| October Corrections/Additions to the 2004 Medicare Physicians Fee Schedule | ||||||||||
| California - Effective January 1, 2004 | ||||||||||
| Facility | CODE/ | PAR | NON-PAR | LIMIT | ||||||
| Setting | AREA | MOD | FEE | FEE | CHARGE | |||||
| 03 | G0336 26 | $ 81.86 | $ 77.77 | $ 89.44 | ||||||
| # | 03 | G0336 26 | $ 81.86 | $ 77.77 | $ 89.44 | |||||
| 03 | G0341 | $ 403.72 | $ 383.53 | $ 441.06 | ||||||
| # | 03 | G0341 | $ 403.72 | $ 383.53 | $ 441.06 | |||||
| 03 | G0342 | $ 736.10 | $ 699.30 | $ 804.20 | ||||||
| # | 03 | G0342 | $ 736.10 | $ 699.30 | $ 804.20 | |||||
| 03 | G0343 | $ 1,214.46 | $ 1,153.74 | $ 1,326.80 | ||||||
| # | 03 | G0343 | $ 1,214.46 | $ 1,153.74 | $ 1,326.80 | |||||
| 05 | G0336 26 | $ 88.83 | $ 84.39 | $ 97.05 | ||||||
| # | 05 | G0336 26 | $ 88.83 | $ 84.39 | $ 97.05 | |||||
| 05 | G0341 | $ 438.94 | $ 416.99 | $ 479.54 | ||||||
| # | 05 | G0341 | $ 438.94 | $ 416.99 | $ 479.54 | |||||
| 05 | G0342 | $ 801.40 | $ 761.33 | $ 875.53 | ||||||
| # | 05 | G0342 | $ 801.40 | $ 761.33 | $ 875.53 | |||||
| 05 | G0343 | $ 1,322.89 | $ 1,256.75 | $ 1,445.26 | ||||||
| # | 05 | G0343 | $ 1,322.89 | $ 1,256.75 | $ 1,445.26 | |||||
| 06 | G0336 26 | $ 87.20 | $ 82.84 | $ 95.27 | ||||||
| # | 06 | G0336 26 | $ 87.20 | $ 82.84 | $ 95.27 | |||||
| 06 | G0341 | $ 430.97 | $ 409.42 | $ 470.83 | ||||||
| # | 06 | G0341 | $ 430.97 | $ 409.42 | $ 470.83 | |||||
| 06 | G0342 | $ 787.01 | $ 747.66 | $ 859.81 | ||||||
| # | 06 | G0342 | $ 787.01 | $ 747.66 | $ 859.81 | |||||
| 06 | G0343 | $ 1,299.05 | $ 1,234.10 | $ 1,419.22 | ||||||
| # | 06 | G0343 | $ 1,299.05 | $ 1,234.10 | $ 1,419.22 | |||||
| 07 | G0336 26 | $ 83.07 | $ 78.92 | $ 90.76 | ||||||
| # | 07 | G0336 26 | $ 83.07 | $ 78.92 | $ 90.76 | |||||
| 07 | G0341 | $ 409.17 | $ 388.71 | $ 447.02 | ||||||
| # | 07 | G0341 | $ 409.17 | $ 388.71 | $ 447.02 | |||||
| 07 | G0342 | $ 745.09 | $ 707.84 | $ 814.02 | ||||||
| # | 07 | G0342 | $ 745.09 | $ 707.84 | $ 814.02 | |||||
| 07 | G0343 | $ 1,229.45 | $ 1,167.98 | $ 1,343.18 | ||||||
| # | 07 | G0343 | $ 1,229.45 | $ 1,167.98 | $ 1,343.18 | |||||
| 09 | G0336 26 | $ 86.97 | $ 82.62 | $ 95.01 | ||||||
| # | 09 | G0336 26 | $ 86.97 | $ 82.62 | $ 95.01 | |||||
| 09 | G0341 | $ 428.85 | $ 407.41 | $ 468.52 | ||||||
| # | 09 | G0341 | $ 428.85 | $ 407.41 | $ 468.52 | |||||
| 09 | G0342 | $ 781.12 | $ 742.06 | $ 853.37 | ||||||
| # | 09 | G0342 | $ 781.12 | $ 742.06 | $ 853.37 | |||||
| 09 | G0343 | $ 1,289.90 | $ 1,225.41 | $ 1,409.22 | ||||||
| # | 09 | G0343 | $ 1,289.90 | $ 1,225.41 | $ 1,409.22 | |||||
| 17 | G0336 26 | $ 80.42 | $ 76.40 | $ 87.86 | ||||||
| # | 17 | G0336 26 | $ 80.42 | $ 76.40 | $ 87.86 | |||||
| 17 | G0341 | $ 396.26 | $ 376.45 | $ 432.92 | ||||||
| # | 17 | G0341 | $ 396.26 | $ 376.45 | $ 432.92 | |||||
| 17 | G0342 | $ 722.58 | $ 686.45 | $ 789.42 | ||||||
| # | 17 | G0342 | $ 722.58 | $ 686.45 | $ 789.42 | |||||
| 17 | G0343 | $ 1,190.78 | $ 1,131.24 | $ 1,300.93 | ||||||
| # | 17 | G0343 | $ 1,190.78 | $ 1,131.24 | $ 1,300.93 | |||||
| 18 | G0336 26 | $ 82.61 | $ 78.48 | $ 90.25 | ||||||
| # | 18 | G0336 26 | $ 82.61 | $ 78.48 | $ 90.25 | |||||
| 18 | G0341 | $ 408.42 | $ 388.00 | $ 446.20 | ||||||
| # | 18 | G0341 | $ 408.42 | $ 388.00 | $ 446.20 | |||||
| 18 | G0342 | $ 748.29 | $ 710.88 | $ 817.51 | ||||||
| # | 18 | G0342 | $ 748.29 | $ 710.88 | $ 817.51 | |||||
| 18 | G0343 | $ 1,230.84 | $ 1,169.30 | $ 1,344.70 | ||||||
| # | 18 | G0343 | $ 1,230.84 | $ 1,169.30 | $ 1,344.70 | |||||
| 26 | G0336 26 | $ 82.41 | $ 78.29 | $ 90.03 | ||||||
| # | 26 | G0336 26 | $ 82.41 | $ 78.29 | $ 90.03 | |||||
| 26 | G0341 | $ 408.06 | $ 387.66 | $ 445.81 | ||||||
| # | 26 | G0341 | $ 408.06 | $ 387.66 | $ 445.81 | |||||
| 26 | G0342 | $ 748.77 | $ 711.33 | $ 818.03 | ||||||
| # | 26 | G0342 | $ 748.77 | $ 711.33 | $ 818.03 | |||||
| 26 | G0343 | $ 1,231.58 | $ 1,170.00 | $ 1,345.50 | ||||||
| # | 26 | G0343 | $ 1,231.58 | $ 1,170.00 | $ 1,345.50 | |||||
| 99 | G0336 26 | $ 77.47 | $ 73.60 | $ 84.64 | ||||||
| # | 99 | G0336 26 | $ 77.47 | $ 73.60 | $ 84.64 | |||||
| 99 | G0341 | $ 381.10 | $ 362.05 | $ 416.36 | ||||||
| # | 99 | G0341 | $ 381.10 | $ 362.05 | $ 416.36 | |||||
| 99 | G0342 | $ 693.91 | $ 659.21 | $ 758.09 | ||||||
| # | 99 | G0342 | $ 693.91 | $ 659.21 | $ 758.09 | |||||
| 99 | G0343 | $ 1,143.49 | $ 1,086.32 | $ 1,249.27 | ||||||
| # | 99 | G0343 | $ 1,143.49 | $ 1,086.32 | $ 1,249.27 | |||||
| # | These amounts apply when service is performed in a facility setting. | |||||||||
| Limiting charge applies to unassigned claims by non-participating providers. | ||||||||||
| CPT Codes, description and two-digit numberic modifiers only are copyright | ||||||||||
| 2003 American Medical Association. | ||||||||||
| 9/9/2004 | ||||||||||