Monday, October 10, 2011

CPT code 20000 - 29902 - Not reimbursed for assistant surgeon

CPT Codes 20000 - 29999


The principles of correct coding discussed in Chapter I apply to the CPT codes in the range 20000-29999. Several general guidelines are repeated in this Chapter. However, those general guidelines from Chapter I not discussed in this Chapter are nonetheless applicable.

Physicians should report the HCPCS/CPT code that describes the procedure performed to the greatest specificity possible. A HCPCS/CPT code should be reported only if all services described by the code are performed. A physician should not report multiple HCPCS/CPT codes if a single HCPCS/CPT code exists that describes the services. This type of unbundling is incorrect coding.

HCPCS/CPT codes include all services usually performed as part of the procedure as a standard of medical/surgical practice. A physician should not separately report these services simply because HCPCS/CPT codes exist for them. Specific issues unique to this section of CPT are clarified in this Chapter.


B. Evaluation and Management (E&M) Services Medicare Global Surgery Rules define the rules for reporting evaluation and management (E&M) services with procedures covered by these rules. This section summarizes some of the rules. All procedures on the Medicare Physician Fee Schedule are assigned a global period of 000, 010, 090, XXX, YYY, ZZZ, or MMM. The global concept does not apply to XXX procedures. The global period for YYY procedures is defined by the Carrier (A/B MAC processing practitioner service claims). All procedures with a global period of ZZZ are related to another procedure, and the applicable global period for the ZZZ code is determined by the related procedure. Procedures with a global period of MMM are maternity procedures.

CPT Code Reimbursement

20005 $252.00
20100 $528.00
20101 $238.00
20102 $286.00
20103 $376.00
20150 $850.85
20200 $124.00
20205 $238.00
20206 $109.00
20220 $168.00
20225 $112.94
20240 $200.00
20245 $428.00
20250 $349.47
20251 $393.07
20500 $67.00
20501 $23.44
20520 $135.00
20525 $301.00
20526 $66.00
20527 $75.10
20550 $55.36
20551 $54.25
20552 $50.96
20553 $29.00
20555 $269.83
20600 $48.20
20605 $50.31
20610 $59.00
20612 $54.93

Confidential

These rates are provided for informational purposes only and are not to be considered a guarantee of payment. Actual payment will be based on Health Options policies, procedures, and Customer Benefit Plans.

Reimbursement by Procedure Codes 20000 - 29999 Effective Jan. 1, 2015

CPT Code Reimbursement

20615 $124.00
20650 $171.00
20660 $182.49
20661 $377.00
20662 $441.73
20663 $404.00
20664 $581.00
20665 $95.00
20670 $149.78
20680 $389.00
20690 $241.26
20692 $396.90
20693 $430.00
20694 $354.00
20696 $1,001.78
20697 $1,248.21
20802 $2,362.52
20805 $3,089.63
20808 $4,002.10
20816 $2,022.11
20822 $1,849.54
20824 $2,166.45
20827 $1,844.00
20838 $2,281.94
20900 $373.00
20902 $290.70
20910 $378.00
20912 $457.99
20920 $373.77
20922 $504.00

Confidential

These rates are provided for informational purposes only and are not to be considered a guarantee of payment. Actual payment will be based on Health Options policies, procedures, and Customer Benefit Plans.

Reimbursement by Procedure Codes 20000 - 29999 Effective Jan. 1, 2015

CPT Code Reimbursement

20924 $481.17
20926 $361.00
20930 $200.00
20931 $110.44
20936 $204.00
20937 $167.17
20938 $182.41
20950 $131.00
20955 $2,425.66
20956 $2,565.01
20957 $2,307.53
20962 $2,214.80
20969 $2,688.44
20970 $2,681.13
20972 $2,240.70
20973 $2,680.73
20974 $53.00
20975 $170.86
20979 $22.00
20982 $3,772.65
21010 $675.99
21011 $304.00
21012 $329.50
21013 $474.50
21014 $509.50
21015 $403.66
21016 $1,018.03
21025 $607.00
21026 $397.00
21029 $659.00

Confidential

These rates are provided for informational purposes only and are not to be considered a guarantee of payment. Actual payment will be based on Health Options policies, procedures, and Customer Benefit Plans

Reimbursement by Procedure Codes 20000 - 29999Effective Jan. 1, 2015

CPT Code Reimbursement

21030 $394.00
21031 $295.00
21032 $293.00
21034 $1,048.00
21040 $294.00
21044 $817.33
21045 $1,132.57
21046 $937.00
21047 $1,153.00
21048 $965.00
21049 $1,097.00
21050 $800.65
21060 $745.26
21070 $601.17
21073 $305.61
21076 $900.00
21077 $2,403.71
21079 $1,632.40
21080 $1,854.59
21081 $1,684.94
21082 $1,383.00
21083 $1,358.00
21084 $1,656.94
21085 $393.00
21086 $1,795.27
21087 $1,775.09
21088 $474.74
21100 $270.00
21110 $459.00
21116 $24.83

Confidential

These rates are provided for informational purposes only and are not to be considered a guarantee of payment. Actual payment will be based on Health Options policies, procedures, and Customer Benefit Plans.

Reimbursement by Procedure Codes 20000 - 29999Effective Jan. 1, 2015

CPT Code Reimbursement

21120 $457.00
21121 $603.00
21122 $627.00
21123 $818.00
21125 $780.00
21127 $829.00
21137 $679.31
21138 $859.11
21139 $955.93
21141 $1,251.79
21142 $1,243.31
21143 $1,270.64
21145 $1,415.00
21146 $1,479.00
21147 $1,516.00
21150 $1,586.39
21151 $1,848.99
21154 $2,034.89
21155 $2,248.96
21159 $2,543.33
21160 $2,679.94
21172 $1,619.39
21175 $1,957.34
21179 $1,388.01
21180 $1,563.66
21181 $595.00
21182 $1,905.99
21183 $2,130.34
21184 $2,245.05
21188 $1,540.41

Confidential

These rates are provided for informational purposes only and are not to be considered a guarantee of payment.Actual payment will be based on Health Options policies, procedures, and Customer Benefit Plans. 

Reimbursement by Procedure Codes 20000 - 29999 Effective Jan. 1, 2015

CPT Code Reimbursement

21193 $1,180.32
21194 $1,319.83
21195 $1,240.00
21196 $1,362.35
21198 $1,058.35
21199 $950.84
21206 $1,019.00
21208 $884.00
21209 $571.00
21210 $861.00
21215 $941.22
21230 $724.83
21235 $653.00
21240 $1,061.22
21242 $973.65
21243 $1,543.00
21244 $959.84
21245 $1,000.00
21246 $813.33
21247 $1,543.98
21248 $1,135.13
21249 $1,450.00
21255 $1,263.00
21256 $1,089.96
21260 $1,105.11
21261 $2,123.76
21263 $1,835.15
21267 $1,489.00
21268 $1,739.00
21270 $833.21

Confidential

These rates are provided for informational purposes only and are not to be considered a guarantee of payment. Actual payment will be based on Health Options policies, procedures, and Customer Benefit Plans.

Reimbursement by Procedure Codes 20000 - 29999 Effective Jan. 1, 2015

CPT Code Reimbursement

21275 $754.82
21280 $481.35
21282 $322.17
21295 $164.32
21296 $367.98
21310 $66.00
21315 $181.00
21320 $222.72
21325 $333.00
21330 $488.00
21335 $686.65
21336 $438.00
21337 $300.00
21338 $483.00
21339 $637.00
21340 $742.14
21343 $922.00
21344 $1,296.00
21345 $705.00
21346 $844.00
21347 $1,008.00
21348 $1,064.51
21355 $316.00
21356 $337.00
21360 $490.80
21365 $1,028.43
21366 $1,148.43
21385 $666.31
21386 $620.31

21387 $711.57


20000 series procedure codes that are "Nevers" for Assistant Surgeon

The below table identified procedure codes that are not eligible for reimbursement when reported by an Assistant Surgeon.

20000 21249 23655 25259 26416 27060 27686 28200 29105
20005 21280 23665 25260 26418 27062 27695 28208 29125
20101 21282 23675 25270 26426 27086 27696 28220 29126
20103 21295 23700 25272 26428 27093 27704 28222 29130
20200 21296 23921 25274 26432 27095 27707 28225 29131
20205 21310 23930 25275 26433 27096 27726 28226 29200
20206 21315 23931 25280 26437 27175 27730 28230 29220
20220 21320 23935 25290 26440 27185 27732 28232 29240
20225 21325 24000 25295 26442 27193 27734 28234 29260
20240 21330 24065 25337 26445 27194 27750 28240 29280
20245 21335 24066 25450 26449 27200 27752 28270 29305
20500 21336 24075 25455 26450 27220 27760 28272 29325
20501 21337 24076 25500 26455 27222 27762 28280 29345
20520 21338 24077 25505 26460 27230 27766 28285 29355
20525 21345 24105 25520 26471 27232 27767 28286 29358
20526 21355 24110 25530 26476 27235 27768 28288 29365
20550 21356 24120 25535 26477 27238 27769 28289 29405
20551 21400 24130 25560 26478 27240 27780 28290 29425
20552 21421 24136 25565 26480 27246 27781 28307 29435
20553 21440 24145 25600 26489 27250 27784 28309 29440
20555 21450 24147 25605 26490 27252 27786 28310 29445
20600 21451 24153 25606 26496 27256 27788 28312 29450
20605 21452 24160 25622 26500 27257 27792 28313 29505
20610 21453 24164 25624 26508 27265 27808 28315 29515
20612 21454 24200 25630 26510 27266 27810 28344 29520
20615 21480 24201 25635 26516 27275 27816 28345 29530
20650 21485 24220 25650 26520 27301 27818 28400 29540
20660 21497 24300 25651 26525 27307 27824 28405 29550
20661 21501 24305 25652 26535 27323 27825 28406 29580
20662 21510 24310 25660 26536 27324 27830 28430 29581
20663 21550 24332 25671 26540 27327 27831 28435 29590
20664 21555 24357 25675 26542 27328 27840 28436 29700
20665 21556 24358 25680 26545 27330 27842 28450 29705
20670 21800 24359 25690 26548 27340 27860 28455 29710
20680 21805 24495 25900 26567 27370 27882 28456 29715
20690 21820 24500 25920 26591 27372 27884 28470 29720
20693 21920 24505 25927 26593 27391 27886 28475 29730
20694 21925 24530 25931 26600 27425 27889 28476 29740
20910 21930 24535 26010 26605 27437 27892 28490 29750
20912 21935 24538 26011 26607 27475 27893 28495 29800
20920 22010 24560 26020 26608 27477 28001 28496 29805
20926 22015 24565 26025 26615 27485 28002 28505 29819
20930 22305 24566 26030 26641 27496 28003 28510 29830
20931 22310 24576 26034 26645 27497 28005 28515 29838
20950 22315 24577 26035 26650 27500 28008 28525 29840
20974 22505 24582 26037 26665 27501 28010 28530 29846
20979 22520 24600 26040 26670 27502 28011 28531 29848
20982 22521 24605 26045 26675 27503 28020 28540 29850
20985 22522 24620 26055 26676 27508 28022 28545 29870
20986 22523 24640 26060 26685 27509 28024 28546 29871
20987 22524 24650 26070 26700 27510 28035 28570 29873
21010 22525 24655 26075 26705 27516 28041 28575 29874
21025 22526 24670 26080 26706 27517 28043 28576 29875
21026 22527 24675 26100 26715 27520 28045 28600 29876
21029 23030 24935 26105 26720 27530 28046 28605 29877
21030 23031 25000 26110 26725 27532 28050 28606 29879
21031 23044 25001 26115 26727 27538 28052 28630 29880
21032 23065 25020 26116 26735 27550 28054 28635 29881
21040 23066 25023 26117 26740 27552 28055 28636 29886
21046 23075 25024 26121 26742 27560 28060 28660 29891
21050 23076 25025 26123 26746 27562 28062 28665 29892
21070 23101 25028 26125 26750 27570 28070 28666 29893
21073 23106 25031 26130 26755 27594 28072 28675 29900
21076 23130 25035 26135 26756 27596 28080 28755 29901
21077 23140 25040 26140 26765 27600 28088 28805 29902
21079 23146 25065 26145 26770 27601 28090 28810
21080 23170 25066 26160 26775 27603 28092 28820
21081 23180 25075 26170 26776 27604 28108 28825
21082 23330 25076 26180 26785 27605 28110 28890
21083 23350 25100 26200 26841 27606 28111 29000
21084 23415 25101 26205 26850 27607 28112 29010
21085 23480 25105 26210 26860 27610 28113 29015
21086 23500 25109 26215 26861 27613 28119 29020
21087 23505 25110 26230 26910 27614 28120 29025
21088 23520 25111 26235 26951 27618 28124 29035
21100 23525 25112 26236 26952 27619 28126 29040
21110 23540 25118 26250 26990 27630 28140 29044
21116 23545 25120 26320 26991 27635 28150 29046
21120 23570 25130 26340 26992 27640 28153 29049
21208 23575 25150 26350 27000 27641 28160 29055
21210 23600 25210 26356 27040 27648 28173 29058
21215 23605 25230 26370 27041 27652 28175 29065
21230 23620 25240 26410 27043 27664 28190 29075
21235 23625 25246 26412 27047 27680 28192 29085
21248 23650 25248 26415 27050 27681 28193 29086

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