CPT® copyright American Medical Association. All Rights Reserved. No fee schedule, basic units, relative values or related listings are included in CPT. AMA does not directly or indirectly practice medicine or dispense medical services. AMA assumes no liability for data contained or not contained herein. CPT is a registered trademark of the American Medical Association Applicable FARs/DFARs Restrictions Apply to Government Use MBC-F.TXT contains ten fields separated by tabs. Field 1 CPT CPT code (5 CHAR) Field 2 MOD Modifier (2 CHAR) Field 3 SDESCR 35-character CPT description (up to 35 characters) Field 4 DESCR 100-character CPT description (up to 100 characters) Field 5 FTOT Facility Relative Value Unit total for Medicare billing (can be less than NTOT) Field 6 NTOT Non-Facility Relative Value Unit total for Medicare billing Field 7 STATUS Billing status code for Medicare billing purposes A = Active Code. These codes are paid separately under the physician fee schedule, if covered. There will be RVUs for codes with this status. The presence of an "A" indicator does not mean that Medicare has made a national coverage determination regarding the service; carriers remain responsible for coverage decisions in the absence of a national Medicare policy. B = Bundled Code. Payment for covered services are always bundled into payment for other services not specified. There will be no RVUs or payment amount for these codes, and no separate payment is made. When these services are covered, payment for them is subsumed by the payment for the services to which they are incident. (An example is a telephone call from a hospital nurse regarding care of a patient). C = Carriers price the code. Carriers will establish RVUs and payment amounts for these services, generally on an individual case basis following review of documentation such as an operative report. E = Excluded from Physician Fee Schedule by regulation. These codes are for items and/or services that CMS chose to exclude from the fee schedule payment by regulation. No RVUS or payment amounts are shown and no payment may be made under the fee schedule for these codes. Payment for them, when covered, generally continues under reasonable charge procedures. I = Not valid for Medicare purposes. Medicare uses another code for reporting of, and payment for, these services. (Code NOT subject to a 90 day grace period.) N = Noncovered Services. These services are not covered by Medicare. R = Restricted Coverage. Special coverage instructions apply. If covered, the service is carrier priced. (NOTE: The majority of codes to which this indicator will be assigned are the alpha-numeric dental codes, which begin with "D". We are assigning the indicator to a limited number of CPT codes which represent services that are covered only in unusual circumstances.) T = Injections. There are RVUS and payment amounts for these services, but they are only paid if there are no other services payable under the physician fee schedule billed on the same date by the same provider. If any other services payable under the physician fee schedule are billed on the same date by the same provider, these services are bundled into the physician services for which payment is made. (NOTE: This is a change from the previous definition, which states that injection services are bundled into any other services billed on the same date.) X = Statutory Exclusion. These codes represent an item or service that is not in the statutory definition of "physician services" for fee schedule payment purposes. No RVUS or payment amounts are shown for these codes, and no payment may be made under the physician fee schedule. (Examples are ambulance services and clinical diagnostic laboratory services.) Field 8 MALE Male only flag--this flag is 1 for procedures that are performed on males only Field 9 FEMALE Female only flag--this flag is 1 for procedures that are performed on females only Field 10 COMP Correct Coding Initiative comprehensive flag--this flag is 1 if the code Field 11 MN Medical necessity flag--this flag is 1 if the procedure appears in any local Medicare coverage decision SAMPLE ------ CPT MOD SDESCR DESCR FTOT NTOT STATUS MALE FEMALE COMP MN ... 48001 PLACEMENT OF DRAIN, PANCREAS PLACEMENT, DRAINS, PERIPANCREATIC, ACUTE PANCREATITIS; W/CHOLECYSTOSTOMY, GASTROSTOMY&JEJUNOSTOMY 53.86 53.86 A 0 0 1 1 48005 RESECT/DEBRIDE PANCREAS RESECTION/DEBRIDEMENT, PANCREAS & PERIPANCREATIC TISSUE, ACUTE NECROTIZING PANCREATITIS 64.1 64.1 A 0 0 1 1 48020 REMOVAL OF PANCREATIC STONE REMOVAL, PANCREATIC CALCULUS 25.07 25.07 A 0 0 1 1 48100 BIOPSY OF PANCREAS, OPEN BX, PANCREAS, OPEN 19.35 19.35 A 0 0 1 1 48102 NEEDLE BIOPSY, PANCREAS BX, PANCREAS, PERCUTANEOUS NEEDLE 6.9 12.91 A 0 0 1 1 48120 REMOVAL OF PANCREAS LESION EXCISION, LESION, PANCREAS 24.73 24.73 A 0 0 1 1 48140 PARTIAL REMOVAL OF PANCREAS PANCREATECTOMY, DISTAL SUBTOTAL, W/WO SPLENECTOMY; W/O PANCREATICOJEJUNOSTOMY 35.4 35.4 A 0 0 1 1 48145 PARTIAL REMOVAL OF PANCREAS PANCREATECTOMY, DISTAL SUBTOTAL, W/WO SPLENECTOMY; W/PANCREATICOJEJUNOSTOMY 36.94 36.94 A 0 0 1 1 48146 PANCREATECTOMY PANCREATECTOMY, DISTAL, NEAR-TOTAL W/PRESERVATION, DUODENUM (CHILD-TYPE PROC) 41.78 41.78 A 0 0 1 1 48148 REMOVAL OF PANCREATIC DUCT EXCISION, AMPULLA, VATER 27.12 27.12 A 0 0 1 1 48150 PARTIAL REMOVAL OF PANCREAS PANCREATECTOMY (WHIPPLE); W/PANCREATOJEJUNOSTOMY 73.64 73.64 A 0 0 1 1 48152 PANCREATECTOMY PANCREATECTOMY (WHIPPLE); W/O PANCREATOJEJUNOSTOMY 67.63 67.63 A 0 0 1 1 48153 PANCREATECTOMY PANCREATECTOMY (PYLORUS SPARING, WHIPPLE); W/PANCREATOJEJUNOSTOMY 73.6 73.6 A 0 0 1 1 48154 PANCREATECTOMY PANCREATECTOMY (PYLORUS SPARING, WHIPPLE); W/O PANCREATOJEJUNOSTOMY 68.01 68.01 A 0 0 1 1 48155 REMOVAL OF PANCREAS PANCREATECTOMY, TOTAL 39.45 39.45 A 0 0 1 1 48160 PANCREAS REMOVAL/TRANSPLANT PANCREATECTOMY, TOTAL/SUBTOTAL W/AUTOLOGOUS TRANSPLANTATION PANCREAS/PANCREATIC ISLETS 0 0 N 0 0 0 1 48180 FUSE PANCREAS AND BOWEL PANCREATICOJEJUNOSTOMY, SIDE-TO-SIDE ANASTOMOSIS 38.04 38.04 A 0 0 1 1 48400 INJECTION, INTRAOP ADD-ON INJECTION PROC, INTRAOPERATIVE PANCREATOGRAPHY 2.74 2.74 A 0 0 1 1 48500 SURGERY OF PANCREATIC CYST MARSUPIALIZATION, CYST, PANCREAS 24.58 24.58 A 0 0 1 1 48510 DRAIN PANCREATIC PSEUDOCYST EXT DRAINAGE, PSEUDOCYST, PANCREAS; OPEN 23.5 23.5 A 0 0 1 1 48511 DRAIN PANCREATIC PSEUDOCYST EXT DRAINAGE, PSEUDOCYST, PANCREAS; PERCUTANEOUS 5.54 25.12 A 0 0 1 1 48520 FUSE PANCREAS CYST AND BOWEL INT ANASTOMOSIS, PANCREATIC CYST TO GI TRACT; DIRECT 24.28 24.28 A 0 0 1 1 48540 FUSE PANCREAS CYST AND BOWEL INT ANASTOMOSIS, PANCREATIC CYST TO GI TRACT; ROUX-EN-Y 30.32 30.32 A 0 0 1 1 48545 PANCREATORRHAPHY PANCREATORRHAPHY, INJURY 28.44 28.44 A 0 0 1 1 48547 DUODENAL EXCLUSION DUODENAL EXCLUSION W/GASTROJEJUNOSTOMY, PANCREATIC INJURY 39.59 39.59 A 0 0 1 1 48550 DONOR PANCREATECTOMY DONOR PANCREATECTOMY, (W/COLD PRESERVATION), W/WO DUODENAL SEGMENT FOR TRANSPLANTATION 0 0 X 0 0 1 1 48551 PREP DONOR PANCREAS BACKBENCH PREP CADAVER DONOR PANCREAS ALLOGRAFT, W/ALLOGRAFT DISSECT FROM TISS 0 0 C 0 0 0 0 48552 PREP DONOR PANCREAS/VENOUS BACKBENCH CADAVER DONOR PANCREAS ALLOGRAFT RECONSTRUCT, VENOUS ANASTOMOSIS, EA 6.07 6.07 A 0 0 0 0 48554 TRANSPL ALLOGRAFT PANCREAS TRANSPLANTATION, PANCREATIC ALLOGRAFT 56.5 56.5 R 0 0 1 1 48556 REMOVAL, ALLOGRAFT PANCREAS REMOVAL, TRANSPLANTED PANCREATIC ALLOGRAFT 25.75 25.75 A 0 0 1 1 48999 PANCREAS SURGERY PROCEDURE UNLISTED PROC, PANCREAS 0 0 C 0 0 0 1 49000 EXPLORATION OF ABDOMEN EXPLORATORY LAPAROTOMY, EXPLORATORY CELIOTOMY W/WO BX(S) (SEP PROC) 18.51 18.51 A 0 0 1 1 49002 REOPENING OF ABDOMEN REOPENING, RECENT LAPAROTOMY 16.82 16.82 A 0 0 1 1 49010 EXPLORATION BEHIND ABDOMEN EXPLORATION, RETROPERITONEAL AREA W/WO BX(S) (SEP PROC) 19.66 19.66 A 0 0 1 1 49020 DRAIN ABDOMINAL ABSCESS DRAINAGE, PERITONEAL ABSCESS/LOCALIZED PERITONITIS EXCLUDES APPENDICEAL ABSCESS; OPEN 35.74 35.74 A 0 0 1 1 49021 DRAIN ABDOMINAL ABSCESS DRAINAGE, PERITONEAL ABSCESS/LOCALIZED PERITONITIS EXCLUDES APPENDICEAL ABSCESS; PERCUTANEOUS 4.68 24.62 A 0 0 1 1 49040 DRAIN, OPEN, ABDOM ABSCESS DRAINAGE, SUBDIAPHRAGMATIC/SUBPHRENIC ABSCESS; OPEN 21.56 21.56 A 0 0 1 1 49041 DRAIN, PERCUT, ABDOM ABSCESS DRAINAGE, SUBDIAPHRAGMATIC/SUBPHRENIC ABSCESS; PERCUTANEOUS 5.54 23.74 A 0 0 1 1 49060 DRAIN, OPEN, RETROP ABSCESS DRAINAGE, RETROPERITONEAL ABSCESS; OPEN 25.01 25.01 A 0 0 1 1 49061 DRAIN, PERCUT, RETROPER ABSC DRAINAGE, RETROPERITONEAL ABSCESS; PERCUTANEOUS 5.12 23.53 A 0 0 1 1 49062 DRAIN TO PERITONEAL CAVITY DRAINAGE, EXTRAPERITONEAL LYMPHOCELE TO PERITONEAL CAVITY, OPEN 18.16 18.16 A 0 0 1 1 49080 PUNCTURE, PERITONEAL CAVITY PERITONEOCENTESIS, ABDOMINAL PARACENTESIS/PERITONEAL LAVAGE; INITIAL 1.9 5.42 A 0 0 1 1 49081 REMOVAL OF ABDOMINAL FLUID PERITONEOCENTESIS, ABDOMINAL PARACENTESIS/PERITONEAL LAVAGE; SUBSEQUENT 1.78 3.93 A 0 0 1 1 ...