Fee Schedule except when radiology or radiotherapy services are provided in a facility that includes the cost of these services in its clinic rate calculation. In these cases, the recipient shall be registered as a clinic patient and the clinic rate shall be billed.
(e) Medicaid management information system (MMIS) modifiers.
Each radiology procedure listed in the Radiology Fee Schedule is preceded by a five-digit number identifying the specific procedure for which payment is claimed. Known as the MMIS procedure code, this number sometimes must be expanded by two additional digits, or modifiers, to describe more completely the particular procedure involved. The modifiers used in radiology are described below:
(1) ‘-60’ Professional component.
When physicians provide radiology services in hospitals but are not paid for these services by the hospitals, the physicians' services are identified for billing purposes by adding the modifier ‘-60’ to the MMIS procedure code.
(2) ‘-61’ Technical and administrative component.
When physicians provide radiology services in hospitals but are not paid for these services by the hospitals, the services, facilities and supplies furnished to the physicians by the hospitals are identified for billing purposes by adding the modifier ‘-61’ to the MMIS procedure code.
(3) ‘-62’ Multiple radiology procedures.
When more than one radiology procedure is performed on different parts of the body during the same visit, the more costly procedure is identified for billing purposes by its MMIS procedure code and the less costly procedure is identified by adding the modifier ‘ -62’ to its MMIS procedure code.
(4) ‘-65’ Multiple vascular radiology procedures.
When more than one vascular radiology procedure is performed at the same time, the more costly procedure is identified for billing purposes by its MMIS procedure code and the less costly procedure is identified by adding the modifier ‘-65’ to its MMIS procedure code.
(5) ‘-66’ Repeal radiology procedures.
When radiology procedures are repeated for reasons other than technical or professional error in the original procedure, the repeat procedure is identified for billing purposes by adding the modifier ‘-66’ to the MMIS procedure code.
(6) ‘-19’ Multiple modifiers.
More than one modifier often may be needed to identify radiology procedures for which payment is sought. Add the modifier ‘-19’ to the MMIS procedure code and list the applicable modifiers in the procedure description.
(f) Radiology Fee Schedule.
Listed below are the maximum medical assistance reimbursement fees for radiology procedures. A fee includes payment for injection procedures only if the MMIS code is not preceded by an asterisk. To be reimbursed for a procedure whose fee is to be determined “By Report” (BR), providers must submit information to MMIS on the nature and extent of the radiology procedure performed, the need for the procedure, and the time, skill and equipment necessary to perform the procedure. Reports, procedure descriptions or itemized invoices should accompany “BR” claims for reimbursement. Interim MMIS procedure codes are denoted by parentheses enclosing the fees. These procedure codes may be used pending final approval and promulgation by the Director of the Budget.
(1) X-ray, diagnostic.
| MMIS Code | Maximum Fee | |
|---|---|---|
| 70001 | Unlisted radiology procedure | BR |
| HEAD AND NECK | ||
| *70002 | Pneumoencephalography or positive contrast encephalography | $75.00* |
| 70003 | including injection procedure | 110.00 |
| *70020 | Ventriculography | 50.00* |
| 70030 | Eye, for foreign body | 20.00 |
| 70040 | for localization of foreign body (70030 not included) | 30.00 |
| 70050 | Combined 70030 and 70040 | 40.00 |
| 70100 | Mandible, partial, less than four views | 15.00 |
| 70110 | complete, minimum of four views | 25.00 |
| 70120 | Mastoids, less than three views per side | 15.00 |
| 70130 | complete study, minimum three views per side | 25.00 |
| 70140 | Facial bones, less than three views | 15.00 |
| 70150 | complete, minimum three views | 25.00 |
| 70160 | Nasal bones | 15.00 |
| *70172 | Nasolacrimal duct (dacryocystography) | 20.00* |
| 70171 | including injection procedure | 30.00 |
| 70190 | Optic foramina | 15.00 |
| 70200 | Orbits, complete, minimum four views | 25.00 |
| 70210 | Paranasal sinuses, less than three views | 12.50 |
| 70231 | complete study, minimum of three views | 20.00 |
| 70240 | Sella turcica | 12.50 |
| 70250 | Skull, less than four views with or without stereo | 15.00 |
| 70260 | complete study, minimum of four views, with or without stereo | 25.00 |
| 70300 | Teeth, single view | 5.00 |
| 70310 | partial examination, less than full mouth | 10.00 |
| 70320 | complete examination, full mouth | 15.00 |
| 70328 | Temporomandibular joint, open and closed, unilateral | 12.50 |
| 70330 | bilateral | 20.00 |
| 70350 | Cephalogram (orthodontic) | 7.50 |
| 70360 | Neck for soft tissues | 10.00 |
| 70370 | Pharynx or larynx, including fluoroscopy | 25.00 |
| 70380 | Salivary gland for calculus | 15.00 |
| *70390 | Sialography | 20.00* |
| 70391 | including injection procedure | 25.00 |
| 70374 | Laryngogram | 25.00 |
| 70134 | Internal auditory meati | (25.00) |
| CHEST | ||
| 71000 | Chest, "minifilm" | $ 4.00 |
| 71010 | Chest, single view | 10.00 |
| 71020 | two views | 15.00 |
| 71023 | three views | (17.50) |
| 71034 | complete, minimum of four views, including fluoroscopy where indicated | 20.00 |
| 76001 | Fluoroscopy, (independent procedure) | 10.00 |
| *71040 | Bronchography, unilateral | 35.00* |
| 71041 | including injection procedure | 50.00 |
| *71060 | bilateral | 40.00* |
| 71061 | including injection procedure | 55.00 |
| 71100 | Ribs, unilateral | 15.00 |
| 71110 | bilateral | 25.00 |
| 71120 | Sternum | 15.00 |
| 71130 | Sternoclavicular joints, minimum of three views | 20.00 |
| SPINE AND PELVIS | ||
| 72010 | Spine, entire, survey study (A-P and lateral) | 40.00 |
| 72040 | cervical, A-P and lateral | 15.00 |
| 72050 | cervical, minimum of four views | 20.00 |
| 72052 | cervical, complete, including flexion and extension studies | 30.00 |
| 72070 | thoracic, minimum of two views | 15.00 |
| 72080 | thoraco-lumbar, A-P and lateral | 15.00 |
| 72100 | lumbo-sacral, A-P and lateral | 15.00 |
| 72110 | complete lumbo-sacral, minimum five views | 30.00 |
| 72120 | lumbo-sacral, bending views | 20.00 |
| 72170 | Pelvis, A-P only | 12.50 |
| 72180 | stereo | 15.00 |
| 72190 | complete, minimum of three views (for Pelvimetry, see 74710) | 20.00 |
| 72200 | sacroiliac studies, A-P only (For complete, see 72190) | 12.50 |
| 72220 | sacrum and coccyx | 15.00 |
| *72265 | Myelography, lumbar or any other single level | 40.00* |
| 72266 | including injection procedure | 80.00 |
| *72270 | Myelography, complete spinal canal | 60.00* |
| 72271 | including injection procedure | 100.00 |
| *72295 | Discography, lumbar or cervical | 50.00* |
| 72296 | including injection procedure | 90.00 |
| UPPER EXTREMITIES | ||
| 73000 | Clavicle | 10.00 |
| 73010 | Scapula | 15.00 |
| 73020 | Shoulder, one projection | 10.00 |
| 73030 | complete study | 15.00 |
| 73050 | Acromio-clavicular joints, bilateral, with or without weighted distraction | 17.50 |
| 73060 | Humerus, including one joint | 10.00 |
| 73070 | Elbow, A-P and lateral | 10.00 |
| 73080 | complete, minimum three views | 12.50 |
| 73090 | Forearm, including one joint | 10.00 |
| 73100 | Wrist, A-P and lateral | 10.00 |
| 73110 | complete study, minimum three views | 12.50 |
| 73120 | Hand | 10.00 |
| 73140 | Fingers | 7.50 |
| LOWER EXTREMITIES | ||
| 73500 | Hip, one view | 12.50 |
| 73510 | complete study | 20.00 |
| 73530 | during operative procedure, up to four studies | 30.00 |
| 73531 | each additional study over four | 7.50 |
| 73540 | Hips and pelvis, infant and child, two views | 15.00 |
| 73550 | Femur, (thigh) including one joint | 15.00 |
| 73560 | Knee, two views | 10.00 |
| 73570 | complete study, minimum three views | 15.00 |
| 73590 | Tibia and fibula (leg) including one joint | 10.00 |
| 73600 | Ankle, two views | 10.00 |
| 73610 | complete study, minimum three views | 12.50 |
| 73620 | Foot, two views | 10.00 |
| 73640 | complete routine study, minimum three views | 12.50 |
| 73631 | complete including special os calcis views | 20.00 |
| 73650 | Os calcis (heel), minimum two views | 10.00 |
| 73660 | Toes | 7.50 |
| ABDOMEN | ||
| 74000 | Abdomen, single A-P | 10.00 |
| 74020 | complete study, minimum of three views | 20.00 |
GASTROINTESTINAL TRACT
| MMIS Code | Maximum Fee | |
|---|---|---|
| All X-ray studies included in fee codes 74220 to 74280 that include examinations of upper or lower gastrointestinal tract shall include fluoroscopic examination as an integral part of the study. All gallbladder series require erect and/or decubitus views necessary to determine the presence or absence of pathology. | ||
| 74220 | Esophagus, must include fluoroscopy | $ 20.00 |
| 74240 | Upper gastrointestinal tract, with or without delayed films, must include fluoroscopy | 30.00 |
| 74241 | with K.U.B., must include fluoroscopy | 35.00 |
| 74245 | with small bowel, includes multiple serial films, must include fluoroscopy | 40.00 |
| 74250 | Small bowel, includes multiple serial films, with or without K.U.B., must include fluoroscopy | 30.00 |
| 74270 | Colon, barium enema, must include fluoroscopy | 25.00 |
| 74275 | barium enema and air contrast, must include fluoroscopy | 40.00 |
| 74280 | air contrast only, minimum six views, must include fluoroscopy | 30.00 |
| 74290 | Cholecystography, oral dye | 20.00 |
| 74300 | Cholangiography, operative | 30.00 |
| 74305 | post-operative | 22.50 |
| 74310 | intravenous | 37.50 |
| 74315 | oral dye | 30.00 |
| *74320 | percutaneous, transhepatic | 25.00* |
| 74321 | including injection procedure | 70.00 |
| 74322 | Transduodenal cholangiography | 30.00 |
| UROLOGICAL | ||
| 74401 | Kidney, ureter and bladder (K.U.B.) single view | 10.00 |
| 74402 | multiple views | 15.00 |
| 74400 | Urography, intravenous, including K.U.B. | 35.00 |
| 74405 | including special hypertensive dye concentration and clearance studies ("renal washout") | 50.00 |
| *74420 | retrograde, including K.U.B. | 25.00* |
| *74430 | Cystography, minimum three views | 20.00* |
| 74431 | including injection procedure | 25.00 |
| 74451 | Urethrocystography, retrograde | 20.00 |
| 74456 | voiding | 35.00 |
| 74415 | Aorto-nephrotomography, intravenous | 75.00 |
| *74460 | Retroperitoneal pneumography | 25.00* |
| 74461 | including injection procedure | 45.00 |
| *74470 | Translumbar renal cyst study (contrast visualization) or antegrade urography | 20.00* |
| 74471 | including injection procedure | 40.00 |
| 74425 | Loopagram, minimum three views | 20.00 |
| 74426 | Loopagram, including injection procedure | 25.00 |
| GYNECOLOGICAL AND OBSTETRICAL | ||
| For abdomen and pelvis, see 72170-72190, 74000, 74020) | ||
| 74710 | Pelvimetry, with or without cephalometry or placental localization | 25.00 |
| 74720 | Placental localization | 20.00 |
| *74740 | Hysterosalpingography | 25.00* |
| 74741 | including injection procedure | 35.00 |
| *74760 | Pelvic pneumography | 25.00* |
| 74761 | including injection procedure | 40.00 |
| MISCELLANEOUS STUDIES | ||
| 76000 | Fluoroscopy (independent procedure) | 10.00 |
| 76125 | Cine Radiology, as part of other radiological procedures except when otherwise included | 20.00 |
| 74427 | Pyelogram intravenous drip infusion (includes injection) | 45.00 |
| 76020 | Bone age studies | 15.00 |
| 76040 | Bone length studies (orthoroentgenogram) | 25.00 |
| 76061 | one survey (long bone or for metastasis) | 35.00 |
| *73527 | Arthrography, contrast, three views or less | 15.00* |
| 73524 | including injection procedure by same physician | 25.00 |
| *73528 | minimum of four views | 25.00* |
| 73529 | including injection procedure by same physician | 35.00 |
| 76350 | Kymograpy | 25.00 |
| 76080 | Fistula or sinus tract study | 15.00* |
| 76081 | including injection procedure | 20.00 |
| 76090 | Mammography, unilateral | 20.00 |
| 76091 | bilateral | 30.00 |
| 76100 | Body section radiography (tomography, planigraphy, etc.) (For more complex studies, an additional value may be warranted.) | 30.00 |
| 75525 | Cardiac Oesophagogram | 25.00 |
| 76300 | Thermography (Breast) uilateral | 20.00 |
| 76351 | Thermography (Breast), bilateral | 30.00 |
| 76140 | Consultation on X-ray examination made elsewhere (This value does not necessarily include consultation involving litigation.) | 15.00 |
| 76141 | Examination in home, additional charge | (20.00) |
| VASCULAR SYSTEM | ||
| *75505 | Angiocardiography, single projection | 100.00* |
| *75507 | additional projection | 25.00* |
| 75510 | by CO 2injection for auricular wall measurement | 50.00 |
| *75600 | Aortography, thoracic or lumbar | 50.00* |
| *75610 | including lower extremities | 75.00* |
| *75660 | Angiography, cerebral, unilateral | 90.00* |
| *75662 | bilateral | 125.00* |
| 75656 | Angiography, 4 Vessel Cerebral (carotid and vertebral) | 200.00 |
| *75710 | extremity, unilateral | 35.00* |
| *75729 | arch, renal or splanchnic vessels | 50.00* |
| *75752 | coronary (Sonne's or comparable technique) | 100.00* |
| *75746 | pulmonary (intravenous) | 50.00* |
| *75809 | Lymphangiography, unilateral or bilateral | 50.00* |
| *75810 | Splenoportography | 40.00* |
| 74331 | Pancreatography | 40.00 |
| *75824 | Venography, extremity or caval | 40.00* |
| *75850 | intraosseus | 40.00* |
| (2)Radiotherapy. Radiotherapy fees include one year follow-up care for treatment of malignancies and 60-day follow-up care for treatment of nonmalignancies. Fees also include office visits during which radiotherapy is provided. However, radiotherapy fees do not include payment for surgical, radiology or laboratory procedures performed with the radiotherapy service. | ||
CONSULTATIONS
| MMIS Code | Maximum Fee | |
|---|---|---|
| 90611 | Initial consultation, Office | 24.00 |
| 90601 | Subsequent consultation (when required to complete diagnosis), office | 18.00 |
| 90612 | Initial consultation, other than office | 20.00 |
| 90602 | Subsequent consultation (when required to complete diagnosis), other than office | 15.00 |
PER TREATMENT SCHEDULE SUPERFICIAL GRENZ OR LOW VOLTAGE X-RAY THERAPY:
| MMIS Code | Maximum Fee | |
|---|---|---|
| 74401 | Dermatoses (3 fields or less), per treatment | 7.50 |
| 77402 | more than 3 fields | 10.00 |
| 77403 | Benign tumors, per treatment | 10.00 |
| 77404 | Malignant lesions, per treatment | 15.00 |
| ORTHOVOLTAGE (150-500 KVP): | ||
| 77466 | Benign lesions, per treatment | 10.00 |
| 77467 | Malignant lesions, per treatment | 15.00 |
| SUPERVOLTAGES, 1 MILLION VOLTS AND HIGHER: (BETATRON, LINEAR ACCELERATOR, COBALT, ETC.) | ||
| 77411 | Per treatment | 20.00 |
(3) Radium and radioisotopes (Nuclear medicine). (For consultation, dosage calculation and preparation, see 90611, 90601, 90612.)
| MMIS Code | Maximum Fee | |
|---|---|---|
| 77276 | Basic value for placement of radioactive material (add cost of radioactive material-see 99070) | 75.00 |
| 77770 | Interstitial application of radium or radioisotope | BR |
| 77760 | Application of radium or radioisotope plaque or mold for malignant lesion | BR |
| 77786 | Application of Thorium X or similar liquid radioactive material, includes office visit (add cost of radioactive material-see 99070) | 7.50 |
| 77787 | Surface application of sealed radioactive sources to benign lesions, including radioactive source, single application | 15.00 |
| 99070 | Cost of materials | BR |
| THERAPEUTIC | ||
| (Radioactive drugs not included, preliminary and follow-up diagnostic tests not included.) | ||
| 79000 | Hyperthyrodidism, , initial | 100.00 |
| 79001 | subsequent, each | 50.00 |
| 79025 | Thyroid suppression, initial | 100.00 |
| 79026 | subsequent, each | 50.00 |
| 79030 | Thyroid carcinoma | BR |
| 79100 | Polycythemia vera, chronic leukemia, etc., per treatment | 30.00 |
| 79400 | Metastic bone or other carcinoma, per treatment | 30.00 |
| 79200 | Inter-cavitary radioactive colloid therapy | 45.00 |
| 79300 | Interstitial radioactive colloid therapy | 150.00 |
| 90792 | Perfusion for malignant disease | 3.00 |
| DIAGNOSTIC | ||
| (Radioactive drugs not included) | ||
| 78000 | Radio-iodine uptake, single determination | 15.00 |
| 78001 | multiple determination (as 6 and 24 hours etc.) | 20.00 |
| 78006 | with scan | 40.00 |
| 78010 | Thyroid scanning only | 25.00 |
| 78003 | Thyroid stimulation or suppression test (including 2 uptakes) (THS or other drugs not included) | 25.00 |
| 78005 | Radioactive study, thyroid washout (thiocyanate, perchlorate or other drugs not included) | (20.00) |
| 78072 | Thyroid carcinoma metastases, imaging, neck and chest only | (45.00) |
| 76360 | Protein bound radio-iodine plasma, or conversion ratio | 15.00 |
| 76370 | Protein bound radio-iodine plasma, or conversion ratio (with uptake) | 25.00 |
| 76352 | Radio-tri-iodo-thyronine (in vitro) uptake | 10.00 |
| CIRCULATION AND BLOOD STUDIES | ||
| 78271 | Vitamin B-12 absorption study (e.g., Schilling Test); with intrinsic factor | 30.00 |
| 78270 | without intrinsic factor | 25.00 |
| 78272 | combined, with and without intrinsic factor | 50.00 |
| 78110 | Blood or plasma volume (e.g., radio-iodinated HSA) | 20.00 |
| 78120 | Red cell mass determination | 30.00 |
| 78130 | Red cell survival (e.g., radio-chromate) | 50.00 |
| 78135 | Red cell survival plus splenic (and/or hepatic) function study | 75.00 |
| 78280 | Gastrointestinal blood loss study | 40.00 |
| 78160 | Plasma radio-iron turnover rate | 30.00 |
| 78170 | Radio-iron red cell utilization and body distribution | 50.00 |
| 78470 | Cardiac output (e.g., radio-iodinated HSA) | 30.00 |
| 78408 | Circulation time (e.g., radio-iodinated HSA) | 30.00 |
| 78034 | Cardiac dynamic flow study | (30.00) |
| 78490 | Tissue clearance studies | 25.00 |
| 78491 | Carotid/cerebral flow study | (40.00) |
| MISCELLANEOUS | ||
| 78222 | Liver function (e.g., radio-iodinated rose bengal) | 30.00 |
| 78226 | Cholescintingraphy | (60.00) |
| 78724 | Renal function(e.g., radio-iodinated hippurate sodium) | 30.00 |
| 78721 | Renogram (Isotope Study/Renal Image Flow) | 85.00 |
| 78288 | Gastrointestinal absorption study with radioactive fat, first phase | 30.00 |
| 78289 | second phase | 20.00 |
| 78282 | Gastrointestinal protein loss (e.g., I-131, P.V.P.) | 30.00 |
| 78081 | Xenon washout | (80.00) |
| 78195 | Lymphatics and lymph glands imaging | (40.00) |
| 78405 | Myocardium, imaging | (60.00) |
| LOCALIZATION AND SCANNING | ||
| 78080 | Bone marrow scan | (45.00) |
| 78803 | Bone tumor | 60.00 |
| 78804 | positron method or complex instrumentation | BR |
| 78054 | Joint scan | (40.00) |
| 78620 | Brain tumor | 60.00 |
| 78606 | positron method or complex instrumentation | BR |
| 78201 | Liver scintiscan | 40.00 |
| 78223 | Liver function with scanning | 60.00 |
| 78850 | Total body or multiple area scanning for metastic carcinoma | 60.00 |
| 78655 | Ocular tumor | 35.00 |
| 78079 | Lacrimal scan | (20.00) |
| 78404 | Cardiac scan | 60.00 |
| 78240 | Pancreas (e.g., Selenium-75) | 40.00 |
| 78070 | Parathyroid scan | 60.00 |
| 78775 | Placental (e.g., RISA) | 25.00 |
| 78185 | Spleen scan | 60.00 |
| 78707 | Renal uptake and scintiscan (e.g., Mercury 203 or 197) | 40.00 |
| 78582 | Lung scan | 60.00 |
| 78607 | Brain scan | 60.00 |
| 70017 | Gamma Cisternogram | 75.00 |
| 78805 | Gallium scan | 60.00 |
| 78290 | Intestinal scan | 40.00 |
| 78230 | Salivary gland(s) scan | 35.00 |
| 78403 | MUGA Scan, cardiac blood pool imaging, with determination of regional ventricular function including ejection fraction and wall motion (e.g., gated blood pool images) | 150.00 |
| 78407 | Cardiac blood pool scan | 40.00 |
| 76155 | Scrotal scan | (40.00) |
(4) Diagnostic ultrasound.
Note:
A-Mode: Implies a one-dimensional ultrasonic measurement procedure.
M-Mode: Implies a one-dimensional ultrasonic measurement procedure with movements of the trace to record amplitude and velocity of moving echo producing structures.
B-Scan: Implies a two-dimensional ultrasonic scanning procedure with a two-dimensional display.
HEAD AND NECK
| MMIS Code | Maximum Fee | |
|---|---|---|
| 76500 | Echoencephalography, Diencephalic Midine (A-Mode) | 20.00 |
| 76505 | Echoencephalography, Complete (Diencephalic Midline and Ventricular Size) (A-Mode) | 30.00 |
| 76516 | Opthalmic Echography (A-Mode) | 40.00 |
| 76517 | Ophthalmic Sonography (contact B-Scan) | 60.00 |
| 76529 | Parotid gland Sonography (B-Mode) | (20.00) |
| 76531 | Soft tissue/neck mass Sonography (B-Scan) | (30.00) |
| 76530 | Thyroid Echography (B-Scan) | 20.00 |
| 76536 | Thyroid Sonography (B-Scan) | 30.00 |
| 76550 | Noninvasive studies carotid artery, B-scan, Doppler | (67.50) |
| HEART | ||
| 76630 | Echocardiagraphy, Pericardial Effusion (M-Mode) | 25.00 |
| 76635 | Echocardiography, Cardiac Valve(s) (M-Mode) | 30.00 |
| 76620 | Echocardiography, Complete (76630 and 76635 combined and chamber dimensions) (M-Mode) | 40.00 |
| 76628 | Echocardiography, limited (e.g., follow-up or limited study) (M-mode) | 20.00 |
| 76621 | Echocardiography, Two-dimensional | (60.00) |
| 76622 | Echocardiography, Two-dimensional and M-Mode | (90.00) |
| 76931 | Pericardiocentesis, by Ultrasonic Guidance (B-Mode, real time) | (BR) |
| 76636 | Doppler Echocardiography, Including 2-D Echocardiography | (87.00) |
| THORAX | ||
| 76935 | Thoracentesis, by Ultrasonic Guidance | (BR) |
| 76631 | Pleural Effusion Echography (B-scan or real time) | 25.00 |
| 76633 | Diaphragm Sonography (B-Scan) | (20.00) |
| 76640 | Breast Echography (B-Scan, real time) | 25.00 |
| 76645 | Breast Sonography (B-Scan) | 50.00 |
| 76632 | Mediastinum Mass Sonography (B-Scan, real time) | (30.00) |
| ABDOMEN AND RETROPERITONEUM | ||
| 76700 | Abdominal Sonography, Complete Survey Study (B-Scan) | 60.00 |
| 76705 | Abdominal Sonography, Limited (e.g., follow-up or limited study) (B-Scan) | 40.00 |
| 76706 | Hepatic Sonography (B-Scan) | 60.00 |
| 76707 | Gallbladder Sonography (B-Scan) | 60.00 |
| 76775 | Adrenal Gland Sonography (B-Scan) | (70.00) |
| 76776 | Renal Sonography (B-Scan) | 60.00 |
| 76940 | Renal cyst aspiration, by Ultrasonic Guidance (B-Scan, real time) | (BR) |
| 76944 | Renal biopsy, by Ultrasonic Guidance (B-Scan real time) | (BR) |
| 76710 | Pancreas Sonography (B-Scan) | 60.00 |
| 76720 | Spleen Sonography (B-Scan) | 60.00 |
| 76730 | Abdominal Aorta Echography (B-Mode, real time) | 25.00 |
| 76735 | Abdominal Aorta Sonography (B-Scan) | 55.00 |
| 76780 | Retroperitoneal Sonography (B-Scan) | 60.00 |
| 76801 | Urinary bladder Sonography (B-Scan) | 40.00 |
| 76803 | Prostate Sonography (B-Scan) | (30.00) |
| 76150 | Scrotal Sonography (B-Scan) | (30.00) |
| OBSTETRICS, GYNECOLOGY AND PELVIS | ||
| 76816 | Pregnancy Diagnosis Sonography (B-Scan) | 30.00 |
| 76817 | Fetal Age Determination (Biparietal Diameter) Sonography (B-Scan) and/or femur length, total intrauterine volume-TIUV and abdominal measurements | 35.00 |
| 76815 | Fetal Growth Rate (series of 76817) Sonography (B-Scan) | 25.00 |
| 76818 | Placental Localization Sonography (B-Scan) | 40.00 |
| 76820 | Pregnancy Sonography, Complete (76816; 76817; 76818 combined) (B-Scan) | 55.00 |
| 76830 | Molar Pregnancy Diagnosis Sonography (B-Scan) | 40.00 |
| 76840 | Ectopic Pregnancy Diagnosis Sonography (B-Scan) | 60.00 |
| 76947 | Amniocentesis, by Ultrasonic guidance (B-Scan, real time) | (BR) |
| 76841 | Intrauterine Contraceptive Device Sonography (B-Scan) | 40.00 |
| 76856 | Pelvic Mass Diagnosis Sonography (B-Scan) | 55.00 |
| PERIPHERAL VASCULAR SYSTEM | ||
| 76900 | Arterial Flow Study, peripheral (Doppler) | 45.00 |
| 76922 | Venous Flow Study, peripheral (Doppler) | (45.00) |
| MISCELLANEOUS | ||
| 76901 | Knee Sonography (B-Scan) | (30.00) |
| 76499 | Ultrasonic planning of radiation field (B-Scan) | (35.00) |
| (5) Computerized tomography scans. The fees for CT Scans with enhancement include the cost of all tomograph scans of the same anatomical site performed at the same session prior to the administration of contrast material. | ||
CT SCANS HEAD
| MMIS Code | Maximum Fee | |
|---|---|---|
| 76101 | CT Scan, head only, multiple views, without enhancement; professional, administrative and technical components | (120.00) |
| 76102 | CT Scan, head only, multiple views, with enhancement; professional, administrative and technical components | (145.00) |
| 76103 | CT Scan, head only, multiple views, without enhancement; administrative and technical components | (90.00) |
| 76104 | CT Scan, head only, multiple views, without enhancement; professional component | (30.00) |
| 76105 | CT Scan, head only, multiple views, with enhancement; administrative and technical components | (110.00) |
| 76106 | CT Scan, head only, multiple views, with enhancement; professional component | (35.00) |
| CT SCANS BODY | ||
| 76107 | Body CT Scan, multiple views performed to investigate a specific anatomical region at the direction of an approved prescriber, without enhancement; includes administrative, technical and professional components | (140.00) |
| 76108 | Body CT Scan, multiple views performed to investigate a specific anatomical region at the direction of an approved prescriber, without enhancement; includes administrative and technical components | (105.00) |
| 76109 | Body CT Scan, multiple views performed to investigate a specific anatomical region at the direction of an approved prescriber, without enhancement; professional component | (35.00) |
| 76110 | Body CT Scan, multiple views performed to investigate a specific anatomical region at the direction of an approved prescriber, with enhancement; professional, administrative and technical components | (170.00) |
| 76111 | Body CT Scan, multiple views performed to investigate a specific anatomical region at the direction of an approved prescriber, with enhancement; includes administrative and technical components | (130.00) |
| 76112 | Body CT Scan, multiple views performed to investigate a specific anatomical region at the direction of an approved prescriber, with enhancement; professional component | (40.00) |
18 CRR-NY 533.6
Current through July 31, 2021
| End of Document |
IMPORTANT NOTE REGARDING CONTENT CURRENCY: The "Current through" date indicated immediately above is the date of the most recently produced official NYCRR supplement covering this rule section. For later updates to this section, if any, please: consult editions of the NYS Register published after this date; or contact the NYS Department of State Division of Administrative Rules at [email protected]. See Help for additional information on the currency of this unofficial version of NYS Rules.