Search
Close this search box.

Outpatient Hospital Fee Schedule Codes

Outpatient Hospital Fee Schedule Codes

OHS CPT-CODE* DESCRIPTION TOTAL
70140 RADIOLOGIC EXAMINATION, FACIAL BONES; LESS
THAN THREE VIEWS   
60.00
70150 RADIOLOGIC EXAMINATION, FACIAL BONES; COMPLETE,
MINIMUM OF THREE VIEWS
72.50
70160 RADIOLOGIC EXAMINATION, NASAL BONES; COMPLETE,
MINIMUM OF THREE VIEWS
73.00
70210 RADIOLOGIC EXAMINATION, SINUSES, PARANASAL,
LESS THAN THREE VIEWS
50.00
70220 RADIOLOGIC EXAMINATION, SINUSES, PARANASAL,
COMPLETE, MINIMUM OF THREE VIEWS
73.00
70250 RADIOLOGIC EXAMINATION, SKULL; LESS THAN
FOUR VIEWS, WITH OR W/O STEREO
60.50
70260 RADIOLOGIC EXAMINATION, SKULL, COMPLETE,
MINIMUM OF FOUR VIEWS, WITH OR W/O STEREO
86.00
70450 COMPUTERIZED AXIAL TOMOGRAPHY, HEAD OR
BRAIN; W/O CONTRAST MATERIAL
458.00
70460 COMPUTERIZED AXIAL TOMOGRAPHY, HEAD OR
BRAIN; WITH CONTRAST MATERIAL
600.00
70470 COMPUTERIZED AXIAL TOMOGRAPHY, HEAD OR
BRAIN; W/O CONTRAST MATERIAL FOLLOWED BY CONTRAST MATERIAL
AND FURTHER SECTIONS  
613.00
70551 MAGNETIC RESONANCE (EG, PROTON) IMAGING,
BRAIN (INCLUDING BRAIN STEM);W/O CONTRAST MATERIAL
826.00
71010 RADIOLOGIC EXAMINATION, CHEST; SINGLE VIEW,
FRONTAL
58.50
71020 RADIOLOGIC EXAMINATION, CHEST; TWO VIEWS,
FRONTAL AND LATERAL
74.00
71100 RADIOLOGIC EXAMINATION, RIBS, UNILATERAL;
TWO VIEWS
67.00
71101 RADIOLOGIC EXAMINATION, RIBS, UNILATERAL;
INCLUDING POSTEROANTERIOR CHEST, MINIMUM OF THREE VIEWS 
75.00
71110 RADIOLOGIC EXAMINATION, RIBS, BILATERAL;
THREE VIEWS
85.00
71250 COMPUTERIZED AXIAL TOMOGRAPHY, THORAX;
W/O CONTRAST MATERIAL
630.00
71260 COMPUTERIZED AXIAL TOMOGRAPHY, THORAX;
WITH CONTRAST MATERIAL(S)
672.00
71270 COMPUTERIZED AXIAL TOMOGRAPHY, THORAX;
W/O CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL AND
FURTHER SECTIONS  
735.00
72010 RADIOLOGIC EXAMINATION, SPINE, ENTIRE,
SURVEY STUDY, ANTEROPOSTERIOR AND LATERAL
128.50
72040 RADIOLOGIC EXAMINATION SPINE, CERVICAL;
ANTEROPOSTERIOR AND LATERAL
64.00
72050 RADIOLOGIC EXAMINATION, SPINE, CERVICAL;
MINIMUM OF FOUR VIEWS
104.00
72052 RADIOLOGIC EXAMINATION, SPINE, CERVICAL;
COMPLETE, INCLUDING OBLIQUE AND FLEXION AND/OR EXTENSION
STUDIES
129.00
72070 RADIOLOGIC EXAMINATION, SPINE; THORACIC,
ANTEROPOSTERIOR AND LATERAL
83.50
72100 RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL;
ANTEROPOSTERIOR AND LATERAL
83.00
72110 RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL;
COMPLETE, W/OBLIQUE VIEWS
119.00
72125 COMPUTERIZED AXIAL TOMOGRAPHY, CERVICAL
SPINE; W/O CONTRAST MATERIAL
431.00
72126 COMPUTERIZED AXIAL TOMOGRAPHY, CERVICAL
SPINE; WITH CONTRAST MATERIAL
489.00
72127 COMPUTERIZED AXIAL TOMOGRAPHY, CERVICAL
SPINE; W/O CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S)
AND FURTHER SECTIONS
567.00
72128 COMPUTERIZED AXIAL TOMOGRAPHY, THORACIC
SPINE; W/O CONTRAST MATERIAL
431.00
72129 COMPUTERIZED AXIAL TOMOGRAPHY, THORACIC
SPINE; WITH CONTRAST MATERIAL
494.00
72130 COMPUTERIZED AXIAL TOMOGRAPHY, THORACIC
SPINE; W/O CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S)
AND FURTHER SECTIONS
567.00
72131 COMPUTERIZED AXIAL TOMOGRAPHY, LUMBAR SPINE;
W/O CONTRAST MATERIAL
431.00
72132 COMPUTERIZED AXIAL TOMOGRAPHY, LUMBAR SPINE;
WITH CONTRAST MATERIAL
489.00
72133 COMPUTERIZED AXIAL TOMOGRAPHY, LUMBAR SPINE;
W/O CONTRAST MATERIAL,FOLLOWED BY CONTRAST MATERIAL(S) AND
FURTHER SECTIONS  
562.50
72141 MAGNETIC RESONANCE (EG, PROTON) IMAGING,
SPINAL CANAL AND CONTENTS, CERVICAL; W/O CONTRAST MATERIAL  
901.00
72146 MAGNETIC RESONANCE (EG, PROTON) IMAGING,
SPINAL CANAL AND CONTENTS, THORACIC; W/O CONTRAST MATERIAL
945.00
72147 MAGNETIC RESONANCE (EG, PROTON) IMAGING,
SPINAL CANAL AND CONTENTS, THORACIC; WITH CONTRAST MATERIAL  
1,024.00
72148 MAGNETIC RESONANCE (EG, PROTON) IMAGING,
SPINAL CANAL AND CONTENTS, LUMBAR; W/O CONTRAST MATERIAL
901.00
72149 MAGNETIC RESONANCE (EG, PROTON) IMAGING,
SPINAL CANAL AND CONTENTS LUMBAR; WITH CONTRAST MATERIAL
976.50
72170 RADIOLOGIC EXAMINATION, PELVIS; ANTEROPOSTERIOR
ONLY
65.00
72190 RADIOLOGIC EXAMINATION, PELVIS; COMPLETE,
MINIMUM OF THREE VIEWS
80.00
73000 RADIOLOGIC EXAMINATION; CLAVICLE, COMPLETE 50.00
73010 RADIOLOGIC EXAMINATION; SCAPULA, COMPLETE 55.00
73020 RADIOLOGIC EXAMINATION, SHOULDER; ONE VIEW 51.50
73030 RADIOLOGIC EXAMINATION, SHOULDER; COMPLETE,
MINIMUM OF TWO VIEWS
75.50
73060 RADIOLOGIC EXAMINATION, HUMERUS, MINIMUM
OF TWO VIEWS
66.50
73070 RADIOLOGIC EXAMINATION, ELBOW; ANTEROPOSTERIOR
AND LATERAL VIEWS
66.50
73080 RADIOLOGIC EXAMINATION, ELBOW; COMPLETE,
MINIMUM OF THREE VIEWS
68.50
73090 RADIOLOGIC EXAMINATION; FOREARM, ANTEROPOSTERIOR
AND LATERAL VIEWS
66.50
73100 RADIOLOGIC EXAMINATION, WRIST; ANTEROPOSTERIOR
AND LATERAL VIEWS
66.50
73110 RADIOLOGIC EXAMINATION, WRIST; COMPLETE,
MINIMUM OF THREE VIEWS
67.00
73120 RADIOLOGIC EXAMINATION, HAND; TWO VIEWS 57.00
73130 RADIOLOGIC EXAMINATION, HAND; MINIMUM OF
THREE VIEWS
76.00
73140 RADIOLOGIC EXAMINATION, FINGER OR FINGERS,
MINIMUM OF TWO VIEWS
55.50
73500 RADIOLOGIC EXAMINATION, HIP; UNILATERAL,
ONE VIEW
68.50
73510 RADIOLOGIC EXAMINATION, HIP; COMPLETE,
MINIMUM OF TWO VIEWS
73.00
73550 RADIOLOGIC EXAMINATION, FEMUR; ANTEROPOSTERIOR
AND LATERAL VIEWS
70.50
73560 RADIOLOGIC EXAMINATION, KNEE; ANTEROPOSTERIOR
AND LATERAL VIEWS
63.50
73562 RADIOLOGIC EXAMINATION, KNEE; ANTEROPOSTERIOR
AND LATERAL, WITH OBLIQUE(S), MINIMUM OF THREE VIEWS
85.00
73564 RADIOLOGIC EXAMINATION, KNEE; COMPLETE,
INCLUDING OBLIQUE, AND TUNNEL, AND/OR PATELLAR AND/OR STANDING
VIEW  
99.50
73590 RADIOLOGIC EXAMINATION; TIBIA AND FIBULA,
ANTEROPOSTERIOR AND LATERAL VIEWS
74.50
73600 RADIOLOGIC EXAMINATION, ANKLE; ANTEROPOSTERIOR
AND LATERAL VIEWS
61.50
73610 RADIOLOGIC EXAMINATION, ANKLE; COMPLETE,
MINIMUM OF THREE VIEWS
62.50
73620 RADIOLOGIC EXAMINATION, FOOT; ANTEROPOSTERIOR
AND LATERAL VIEWS
60.00
73630 RADIOLOGIC EXAMINATION, FOOT; COMPLETE,
MINIMUM OF THREE VIEWS
52.00
73650 RADIOLOGIC EXAMINATION; CALCANEUS, MINIMUM
OF TWO VIEWS
62.00
73660 RADIOLOGIC EXAMINATION; TOE OR TOES, MINIMUM
OF TWO VIEWS
63.00
73720 MAGNETIC RESONANCE (EG, PROTON) IMAGING,
LOWER EXTREMITY, OTHER THAN JOINT
901.00
74000 RADIOLOGIC EXAMINATION, ABDOMEN; SINGLE
ANTEROPOSTERIOR VIEW
72.00
74010 RADIOLOGIC EXAMINATION, ABDOMEN; ANTEROPOSTERIOR
AND ADDITIONAL OBLIQUE AND CONE VIEWS
80.00
74020 RADIOLOGIC EXAMINATION, ABDOMEN; COMPLETE,
INCLUDING DECUBITUS AND/OR ERECT VIEWS
95.00  
74022 RADIOLOGIC EXAMINATION, ABDOMEN; COMPLETE
ACUTE ABDOMEN SERIES, INCLUDING SUPINE, ERECT, AND/OR DECUBITUS
VIEWS, UPRIGHT PA CHEST
102.50
74150 COMPUTERIZED AXIAL TOMOGRAPHY, ABDOMEN;
W/O CONTRAST MATERIAL
630.00
74160 COMPUTERIZED AXIAL TOMOGRAPHY, ABDOMEN;
WITH CONTRAST MATERIAL(S)
651.50
74170 COMPUTERIZED AXIAL TOMOGRAPHY, ABDOMEN;
W/O CONTRAST MATERIAL FOLLOWED BY CONTRAST MATERIAL(S) AND
FURTHER SECTIONS
726.50
74220 RADIOLOGIC EXAMINATION; ESOPHAGUS 100.00
74230 SWALLOWING FUNCTION, PHARYNX AND/OR ESOPHAGUS,
WITH CINERADIOGRAPHY AND/OR VIDEO
100.00
74240 RADIOLOGIC EXAMINATION, GASTROINTESTINAL
TRACT, UPPER; WITH OR WITHOUT DELAYED FILMS, W/O KUB
131.00
74241 RADIOLOGIC EXAMINATION, GASTROINTESTINAL
TRACT, UPPER; WITH OR WITHOUT DELAYED FILMS, WITH KUB  
131.00
74245 RADIOLOGIC EXAMINATION, GASTROINTESTINAL
TRACT, UPPER; WITH SMALL BOWEL, INCLUDES MULTIPLE SERIAL
FILMS  
142.00
74246 RADIOLOGIC EXAMINATION, GASTROINTESTINAL
TRACT, UPPER, AIR CONTRAST, WITH SPECIFIC HIGH DENSITY BARIUM,
EFFERVESCENT AGENT, WITH OR WITHOUT GLUCAGON; WITH OR WITHOUT
DELAYED FILMS, W/O KUB  
142.00
74247 RADIOLOGIC EXAMINATION, GASTROINTESTINAL
TRACT, UPPER, AIR CONTRAST, WITH SPECIFIC HIGH DENSITY BARIUM,
EFFERVESCENT AGENT, WITH OR WITHOUT GLUCAGON; WITH OR WITHOUT
DELAYED FILMS, WITH KUB  
142.00
74250 RADIOLOGIC EXAMINATION, SMALL BOWEL, INCLUDES
MULTIPLE SERIAL FILMS
101.00
74270 RADIOLOGIC EXAMINATION, COLON; BARIUM ENEMA 129.00
74280 RADIOLOGIC EXAMINATION, COLON; AIR CONTRAST
WITH SPECIFIC HIGH DENSITY BARIUM, WITH OR W/O GLUCAGON  
147.00
74290 CHOLECYSTOGRAPHY, ORAL CONTRAST 100.00
74400 UROGRAPHY (PYELOGRAPHY), INTRAVENOUS, WITH
OR W/O KUB, WITH OR W/O TOMOGRAPHY
158.00
74405 UROGRAPHY (PYELOGRAPHY), INTRAVENOUS, WITH
OR W/O KUB, WITH OR W/O TOMOGRAPHY WITH SPECIAL HYPERTENSIVE
CONTRAST CONCENTRATION AND/OR CLEARANCE STUDIES   
168.00
74415 UROGRAPHY, INFUSION, DRIP TECHNIQUE AND/OR
BOLUS TECHNIQUE; WITH NEPHROTOMOGRAPHY
210.00
74456 URETHROCYSTOGRAPHY, VOIDING; COMPLETE PROCEDURE
(74456 [COMPLETE PROCEDURE] HAS BEEN DELETED, SEE 51600,
74455) 
110.00 
76090 MAMMOGRAPHY; UNILATERAL 61.50
76091 MAMMOGRAPHY; BILATERAL 75.00
76092 SCREENING MAMMOGRAPHY, BILATERAL (TWO VIEW
FILM STUDY OF EACH BREAST)
60.00
76100 RADIOLOGIC EXAMINATION, SINGLE PLANE BODY
SECTION, (EG, TOMOGRAPHY), OTHER THAN WITH UROGRAPHY
131.00
76536 ECHOGRAPHY, SOFT TISSUES OF HEAD AND NECK
(EG, THYROID, PARATHYROID, PAROTID), B-SCAN AND/OR REAL
TIME W/IMAGE DOCUMENTATION
168.00
76645 ECHOGRAPHY, BREAST(S) (UNILATERAL OR BILATERAL),
B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION
65.00
76700 ECHOGRAPHY, ABDOMINAL, B-SCAN AND/OR REAL
TIME W/IMAGE DOCUMENTATION; COMPLETE
200.00
76705 ECHOGRAPHY, ABDOMINAL, B-SCAN AND/OR REAL
TIME W/IMAGE DOCUMENTATION; LIMITED  (EG, SINGLE ORGAN,
QUADRANT, FOLLOW-UP)  
126.00
76770 ECHOGRAPHY, RETROPERITONEAL (EG, RENAL,
AORTA, NODES), B-SCAN AND/OR REALTIME WITH IMAGE DOCUMENTATION;
COMPLETE
158.00
76805 ECHOGRAPHY, PREGNANT UTERUS, B-SCAN AND/OR
REAL TIME WITH IMAGE DOCUMENTATION; COMPLETE (COMPLETE FETAL
AND MATERNAL EVALUATION)
168.00
76815 ECHOGRAPHY, PREGNANT UTERUS, B-SCAN AND/OR
REAL TIME WITH IMAGE DOCUMENTATION; LIMITED (GESTATIONAL
AGE, HEARTBEAT, PLACENTAL LOCATION, FETAL POSITION, OR EMERGENCY
IN THE DELIVERY ROOM)  
105.00
76816 ECHOGRAPHY, PREGNANT UTERUS, B-SCAN AND/OR
REAL TIME WITH IMAGE DOCUMENTATION; FOLLOW-UP OR REPEAT
105.00
76855 ECHOGRAPHY, PELVIC AREA (DOPPLER) (76855
HAS BEEN DELETED. TO REPORT, SEE (93975, 93979)  
142.00
76856 ECHOGRAPHY, PELVIC (NONOBSTETRIC), B-SCAN
AND/OR REAL TIME WITH IMAGE DOCUMENTATION; COMPLETE
158.00
80002 AUTOMATED MULTICHANNEL TEST; 1 OR 2 CLINICAL
CHEMISTRY TEST(S)
31.00
80003 3 CLINICAL CHEMISTRY TESTS 42.00
80004 4 CLINICAL CHEMISTRY TESTS 52.00
80005 5 CLINICAL CHEMISTRY TESTS 52.00
80006 6 CLINICAL CHEMISTRY TESTS 68.00
80007 7 CLINICAL CHEMISTRY TESTS 68.00
80008 8 CLINICAL CHEMISTRY TESTS 68.00
80009 9 CLINICAL CHEMISTRY TESTS 68.00
80010 10 CLINICAL CHEMISTRY TESTS 68.00
80011 11 CLINICAL CHEMISTRY TESTS 68.00
80012 12 CLINICAL CHEMISTRY TESTS 73.00
80016 13-16 CLINICAL CHEMISTRY TESTS 73.00
80018 17-18 CLINICAL CHEMISTRY TESTS 78.00
80019 19 OR MORE CLINICAL CHEMISTRY TESTS 75.00
80031 THERAPEUTIC QUANTITATIVE DRUG MONITORING
IN BODY FLUIDS AND/OR EXCRETA (80031HAS BEEN DELETED. TO
REPORT, SEE THERAPEUTIC DRUG ASSAYS)
62.00
80058 HEPATIC FUNCTION PANEL 81.00
80061 LIPID PANEL 69.00
80063 CARDIAC INJURY PANEL (80063 HAS BEEN DELETED.
TO REPORT, SEE CODES FOR SPECIFIC TESTS)  
81.00
80064 CARDIAC INJURY PANEL; W/CREATINE PHOSPHOKINASE
AND/OR LACTIC DEHYDROGENASE ISOENZYME DETERMINATION (80064
HAS BEEN DELETED. TO REPORT SEE CODES FOR SPECIFIC TESTS)  
81.00
80070 THYROID PANEL (80070 HAS BEE DELETED. TO
REPORT, SEE 80091)
77.00
80073 RENAL PANEL (80073 HAS BEEN DELETED. TO
REPORT, SEE CODES 80002 – 80019)
53.00
81000 URINALYSIS 14.00
81002 URINALYSIS, W/O MICROSCOPY 14.00
81015 URINALYSIS, MICROSCOPIC ONLY 10.00
82150 AMYLASE 31.00
82250 BILIRUBIN; TOTAL OR DIRECT 25.00
82251 BILIRUBIN; TOTAL AND DIRECT 35.00
82270 BLOOD, OCCULT; FECES SCREENING 19.00
82310 CALCIUM, BLOOD; CHEMICAL 21.00
82372 CARBAMAZEPINE, SERUM (82372 HAS BEEN DELETED.
TO REPORT, USE 80156)
50.00
82374 CARBON DIOXIDE (BICARBONATE), COMBINING
POWER OR CONTENT
22.00
82435 CHLORIDE; BLOOD (SPECIFY CHEMICAL OR ELECTROMETRIC) 22.00
82465 CHOLESTEROL, SERUM, TOTAL 20.00
82550 CREATINE PHOSPHOKINASE (CPK), TIMED KINETIC
ULTRAVIOLET METHOD
13.00
82552 CREATINE PHOSPHOKINASE (CPK), ISOENZYMES 52.00
82555 CREATINE PHOSPHOKINASE (CPK), COLORIMETRIC 26.00
82565 CREATINE 22.00
82660 DRUG SCREEN (AMPHETAMINES, BARBITURATES,
ALKALOIDS) (82660 HAS BEEN DELETED. (TO REPORT, SEE 80100,
80101)
76.50
82803 GASES, pH, pCO2,
p02 SIMULTANEOUS
73.00
82947 GLUCOSE; EXCEPT URINE 19.50
82948 GLUCOSE; STICK TEST 11.00
83615 LACTIC DEHYDROGENASE (LDH), KINETIC ULTRAVIOLET
METHOD
22.00
83620 LACTIC DEHYDROGENASE (LDH), COLORIMETRIC
OR FLUOROMETRIC (83620 HAS BEEN (DELETED. TO REPORT, USE
83615)
22.00
83705 LIPIDS, FRACTIONATED (83705 HAS BEEN DELETED.
TO REPORT CHOLESTEROL, SEE 82465, 83718-83721. FOR TRIGLYCERIDES,
SEE 84478)  
58.00
83718 LIPOPROTEIN HIGH DENSITY CHOLESTEROL BY
PRECIPITATION METHOD
40.00
83725 LITHIUM, BLOOD, QUANTITATIVE (83725 HAS
BEEN DELETED. TO REPORT, USE 80178)
27.00
84045 PHENYTOIN (84045 HAS BEEN DELETED. TO REPORT,
SEE 80185)
50.00
84075 PHOSPHATASE, ALKALINE 26.00
84132 POTASSIUM; SERUM 23.00
84155 PROTEIN; TOTAL, EXCEPT REFRACTOMETRY 16.00
84165 PROTEIN, TOTAL, SERUM; ELECTROPHORETIC
FRACTIONATION AND QUANTITATION
31.00
84295 SODIUM; SERUM 26.00
84420 THEOPHYLLINE, BLOOD OR SALIVA (84420 HAS
BEEN DELETED. TO REPORT, USE 80198)
52.00
84435 THYROXINE, (T-4), CPB OR RESIN UPTAKE 37.00
84436 THYROXINE, TRUE (TT-4), RIA 37.00
84439 THYROXINE, FREE (FT-4), RIA (UNBOUND T-4
ONLY)
37.00
84443 THYROID STIMULATING HORMONE 56.00
84450 TRANSAMINASE, GLUTAMIC OXALOACETIC, (SGOT),
BLOOD; TIMED KINETIC ULTRAVIOLET METHOD  
22.00
84455 TRANSAMINASE, GLUTAMIC OXALOACETIC, BLOOD;
COLORIMETRIC OR FLUOROMETRIC (84455 HAS BEEN DELETED. TO
REPORT, USE 84450)  
22.00
84460 TRANSAMINASE, GLUTAMIC PYRUVIC (SGPT),
BLOOD; TIMED KINETIC ULTRAVIOLET METHOD
18.00
84465 TRANSAMINASE, GLUTAMIC PYRUVIC, BLOOD;
COLORIMETRIC OR FLUOROMETRIC (84465 HAS (BEEN DELETED. TO
REPORT, USE 84460)
18.00
84478 TRIGLYCERIDES, BLOOD 24.00
84479 TRIDOTHYRONINE (T-3), RESIN UPTAKE 26.00
84480 TRIDOTHYRONINE, TOTAL (TT-3) 48.00
84520 UREA NITROGEN, (BUN); QUANTITATIVE 19.00
84525 UREA NITROGEN, (BUN); SEMIQUANTITATIVE
(EG, REAGENT STRIP TEST)
21.00
84550 URIC ACID; BLOOD, CHEMICAL 22.00
84555 URIC ACID; UNICASE, ULTRAVIOLET METHOD 22.00
84702 GONADOTROPIN, CHORIONIC; QUANTITATIVE 34.00
84703 GONADOTROPIN, CHORIONIC; QUALITATIVE 36.00
85002 BLEEDING TIME 19.50
85007 BLOOD COUNT; MANUAL DIFFERENTIAL WBC COUNT 12.00
85009 BLOOD COUNT; DIFFERENTIAL WBC COUNT, BUFFY
COAT
16.00
85012 BLOOD COUNT; EOSINOPHIL COUNT, DIRECT 16.00
85014 BLOOD COUNT; HEMATOCRIT 16.00
85018 BLOOD COUNT; HEMOGLOBIN, COLORIMETRIC 16.00
85021 BLOOD COUNT; HEMOGRAM, AUTOMATED 16.00
85022 BLOOD COUNT; HEMOGRAM, AUTOMATED, AND MANUAL
DIFFERENTIAL WBC COUNT
25.00
85023 BLOOD COUNT; HEMOGRAM AND PLATELET COUNT,
AUTOMATED AND MANUAL DIFFERENTIAL WBC COUNT 
26.00
85024 BLOOD COUNT; HEMOGRAM AND PLATELET COUNT,
AUTOMATED, AND AUTOMATED PARTIALDIFFERENTIAL WBC COUNT  
26.00
85025 BLOOD COUNT; HEMOGRAM AND PLATELET COUNT,
AUTOMATED AND AUTOMATED COMPLETE  DIFFERENTIAL WBC
COUNT  
26.00
85027 BLOOD COUNT; HEMOGRAM AND PLATELET COUNT,
AUTOMATED
26.00
85031 BLOOD COUNT; HEMOGRAM, MANUAL, COMPLETE
CBC
25.00
85048 BLOOD COUNT; WHITE BLOOD CELL (WBC) 16.00
85580 PLATELET; COUNT (REES-ECKER) (85580 HAS
BEEN DELETED. TO REPORT, USE 85590)
18.00
85590 PLATELET, MANUAL COUNT 18.00
85610 PROTHROMBIN TIME 19.00
85650 SEDIMENTATION RATE (ESR); WINTROBE TYPE 18.50
85651 SEDIMENTATION RATE (ESR); NON-AUTOMATED
19.00
85730 THROMBOPLASTIN TIME, PARTIAL (PTT); PLASMA
OR WHOLE BLOOD
32.00
85732 THROMBOPLASTIN TIME, PARTIAL (PTT); SUBSTITUTITION,
PLASMA
23.00
86006 ANTIBODY, NON-RBC, QUALITATIVE; FIRST ANTIGEN,
SLIDE OR TUBE (86006 HAS BEEN (DELETED. TO REPORT, SEE 83519
AND 86336 AND CODE FOR SPECIFIC METHOD)
27.00
86080 BLOOD TYPING; ABO ONLY (86080 HAS BEEN
DELETED. FOR BLOOD TYPING, SEE 86900-86910)  
16.00
86082 BLOOD TYPING; ABO AND Rho(D) (86082 HAS
BEEN DELETED. TO REPORT, SEE 86900, 86901)
21.00
86151 CARCINOEMBRYONIC ANTIGEN (CEA); RIA OR
EIA (86151 HAS BEEN DELETED. TO REPORT, SEE 82378)
69.00
86287 HEPATITIS B SURFACE ANTIGEN, RIA OR EIA 31.00
86300 HETEROPHILE ANTIBODIES; SCREENING, SLIDE
OR TUBE (86300 HAS BEEN DELETED. (TO REPORT, SEE 86308)
23.00
86430 RHEUMATOID FACTOR; QUALITATIVE 21.00
87040 CULTURE, BACTERIAL, DEFINITIVE; BLOOD 47.00
87045 CULTURE, BACTERIAL, DEFINITIVE, STOOL 47.00
87060 CULTURE, BACTERIAL, DEFINITIVE, THROAT
OR NOSE
47.00
87070 CULTURE, BACTERIAL, DEFINITIVE, ANY OTHER
SOURCE
43.50
87075 CULTURE, BACTERIAL, ANY SOURCE; ANAEROBIC 47.00
87081 CULTURE, BACTERIAL, SCREENING ONLY, FOR
SINGLE ORGANISMS
21.00
87082 CULTURE, PRESUMPTIVE, PATHOGENIC ORGANISMS,
SCREENING ONLY, BY COMMERCIAL KIT;  FOR SINGLE ORGANISMS
21.00
87086 CULTURE, BACTERIAL, URINE; QUANTITATIVE,
COLONY COUNT
47.00
87177 OVA AND PARASITES, DIRECT SMEARS, CONCENTRATION
AND IDENTIFICATION
33.00
87205 SMEAR, PRIMARY SOURCE, WITH INTERPRETATION;
ROUTINE STAIN FOR BACTERIA, FUNGI, OR CELL TYPES
18.00
87210 SMEAR, PRIMARY SOURCE, WITH INTERPRETATION;
WET MOUNT WITH SIMPLE STAIN FOR BACTERIA, FUNGI, OVA, AND/OR
PARASITES
21.00
88150 CYTOPATHOLOGY, SMEARS, CERVICAL OR VAGINAL,
UP TO THREE SMEARS; SCREENING BYTECHNICIAN UNDER PHYSICIAN
SUPERVISION
16.00

CPT-4 CODE*   PROCEDURE DESCRIPTION
1 92585 BRAINSTEM EVOKED RESPONSE RECORDING
(EVOKED RESPONSE [EEG] AUDIOMETRY)
2 93017 CARDIOVASCULAR STRESS TESTING
WITH MAXIMAL OR SUBMAXIMAL TREADMILL OR BICYCLE EXERCISE
3 93018 INTERPRETATION AND REPORT ONLY
4 93041 RHYTHM ECG, ONE TO THREE LEADS;
TRACING ONLY W/O I & R
5 93201 PHONOCARDIOGRAM WITH OR W/O
ECG LEAD; WITH SUPERVISION DURING RECORDING WITH I &
O
6 93202 PHONOCARDIOGRAM WITH OR W/O
ECG; TRACING ONLY W/O I & R, ETC.
7 93205 PHONOCARDIOGRAM WITH ECG LEAD,
WITH INDIRECT CAROTID ARTERY AND/OR JUGULAR VEIN
8 93208 PHONOCARDIOGRAM WITH ECG LEAD,
WITH INDIRECT CAROTID ARTERY AND/OR JUGULAR VEIN
9 93210 PHONOCARDIOGRAM, INTRACARDIAC
10 93220 VECTORCARDIOGRAM (VGC) WITH
OR W/O ECG LEAD, WITH I & R
11 93221 VECTORCARDIOGRAM (VGC) WITH
OR W/O ECG LEAD, TRACING ONLY W/O I & R
12 93224 ELECTROCARDIOGRAPHIC MONITORING
FOR 24 HRS. BY CONTINUOUS ORIGINAL ECG WAVEFORM, ETC.
13 93227 ELECTROCARDIOGRAPHIC MONITORING
FOR 24 HRS. BY CONTINUOUS ORIGINAL ECG WAVEFORM, ETC.
14 93235 ELECTROCARDIOGRAPHIC MONITORING
FOR 24 HRS. BY CONTINUOUS COMPUTERIZED MONITORING, ETC.
15 93278 SIGNAL-AVERAGED ELECTROCARDIOGRAPHY
(SAECG) WITH OR W/O ECG
16 93307 ECHOCARDIOGRAPHY, REAL-TIME
WITH IMAGE DOCUMENTATION (2D) WITH OR W/O M-MODE
17 93308 ECHOCARDIOGRAPHY, REAL-TIME
WITH IMAGE DOCUMENTATION (2D) WITH OR W/O M-MODE
18 93320 DOPPLER ECHOCARDIOGRAPHY, PULSED
WAVE AND/OR CONTINUOUS WAVE WITH SPECTRAL DISPL
19 93850 NON-INVASIVE STUDIES OF CEREBRAL
ARTERIES OTHER THAN CAROTID (93850 HAS BEEN DELETED; TO
REPORT, PLEASE SEE 93875 – 93882)
20 93860 NON-INVASIVE STUDIES OF CAROTID
ARTERIES, NON-IMAGING (EG, PHONOANGIOGRAM)- (93860 HAS BEEN
DELETED; TO REPORT, PLEASE SEE 93875 – 93882)
21 93870 NON-INVASIVE STUDIES OF CAROTID
ARTERIES, IMAGING (EG, FLOW IMAGING) – (93870 HAS BEEN DELETED;
TO REPORT, PLEASE SEE 93880 & 93882)
22 93880 DUPLEX SCAN OF EXTRACRANIAL
ARTERIES; COMPLETE BILATERAL STUDY
23 93882 DUPLEX SCAN OF EXTRACRANIAL
ARTERIES; FOLLOW-UP OR LIMITED STUDY
24 93886 TRANSCRANIAL DOPPLER STUDY
OF THE INTERCRANIAL ARTERIES; COMPLETE
25 93888 TRANSCRANIAL DOPPLER STUDY
OF THE INTERCRANIAL ARTERIES; FOLLOW-UP
26 93890 NON-INVASIVE STUDIES OF UPPER
EXTREMITY ARTERIES (EG SEGMENTAL BLOOD) – (93890 HAS BEEN
DELETED; TO REPORT, PLEASE SEE 93920, 93931)
27 93910 NON-INVASIVE STUDIES OF LOWER
EXTREMITY ARTERIES (EG SEGMENTAL BLOOD) – (93910 HAS BEEN
DELETED; TO REPORT, PLEASE SEE 93920, 93931)
28 93920 NON-INVASIVE PHYSIOLOGIC STUDY
OF BILATERAL EXTREMITY ARTERIES, WITH
29 93921 NON-INVASIVE PHYSIOLOGIC STUDY
OF BILATERAL EXTREMITY ARTERIES, WITH
30 93925 DUPLEX SCAN OF LOWER EXTREMITY
ARTERIES OR ARTERIAL BYPASS GRAFTS; COM
31 93926 DUPLEX SCAN OF LOWER EXTREMITY
ARTERIES OR ARTERIAL BYPASS GRAFTS; FOL
32 93930 DUPLEX SCAN OF UPPER EXTREMITY
ARTERIES OR ARTERIAL BYPASS GRAFTS; COM
33 93931 DUPLEX SCAN OF UPPER EXTREMITY
ARTERIES OR ARTERIAL BYPASS GRAFTS; FOL
34 93950 NON-INVASIVE STUDIES OF EXTREMITY
VEINS (EG, DOPPLER STUDIES WITH EVALUATION) – (93950 HAS
BEEN DELETED; TO REPORT, PLEASE SEE 93965 – 93971)
35 93960 QUANTITATIVE VENOUS FLOW STUDIES
(EG, CAPACITANCE AND OUTFLOW MEASURE) – (93960 HAS BEEN
DELETED; TO REPORT, PLEASE SEE 93965 – 93971)
36 93965 NON-INVASIVE PHYSIOLOGIC STUDIES
OF EXTREMITY VEINS, BILATERAL, (EG,
37 93970 DUPLEX SCAN OF EXTREMITY VEINS
INCLUDING RESPONSES TO COMPRESSION AND
38 93971 DUPLEX SCAN OF EXTREMITY VEINS
INCLUDING RESPONSES TO COMPRESSION AND
39 93975 DUPLEX SCAN OF ARTERIAL INFLOW
AND VENOUS OUTFLOW OF ABDOMINAL, PELVIC
40 93976 DUPLEX SCAN OF ARTERIAL INFLOW
AND VENOUS OUTFLOW OF ABDOMINAL, PELVIC
41 93978 DUPLEX SCAN OF AORTA, INFERIOR
VENA CAVA ILIAC VASCULATURE, OR BYPASS
42 93979 DUPLEX SCAN OF AORTA, INFERIOR
VENA CAVA ILIAC VASCULATURE, OR BYPASS
43 95863 ELECTROMYOGRAPHY; TWO EXTREMITIES
AND RELATED PARASPINAL AREAS
44 95864 ELECTROMYOGRAPHY; FOUR EXTREMITIES
AND RELATED PARASPINAL AREAS
45 95867 ELECTROMYOGRAPHY; CARNIAL NERVE-SUPPLIED
MUSCLES; UNILATERAL
46 95868 ELECTROMYOGRAPHY; CARNIAL NERVE-SUPPLIED
MUSCLES; BILATERAL
47 95925 SOMOTOSENSORY TESTING (E.G.
CEREBRAL EVOKED POTENTIAL) 1 OR MORE NERVE
48 95950 MONITORING FOR IDENTIFICATION
AND LATERALIZATION OF CEREBRAL SEIZURE
49 97010 PHYSICAL MEDICINE TREATMENT
TO ONE AREA; HOT OR COLD PACKS
50 97012 PHYSICAL MEDICINE TREATMENT
TO ONE AREA; TRACTION, MECHANICAL
51 97014 PHYSICAL MEDICINE TREATMENT
TO ONE AREA; ELECTRICAL STIMULATION
52 97016 PHYSICAL MEDICINE TREATMENT
TO ONE AREA; VASOPNEUMATIC DEVICES
53 97018 PHYSICAL MEDICINE TREATMENT
TO ONE AREA; PARAFFIN BATH
54 97020 PHYSICAL MEDICINE TREATMENT
TO ONE AREA; MICROWAVE
55 97022 PHYSICAL MEDICINE TREATMENT
TO ONE AREA; WHIRLPOOL
56 97024 PHYSICAL MEDICINE TREATMENT
TO ONE AREA; DIATHERMY
57 97026 PHYSICAL MEDICINE TREATMENT
TO ONE AREA; INFRARED
58 97028 PHYSICAL MEDICINE TREATMENT
TO ONE AREA; ULTRAVIOLET
59 97039 PHYSICAL MEDICINE TREATMENT
TO ONE AREA; UNLISTED MODALITY (SPECIFY)
60 97110 PHYSICAL MEDICINE TREATMENT
TO ONE AREA, INITIAL 30 MINUTES, EA. VISIT
61 97112 PHYSICAL MEDICINE TREATMENT
TO ONE AREA, INITIAL 30 MINUTES, EA. VISIT
62 97114 PHYSICAL MEDICINE TREATMENT
TO ONE AREA, INITIAL 30 MINUTES, EA. VISIT
63 97116 PHYSICAL MEDICINE TREATMENT
TO ONE AREA, INITIAL 30 MINUTES, EA. VISIT
64 97118 PHYSICAL MEDICINE TREATMENT
TO ONE AREA, INITIAL 30 MINUTES, EA. VISIT
65 97120 PHYSICAL MEDICINE TREATMENT
TO ONE AREA, INITIAL 30 MINUTES, EA. VISIT
66 97122 PHYSICAL MEDICINE TREATMENT
TO ONE AREA, INITIAL 30 MINUTES, EA. VISIT
67 97124 PHYSICAL MEDICINE TREATMENT
TO ONE AREA, INITIAL 30 MINUTES, EA. VISIT
68 97126 PHYSICAL MEDICINE TREATMENT
TO ONE AREA, INITIAL 30 MINUTES, EA. VISIT
69 97128 PHYSICAL MEDICINE TREATMENT
TO ONE AREA, INITIAL 30 MINUTES, EA. VISIT
70 97138 PHYSICAL MEDICINE TREATMENT
TO ONE AREA, INITIAL 30 MINUTES, EA. VISIT
71 97145 PHYSICAL MEDICINE TREATMENT
TO ONE AREA, EA. ADDL. 15 MIN.
72 97220 HUBBARD TANK, INITIAL 30 MINUTES,
EACH VISIT
73 97221 HUBBARD TANK, EACH ADDITIONAL
15 MINUTES, UP TO ONE HOUR
74 97240 POOL THERAPY OR HUBBARD TANK
WITH THERAPEUTIC EXERCISES, INITIAL 30 MIN.
75 97241 POOL THERAPY OR HUBBARD TANK
WITH THERAPEUTIC EXERCISES, EA. ADD. 15 MIN.
76 97260 MANIPULATION (CERVICAL, THORACIC,
LUMBOSACRAL, SACROILIAC, HAND, WRIST
77 97261 MANIPULATION (CERVICAL, THORACIC,
LUMBOSACRAL, SACROILIAC, HAND, WRIST
78 97500 ORTHOTICS TRAINING (DYNAMIC
BRACING, SPLINTING) UPPER EXTREMITIES
79 97501 ORTHOTICS TRAINING (DYNAMIC
BRACING, SPLINTING) UPPER EXTREMITIES, EA.
80 97520 PROSTHETIC TRAINING; INITIAL
30 MINUTES, EACH VISIT
81 97521 PROSTHETIC TRAINING; EACH ADDITIONAL
15 MINUTES
82 97530 KINETIC ACTIVITIES TO INCREASE
COORDINATION, STRENGTH AND/OR RANGE OF
83 97531 KINETIC ACTIVITIES TO INCREASE
COORDINATION, STRENGTH AND/OR RANGE F
84 97540 TRAINING IN ACTIVITIES OF DAILY
LIVING (SELF CARE SKILLS AND/OR DAILY
85 97541 TRAINING IN ACTIVITIES OF DAILY
LIVING (SELF CARE SKILLS AND/OR LIFE
86 97720 EXTREMITY TESTING FOR STRENGTH,
DEXTERITY, OR STAMINA; INITIAL 30 MIN.
87 97721 EXTREMITY TESTING FOR STRENGTH,
DEXTERITY, OR STAMINA; EA. ADD. 15 MIN.
88 97752 MUSCLE TESTING WITH TORQUE
CURVES DURING ISOMETRIC AND ISOKINETIC
89 97798 OCCUPATIONAL THERAPY (97798
HAS BEEN DELETED; TO REPORT, PLEASE SEE 97799)
90 97799 UNLISTED PHYSICAL MEDICINE
SERVICE OR PROCEDURE

NOTE: SEE “PHYSICIANS’ CURRENT PROCEDURAL TERMINOLOGY” (CPT) CODE BOOK FOR COMPLETE PROCEDURE DESCRIPTION. ALL OTHER PROCEDURES NOT LISTED IN THIS SCHEDULE SHALL BE PAID AT THE HOSPITAL’S USUAL AND CUSTOMARY OR NORMAL BILLED CHARGE AMOUNTS.

Workers’ compensation payments for the above procedures shall be paid at the hospital’s usual and customary or normal billed charge amount less 5%.

CPT codes and descriptions only are copyright © 1993 American Medical Association.

Severe Weather: Donate to the Arkansas Disaster Relief Program